Belte r r a Cor p or at ion S afety M an ual D oc I D C H S M BE L 2 0 1 7 Pa g e 5 04 of 53 8 Near Miss R e po rt Doc u m e n t Identif icat ion F R M 037 P age Nu m b e r 1 of 1 Na me Da te a nd Tim e De sc riptio n of n e a r miss incide nt L oc a ti on of I nc id e nt De tails o f a n y da m a g e to e quipm e nt or pr ope rt y C omm e nts on a c ti on to be ta ke n to avoid si mi lar incide nt R e porte d to