10 Near Miss Reporting Examples

Discover real-life near miss incident examples with this PDF collection that emphasizes the importance of reporting near misses in workplaces, no matter what industry you’re in.

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Why is Near Miss Reporting Important?

The primary and crucial role of near miss reporting is to prevent an incident from recurring. It also ensures that underlying issues are identified and addressed before they cause an even bigger problem in the future. With this, it is essential that workplaces utilize a template or set of near miss reporting checklists that cater to their needs.

Benefits of Near Miss Reporting using PDF Forms

Utilizing PDF near miss reporting forms provides several advantages in promoting a systematic and efficient process for near miss reporting. Here are a few of them:

  • Observe consistency across different reports through a standardized format for reporting
  • Capture accurate and comprehensive information that addresses essential areas of the incident
  • Encourage proactive reporting with PDF templates that are simple, straight to the point, and easy to use
  • Customize PDF templates to make sure that they include industry-specific information to ensure relevance and effectiveness
  • Promote timely reporting even without electronic devices through printable near miss reporting PDF templates

How to Create Your Near Miss Reporting PDF Template

Whether you’re customizing an existing PDF form or creating a new one from scratch, you have to make sure that it will address key points and serve its intended purpose. Thus, the modification process should prioritize clarity, simplicity, and user-friendliness.

To begin,

  • Choose a tool that provides flexibility, allowing you to customize the form while maintaining consistent branding. This ensures a cohesive appearance, reinforcing the organizational identity throughout the document.
  • Organize form items in a logical order based on their frequency and priority. This helps streamline the user experience, making it intuitive and efficient for individuals filling out the form. Consider incorporating menus, checkboxes, or other interactive elements to simplify data input and ensure accurate reporting.
  • Include visual aids such as photo instructions, tooltips, or examples to guide users in navigating and completing the template effectively.

10 Near Miss PDF Example Form & Reports

Utilizing standardized PDF templates for near miss reporting ensures that they are accomplished on time and include all the essential information needed. These PDF forms help streamline the reporting process by providing a structured and consistent format, promoting efficiency, and raising the bar for workplace safety. To help you get started, we’ve put together a collection of PDF templates that can be utilized for near miss reporting.

1. Near Miss Report PDF Form

This general near miss report template in PDF form can be used across different industries and allows you to do the following:

  • Select the category the near miss incident most relates to (e.g., fall from equipment, hazardous manual handling, falling object, etc.)
  • Specify the location where the near miss happened
  • Describe the incident in detail and identify the possible root cause

2. Near Miss Incident PDF Report

Use this near miss incident PDF report to raise safety issues before they become bigger problems. It can be implemented in various industries, including those at constant risk of slips, trips, and falls. With this PDF template, you can:

  • Add a photo as an instruction guide for template users
  • Specify the exact date and time when the near miss incident happened
  • Choose the level of anonymity as the reporter of the near miss
Near miss incident pdf report form

near miss incident sample pdf report

Near Miss PDF Example for reporting a near miss for Slips Trips and Falls

3. Quick Near Miss PDF Form

This quick near miss incident PDF template is designed for situations where incidents briefly interrupted operations or involved minor disruptions that did not halt ongoing activities. It is suitable for documenting near misses that had a limited impact on operations but warrant attention for improvement. This PDF form allows you to accomplish the following:

  • Add the location, date, and exact time when the incident occurred
  • Describe the details of the incident
  • Document if the incident disrupted normal daily operations or if it’s just business as usual
Quick near miss pdf form

quick near miss pdf example report

Near Miss PDF Example for reporting a near miss in the warehouse

4. Near Miss Notification PDF Form

Complete this near miss notification PDF form to report near miss incidents in a workplace. Through this template, you can promptly let your direct manager and safety manager know when a safety issue needs to be addressed. Additionally, you can:

  • Choose the category the incident mostly relates to. If not, specify the particular nature
  • Explain what happened, including the type of pain or body part affected, if any
  • Provide insights on the lessons learned because of the near miss incident
near miss notification pdf form

Near miss notification example pdf report

Near Miss PDF Example for reporting a near miss for hazardous substances

5. Incident, Injury, Near Miss, and Hazard Report PDF Form

This multi-use reporting PDF form can be utilized to inform about various concerns, like incidents, injuries, hazards, and near misses. With this template, you’ll be able to do the following:

  • Specify what type of issue are you reporting (incident, injury, hazard, near miss)
  • Include if there is property or environmental damage involved
  • Identify if any person/employee is injured and add their details
incident injury near miss hazard pdf form

Incident inury near miss and hazard sample report

Near Miss PDF Example for reporting a chemical spill near miss

6. OSHA Near Miss Report PDF Form

This near miss form is based on the incident investigation form provided by OSHA in their Incident Investigation Guide for Employers. This PDF form can be used to do the following:

  • Document the scene through a detailed explanation of the circumstances
  • Collect information, including people involved and the eyewitness
  • Enforce corrective actions to address the raised concern
OSHA near miss example pdf form

OSHA Near Miss Example PDF Report

Near Miss PDF Example for reporting a near miss for equipment malfunction

7. Near Miss Report in Construction PDF Form

Businesses in the construction industry can customize this digital reporting form to cater to their needs before printing it as a PDF. With this PDF template, users can do the following:

  • Specify the location type of the incident (track, construction site, station, etc.)
  • Determine the incident type, e.g., near miss, unsafe condition, unsafe act
  • Describe the situation as well as suggest corrective actions to prevent recurrence
near miss report in construction example pdf form

near miss report in construction example pdf report

Near Miss PDF Example for reporting a near miss in a construction site

8. Safety Near Miss Report PDF Template

Similar to the other general near miss templates, safety managers and safety officers from different industries can use this PDF template to report any forms of near misses in workplaces. This template enables users to:

  • Indicate the exact date, time, and location of the incident
  • Add if there are witnesses present during the incident
  • Provide signatures of key people involved in the situation
safety near miss example pdf form

safety near miss example pdf report

Near Miss PDF Example for reporting a near miss for an electrical incident

9. Near Miss in Manufacturing Report PDF Form

Businesses in the manufacturing industry can leverage this ready-to-use yet customizable template to report any near misses during work. With this PDF form, reporters can do the following:

  • Provide the exact location of the incident (growing room, workshop, office, clean room, warehouse, etc.)
  • Specify the type of incident that took place, e.g., machinery, electrical, or transportation-related
  • Describe the hazard in detail and give the name of witnesses, if any
near miss in manufacturing example pdf form

near miss in manufacturing example pdf report

Near Miss PDF Example for reporting a near miss for a manufacturing incident

10. Near Miss Working at Heights Report PDF Checklist

This PDF template can be used to report near miss incidents while working at heights. The goal of this checklist is to prevent the recurrence of these kinds of incidents. Through this PDF template, you can:

  • Check if risk assessments are performed regularly when working at height
  • Determine whether reports identify working at height as a common cause of near misses
  • Investigate if root causes are promptly identified
near miss working at heights example pdf form

near miss working at heights example pdf report

Near Miss PDF Example for reporting a near miss for a working at heights incident

Jaydee Reyes
Article by

Jaydee Reyes

SafetyCulture Content Specialist
Jaydee Reyes is a content writer and researcher for SafetyCulture. Her six-year experience in the field of data research and media monitoring adds expertise and quality to her work. She is also a champion of leveraging technology to promote a culture of safety in workplaces around the world. As a content specialist, she aims to help companies adapt to digital changes through interesting and informational articles.