Template

Envirotrol Near Miss Report

by Aaron Brookins, from the Community

10+

Use this Envirotrol Near Miss Report template to quickly document potential hazards and incidents that did not result in injury. Record the location, time, department, classification, likely injuries and causes, attach photos, note root causes, and log corrective actions taken. Capture signatures to confirm completion and accountability. Designed for construction and field operations to improve reporting, prevent accidents, and strengthen workplace safety.

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Create and share professional reports instantly

Confirm accountability and compliance with a digital log

With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
Near Miss Reporting Template
Use this Near Miss Reporting template to document potential hazards and incidents that did not result in injury. Capture audit details, site, department, date and time, who was involved, and whether it involved an unsafe act, condition, or equipment. Describe the near-miss, outline primary and contributing causes, and record corrective actions such as removing hazards, repairing or replacing equipment, or retraining staff. Include management sign-off to close the loop. Standardize near-miss investigations to reduce risk, strengthen safety culture, and prevent future incidents across operations.
by Danny White, from the Community
Downloads: 10+
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Template
Near Miss and High Potential Reporting
This Near Miss and High Potential Reporting template helps teams document potential incidents that did not result in injury but indicate risk. Capture event details, date and time, people involved, and whether it was an unsafe act, condition, or equipment issue. Record causes, corrective actions such as removing hazards, repairs, or retraining, and secure management sign-off. Use it to standardize reporting and strengthen safety and compliance across worksites.
by Danny White, from the Community
Downloads: 0
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Template
Incident and Near Miss Report
Use this Incident and Near Miss Report template to capture key details about accidents and near misses on site. Log the date, time, job, location, description of the event, injuries, property or equipment damage, and photos. Identify likely causes, add annotations of the surrounding environment, and record corrective actions to stop recurrence. Include signatures for preparer and site manager or supervisor once actions are implemented and monitored. Designed for workplace safety programs, especially on construction sites, this template supports consistent reporting and investigation to improve safety outcomes.
by Jeff Pratt, from the Community
Downloads: 0
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Template
C2SC Near Miss Report
Capture and report near miss incidents quickly with this C2SC Near Miss Report template. Record the date and time, job location, people involved, and a clear description of what occurred. Document contributing working or environmental conditions, actions taken, and lessons learned, and attach photos or other media as evidence. Export the completed report and share it with your Area Safety Supervisor to drive corrective actions. Designed to improve construction site safety by identifying root causes and preventing reoccurrence. Templates are examples only and not a substitute for professional advice.
by Jordan Ludwig, from the Community
Downloads: 10+
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Near Miss Reporting Template

Use this Near Miss Reporting template to document potential hazards and incidents that did not result in injury. Capture audit details, site, department, date and time, who was involved, and whether it involved an unsafe act, condition, or equipment. Describe the near-miss, outline primary and contributing causes, and record corrective actions such as removing hazards, repairing or replacing equipment, or retraining staff. Include management sign-off to close the loop. Standardize near-miss investigations to reduce risk, strengthen safety culture, and prevent future incidents across operations.

by Danny White, from the Community

10+

Get

Template

Near Miss and High Potential Reporting

This Near Miss and High Potential Reporting template helps teams document potential incidents that did not result in injury but indicate risk. Capture event details, date and time, people involved, and whether it was an unsafe act, condition, or equipment issue. Record causes, corrective actions such as removing hazards, repairs, or retraining, and secure management sign-off. Use it to standardize reporting and strengthen safety and compliance across worksites.

by Danny White, from the Community

Get

Template

Incident and Near Miss Report

Use this Incident and Near Miss Report template to capture key details about accidents and near misses on site. Log the date, time, job, location, description of the event, injuries, property or equipment damage, and photos. Identify likely causes, add annotations of the surrounding environment, and record corrective actions to stop recurrence. Include signatures for preparer and site manager or supervisor once actions are implemented and monitored. Designed for workplace safety programs, especially on construction sites, this template supports consistent reporting and investigation to improve safety outcomes.

by Jeff Pratt, from the Community

Get

Template

C2SC Near Miss Report

Capture and report near miss incidents quickly with this C2SC Near Miss Report template. Record the date and time, job location, people involved, and a clear description of what occurred. Document contributing working or environmental conditions, actions taken, and lessons learned, and attach photos or other media as evidence. Export the completed report and share it with your Area Safety Supervisor to drive corrective actions. Designed to improve construction site safety by identifying root causes and preventing reoccurrence. Templates are examples only and not a substitute for professional advice.

by Jordan Ludwig, from the Community

10+

Get

Envirotrol Near Miss Report

About author

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Near Miss Reporting Template

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Near Miss Reporting Template

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