Template

ICS Near Miss/Hit Investigation Template

by Corey Crosby, from the Community

Use this ICS Near Miss and Hit Investigation template to document jobsite incidents that did not result in injury or damage but had the potential to do so. Capture jobsite name or number, date and time, employees involved, preparer, and location. Record a clear narrative of the event, identify root causes, and specify corrective or disciplinary actions to prevent recurrence. Note any training required or retraining for personnel and add comments for additional context. This structured checklist supports consistent reporting, accountability, and continuous improvement across construction sites and crews.

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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 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
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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
ICS Incident Investigation Checklist
Use this ICS incident investigation checklist to document workplace accidents on construction sites. Capture essential details including injured employee information, job and contractor data, location of the event, injury description and affected body parts, immediate treatment, PPE usage, and whether the incident is OSHA reportable. Record root causes, corrective and disciplinary actions, and retraining topics to prevent recurrence. Classify the injury, note first aid or medical aid provided, and flag questionable claims. This template helps standardize investigations and supports compliance and continuous safety improvement.
by Corey Crosby, from the Community
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Template
Envirotrol Near Miss Report
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.
by Aaron Brookins, from the Community
Downloads: 10+
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ICS Near Miss/Hit Investigation Template

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Near Miss and High Potential Reporting

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