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Near-Miss or Unsafe Act :: Risk Management - Injury & Incident Reporting - Report a Near-Miss or Unsafe Act

Extension employees should submit all near-miss/unsafe act reports using an Extension-specific SharePoint workflow.

Guidance for Submitting

Submit a report if there is an incident that:

  • Did not result in property damage;
  • Did not result in personal injury;
But, given a slight shift in time or position, a high-risk injury/incident could have occurred

Instructions for Submitting a Near-Miss/Unsafe Act to Risk Management

*Make sure that you have initiated the Extension Phone Tree as part of the High-Risk Injury/Incident Response workflow.

1) Complete the Near-Miss Report

  • Download the Near-Miss Report to your local computer. Complete the report.
    • Note: If you have printed copies that you have filled out by hand, you can scan them into PDFs. 

2) Submit the Report Form through SharePoint

/images/group419/shared/InjuryIncidentReportingWorkflow/DraftReportButton-InjuryandIncidentReporting.png
  • Complete these fields for your submission:
    • Record Title: Append [First Name] [Last Name] [Date] to the template document name
      • E.g. Near-Miss-Report - Nathaniel Shay 2019.11.04
    • Incident Type: Select whether it is a non-employee injury/incident, near-miss, or vehicle accident report. 
    • Description: Include a brief description of why you are submitting the report. 
    • Incident Date: Date the incident documented in the report occurred.
    • 4-H Accident?: Select whether the incident was 4-H related (Yes/No).
    • Upham Woods Accident?: Select whether the incident was Upham Woods related (Yes/No).
    • Volunteer Related: Select whether the incident involved a volunteer (Yes/No).
    • Immediate Supervisor: Your immediate supervisor's email.
    • Institute Director: Your institute director's email.
    • Attach Completed Report: Upload the completed report as an attachment. 
  • When you are ready to submit, click on the "My Reports" button. Find your Report. 
/images/group419/shared/InjuryIncidentReportingWorkflow/MyReportsButton-InjuryandIncidentReporting.png
  • Click "Send to Risk Management".
/images/group419/shared/InjuryIncidentReportingWorkflow/SendtoRiskManagement-InjuryandIncidentReporting.png
  • Click "Run Flow."
/images/group419/shared/InjuryIncidentReportingWorkflow/RunFlow.png

Help with Near-Miss/Unsafe Act Report

  • If you have any questions related to the report form, please contact the Office of Risk Management (608) 262-0379.
  • If you have any questions related to the Extension SharePoint Workflow, please contact the Extension Help Desk (all tickets will be routed through DoIT Help Desk).


Topics Map > Employee Handbook > Risk Management > Injury & Incident Reporting > Near-Miss or Unsafe Act
Results: 1-7 of 7
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No.Document TitleIDUpdatedHits
1 Risk Management - Injury & Incident Reporting - What are Low-Risk Incidents?
958402020-05-05349
2 Risk Management - Injury & Incident Reporting - Using Professional Judgement for Reporting
964432020-05-05276
3 Risk Management - Injury & Incident Reporting - Report a Near-Miss or Unsafe Act
955472020-05-05224
4 Risk Management - Injury & Incident Reporting - Find your Supervisor's Emergency Phone Number
967632020-05-05243
5 Risk Management - Injury & Incident Reporting - FAQs
967682020-05-05186
6 Risk Management - Injury & Incident Reporting - Escalate Using the Extension Phone Tree
959812020-05-05529
7 Risk Management - Injury & Incident Reporting - All Reports
955442020-05-05426


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