Near Miss Report Form (NMR)

INCIDENT REPORT SYSTEM
Near Miss Report Form (NMR)


Vessel Name: ……………..                 Date: ………………..                   Report No: ……/………..                        
-Deck Dept:                                                           
-Engine Dept:                                                                                                                                                                                                                                        
-Catering Dept:                                                      
-Entry made in Log Book:                                     
-Voyage No:  …………………………………….
- At Sea ?     ………………………………………
- At Port (in /out) ………………………………
- Date of Incident: ……………………………...
Description of Near Miss:




Cause:




Corrective Action Taken:



Recommended Preventive Action:


Agreed / Expected completed date:
Responsible Officer:                                                              Master:
Name:                                                                                      Name:
Signature:                                                                                Signature:
Closing of the Report:
This Report is now closed.
Final Corrective action was:



Date:                                                                             Master:
                                                                            Name:
                                                                                         Signature:


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