Incident Form Near Miss/Incident Report Details Complete the form below to notify Head Office of any near-miss incidents. Name Date of Incident* DD slash MM slash YYYY Time of Incident Line Manager*Line Manager *Angel AngelovLee BirchPaul CarrottPaul CorbridgeJames DawsonAshley EptonMark FraryEdward HallJim HayesPeter LordDave ParkerCatherine RolandJames ThompsonStuart ThomsonGarry WilkinsonThomas WilksOperation undertaken ** Location of event* Vehicle type and registration Incident details*If you have any photos upload them here: Drop files here or Select files Accepted file types: jpg, gif, png, pdf, Max. file size: 50 MB, Max. files: 5. Signature Signature Date DD slash MM slash YYYY