Report Near Miss - Dan Beard Council, Scouting America

Use this form to report near misses – incidents that could have resulted in harm but did not. Valuable for identifying safety and program practice improvements. Near misses with clear lessons learned can bring to light opportunities to improve safety performance or program practices.

General Details

Incident Date:(Required)

Incident Time:(Required)

Date Reported to Council:(Required)

Reporter Information

Reported By: Name(Required)

First Last

Reported By: Primary Phone(Required)

Reported By: Secondary Phone(Required)

Reported By: Email(Required)

Reported By: Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Near Miss Details

Council/BSA Location of Incident:(Required)

Location of Incident:(Required)

Specific Area Where Incident Occurred:(Required)

Adventure, Program, or Event:(Required)

Incident Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

General Classification of Individual Involved (Cub Scout, Registered Leader, ect.):(Required)

Description of Incident (Clear, Concise, Complete Facts)(Required)

Lessons Learned (What could be done to prevent future occurrences):(Required)

File Upload

Attachments such as photos and statements can be helpful when making a report of incident.

File

Max. file size: 2 GB.

Report a Near Miss

General Details

Reporter Information

Near Miss Details

File Upload

Helpful Links

Hours

Incident Report

Report a Near Miss

General Details

Reporter Information

Near Miss Details

File Upload