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📄 FOI_Release_2026-143_p184 | p.184
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Safety Concern & Near Miss Form Supervisor @

Event Report

Instructions

Reminder: The system does not auto-save, please save frequently to avoid losing data

Event Reporting

This form should be only used for reporting near miss, safety concerns, and unsafe acts, events, or situations that did not result in an injury or

iliness.

Near Miss - Incidents that resulted in no injury (inclusive of psychological), but had the potential for causing serious injury, are sometimes called
“close calls" or "near misses"

Safety Concern - Any condition or practice that may cause a substantial probability of physical (or psychological) harm, property loss and/or

environmental impact

Unsafe Act - Actions/behaviours that result in accidents, property loss, or harm to the environment, putting the life, health, or safety of another
person directly in danger

Employee Reporting Information

Employee
Reporting

*

Please provide
your contact email
address
Organization
Home Location

Date of Incident *

Date Reported *

Holand, Mark (E21987)

mark_holand@bertc.bc.ca

BC Rapid Transit Co. Ltd(BCR)
Operations & Maintenance Centre 1(070)
2026/01/22

2026/01/22

Self Reporting
Number

Employee Job
Type

Employee Contact
Phone Number

Department

Incident Time

Time Reported *

75625

Control Operator 80 (BU023)

236-994-3376

Control Operations(74300)

06:30

12:33

000204