Near-Miss Learning Backlog Template

{ "Title": "Near-Miss Learning Backlog Entry", "IntroductionHtml": "

Use this form to capture near-misses quickly, translate them into small learning experiments, assign owners and dates, and record outcomes. The goal is not paperwork but a steady pipeline of tested changes that reduce risk and become part of standard work. Be concise, focus on observable facts, and propose an experiment you can try within a few days or weeks.

Note: This template is a starting point. Adjust risk ratings, owners, and follow-up cadence to match your site practices. Avoid treating this as a blame form—it exists to learn and prevent harm.

", "SubmitLabel": "Save near-miss", "SuccessMessage": "Near-miss saved. Add another entry or review the backlog to prioritize experiments.", "DataType": "NearMissBacklogEntry", "SchemaVersion": 1, "Fields": [ { "Key": "report_date", "FieldType": "text", "Label": "Date reported", "HelpText": "Use YYYY-MM-DD or local date format. Helpful for trend analysis.", "Required": true }, { "Key": "reporter_name", "FieldType": "text", "Label": "Reporter name", "HelpText": "Optional. Who observed or reported the near-miss? Useful for follow-up." }, { "Key": "location", "FieldType": "text", "Label": "Location / line / machine", "HelpText": "Where did this occur? Be specific enough for a quick visit." }, { "Key": "incident_summary", "FieldType": "textarea", "Label": "Short incident summary", "HelpText": "Describe what happened in one or two sentences. Focus on observable facts (who, what, where, when).", "Required": true }, { "Key": "immediate_containment", "FieldType": "textarea", "Label": "Immediate containment steps taken", "HelpText": "What immediate actions prevented harm or escalation? Example: stopped machine, isolated area, notified supervisor." }, { "Key": "risk_rating", "FieldType": "scale", "Label": "Risk rating (likelihood x severity)", "HelpText": "Rate the potential harm if the same situation repeated. 1 = Low (minor/no injury, low damage), 5 = High (serious injury, major damage). Use conservative judgment to prioritize experiments.", "Min": 1, "Max": 5 }, { "Key": "root_cause_hypothesis", "FieldType": "textarea", "Label": "Root cause hypothesis", "HelpText": "A concise hypothesis about why this happened. Example: missing guard, confusing work instruction, worn part, production pressure. This is a starting point for an experiment." }, { "Key": "proposed_experiment", "FieldType": "textarea", "Label": "Proposed experiment (what we'll try)", "HelpText": "Describe a small, testable change you can try quickly to validate the hypothesis. Keep it specific and time-boxed (e.g., add visual tape guide for 2 weeks, trial a poka-yoke on one machine, change shift handoff checklist).", "Required": true }, { "Key": "experiment_type", "FieldType": "select", "Label": "Type of experiment", "HelpText": "Select the category that best fits the proposed experiment.", "Options": [ { "Value": "process_change", "Label": "Process change / workflow" }, { "Value": "training", "Label": "Training / coaching" }, { "Value": "engineering_control", "Label": "Engineering control / design change" }, { "Value": "administrative_control", "Label": "Administrative control (policy, schedule)" }, { "Value": "inspection", "Label": "Inspection / checklist" }, { "Value": "ppe", "Label": "PPE / protective measure" }, { "Value": "other", "Label": "Other" } ] }, { "Key": "owner", "FieldType": "text", "Label": "Owner (who will run the experiment)", "HelpText": "Person responsible for running the experiment and reporting results. Include a backup if appropriate.", "Required": true }, { "Key": "due_date", "FieldType": "text", "Label": "Target due date", "HelpText": "Target date to complete the experiment and record results. Use YYYY-MM-DD. Keep timelines short where possible." }, { "Key": "priority", "FieldType": "select", "Label": "Team priority", "HelpText": "Team assigns priority based on risk, ease, and potential impact.", "Options": [ { "Value": "low", "Label": "Low" }, { "Value": "medium", "Label": "Medium" }, { "Value": "high", "Label": "High" }, { "Value": "critical", "Label": "Critical" } ] }, { "Key": "status", "FieldType": "select", "Label": "Status", "HelpText": "Current state of the backlog item.", "Options": [ { "Value": "proposed", "Label": "Proposed" }, { "Value": "in_progress", "Label": "In progress" }, { "Value": "completed", "Label": "Completed" }, { "Value": "deferred", "Label": "Deferred" }, { "Value": "not_actionable", "Label": "Not actionable" } ], "Required": true }, { "Key": "result_summary", "FieldType": "textarea", "Label": "Result summary (what happened)", "HelpText": "After running the experiment, summarize observations, measurements, whether the hypothesis was supported, and any unintended effects. If status is 'Completed', this should be filled." }, { "Key": "learning_captured", "FieldType": "textarea", "Label": "Learning to capture into standard work", "HelpText": "Concretely state what should change in standard work, training, drawings, or checklists if the experiment succeeded. If no standard change, note why. This connects the experiment to sustainable improvement." }, { "Key": "linked_standard_work", "FieldType": "text", "Label": "Link to standard work / procedure", "HelpText": "URL, document id, or location of the existing standard work that should be updated if the experiment succeeds." }, { "Key": "tags", "FieldType": "text", "Label": "Tags / keywords", "HelpText": "Short comma-separated tags (e.g., guarding, handoff, lubrication) to help filtering and dashboards." }, { "Key": "follow_up_actions", "FieldType": "textarea", "Label": "Follow-up actions", "HelpText": "Any required next steps after the experiment (who will update documentation, train staff, order parts). Include owners and due dates." }, { "Key": "notify_team", "FieldType": "yesno", "Label": "Notify team / supervisor", "HelpText": "Select yes to trigger standard notification workflows (if your site has them)." } ] }