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 > Home Page > Fire > Valley Safety Officers Committee > Valleywide Safety Officers Regional Near Miss Reporting

Valleywide Safety Officers Regional Near Miss Reporting

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Date of Event Required Incident Number Fire Department or District Required Chandler Fire DepartmentDaisy Mountain Fire DepartmentGlendale Fire DepartmentMesa Fire and Medical DepartmentPhoenix Fire DepartmentScottsdale Fire DepartmentTempe Fire DepartmentAvondale Fire and RescueGilbert Fire DepartmentGuadalupe Fire DepartmentPeoria Fire DepartmentTolleson Fire DepartmentEl Mirage Fire DepartmentGoodyear Fire DepartmentQueen Creek Fire DepartmentSun City Fire DistrictApache Junction Fire DistrictBuckeye Fire DepartmentBuckeye Valley Fire DistrictMaricopa Fire DepartmentSun City West Fire DistrictSun Lakes Fire DistrictSurprise Fire Department Station Unit Shift Rank Required Name Age at time of event 16-2425-3334-4243-5152-60 Experience at time of event (in years) Required 0-34-67-1011-1314-1616-2021+ Event Type Required Fire emergency event: structure fire, vehicle fire, wildland fire, etc.Non-fire emergency event: auto extrication, technical rescue, emergency medical call, service call, etc.On-duty activities: apparatus and station maintenance, meetings, tours, etc.Training activities: formal training classes, in-station drills, multi company drills, etc.Vehicle event: responding to, returning from, routine driving, etc. How many consecutive hours did you work prior to the event? Required 0-45-89-1213-1617-2021-2424+ What was your participation in the event? Required Involved Witness Contributing Factors Required Accountability Command Communication Decision Making Equipment Fatigue Horseplay Human Error Individual Action Procedure Protocol Situational Awareness SOP/SOG Staffing Task Allocation Teamwork Unknown Weather Other If you marked "Other," please explain Loss Potential Required Environmental Life Threatening injury Lost time injury Minor injury Property damage Unknown Have you been involved in a similar event? Required Yes No Do you think this will happen again? Yes No Unknown Description of Near Miss Required What were the lessons learned from this event? What recommendations do you have for the department based on this experience? Would you like someone from the safety team to follow-up with you? Required Yes No Would you be willing to present this Near Miss at a training session or in a safety bulletin? Required Yes No If you answered yes to either of the above questions, please provide contact information: Name, email, telephone number