ARTEMIS MARINE INC.

Near miss and hazard report

Report the event and potential consequence even when no damage occurred.

Form near-miss | Template 1.1.0

Complete locally and print or save as PDF before closing. Entries are not submitted or automatically saved. Apply vessel-specific procedures and approval before use.

Vessel and official numberRecord reference and datePrepared by and roleDate time location and activityWhat happened and potential consequenceImmediate controls and person notifiedEvidence and contributing factorsRecommended action owner and due dateFollow-up review and feedback