Ohio State is in the process of revising websites and program materials to accurately reflect compliance with the law. While this work occurs, language referencing protected class status or other activities prohibited by Ohio Senate Bill 1 may still appear in some places. However, all programs and activities are being administered in compliance with federal and state law.

Near-Miss Incident Report Form

Indicates required field

This form is used to help identify possible safety concerns and will not be used for repercussion but as a teaching tool.

Personal Information
Position
Location Information
Incident Information
Type of incident
Incident occurred during
Was University police or 911 called?
Was there an injury?
Injury Information
Type of injury (Check all that apply)
    • Was the victim wearing personal protective equipment? (Check all that apply)
    • LSO/TA Information
    PI/LS Information
    Safety Suggestions