Close Call Report Form

"*" indicates required fields

MM slash DD slash YYYY
Event Time*
Please provide as much detail as possible. ELR, Mileage, Address
Please provide a description of the issue with as much detail as possible. It is helpful if you can provide details of the activity taken place at the time of the event.
A brief description of what could have happened due to this close call.
Please state what was carried/completed to reduce/remove immediate risk? If the risk is still present, what action(s) is required to be carried out?
Has the issue been resolved?*
This field is for validation purposes and should be left unchanged.