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Template

Incident, Accident and Near Miss Report

by William Kidd, from the Community

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Use this incident, accident, and near miss report template to document workplace events consistently. Log dates, locations, persons involved, supervisors, and witness statements. Capture injury details, body part affected, treatment given, and whether machinery was involved. Include weather conditions, photos, voluntary statements, and immediate actions taken. Identify contributing factors and define corrective actions to prevent recurrence and strengthen site safety programs.

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

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.