Form - Near-Miss and Good-Catch Report

The 60-second report. It lives on a QR code on every apparatus and station wall, as a paper copy in every apparatus, and as the script the on-duty district chief uses when a member phones one in. Anyone may report anything that nearly caused harm, or that was caught before it did. Reports may be anonymous. The health and safety officer acknowledges every report within five working days and tells the reporter what happened within 30 days (Incident Investigation and Learning Program element 5.1).

The form is deliberately short. Research with volunteer brigades found that people report when it is simple and when they know what happens as a result (NZFS, 2016b). The design answers the accreditation criterion that near-miss reporting be used to teach and share lessons (CPSE, 2019, criterion 11A.6).

This report is for learning. What you write here will not be used for discipline or performance management and will not go in anyone’s personnel file. You do not have to give your name. If you do, it is only so we can tell you what happened. (Policy - Incident, Injury, Exposure and Near-Miss Reporting and Investigation section 8)

Type of report (tick one): ☐ Near miss ☐ Good catch ☐ Something that went well and should be studied ☐ Not sure, you decide

Thank you. You just made the next call safer.

“Thanks for calling this in. I am going to write it down as you say it; it is for learning and will not be used against anyone. What happened? Where and when? What could it have been? What stopped it? What do you think would prevent it? Do you want to hear back, and if so how do I reach you? Thank you. The HSO will acknowledge this within five days.”

Kept in {{Records system}} per 05 Document Control and Records. De-identified 12 months after receipt; the de-identified record is kept for the department’s near-miss database and for external sharing with the fire chief’s approval.