Princeton University Incident/Near Miss Reporting Form

Background Information on Injured Person
Enter name of department and shop or lab(if applicable)
Witnesses (if any)
Description of Incident/Near Miss
Describe sequence of events. Include as much detail as possible.
Contributing Factors
Describe conditions or practices, if any, that may have led to the occurrence of this incident
Corrective Actions
In your opinion, what are reasonable actions or steps that could be taken to eliminate or reduce the likelihood of a recurrence.

Additional Emails (Not Required)

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