Lesson Learned/Best Practice Briefing


TitleThe Importance of Reporting Near Misses

EventOther Facility Event

Event Date06/19/2019

CategoryOCA - DOE Operating Experience Summary

This Department of Energy (DOE) Operating Experience Summary (OES) document provides examples and information about the importance of reporting near misses. Near misses are described as follows in the DOE Order 232.2A, Occurrence Reporting and Processing of Operations Information:

"A near miss to an injury, where something physically happened that was unexpected or unintended AND where no barrier prevented an event from having a reportable consequence (i.e., happenstance was the main reason the event did not result in a reportable injury)."

Near miss events involve little or no damage and so may be overlooked and not followed up on or reported. However, near misses provide a "free" opportunity to identify previously unidentified and/or uncontrolled hazards and to correct them during future work planning processes.

Please share this document within your communities of practice to foster continuous improvement in safety.

Actions to Prevent Recurrence

Lessons Learned are part of the ISM Core Function 5, Feedback and Improvement. Applicable Lessons Learned are to be considered during working planning activities and incorporated in work processes, prior to performing work.
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Uploaded documents/attachments:
OES_Near Miss_June19.pdf

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