Template

Incident and Near Miss Report

by Jeff Pratt, from the Community

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.

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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
Incident, Accident, and Near Miss Report
Use this incident, accident, and near miss report to document workplace events clearly and consistently. Capture incident details, injuries, property or equipment damage, likely causes, photos, and corrective actions. The form supports sign offs and supervisor approval to ensure actions are adopted and monitored. Intended to help teams notify The Boring Company management and subcontractors promptly and drive a strong safety culture across construction projects.
by wayne merideth, from the Community
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Template
Incident Reporting Form
This Incident Reporting Form helps teams capture the full details of workplace incidents and near misses. Record date, time, location, weather conditions and whether it was an incident or near miss. Add photos, note injuries, treatment provided and any police incident number. Include witness contact details and signatures. Use HSE near miss guidance, reflect on risk assessment, and propose preventive actions to avoid recurrence. Ideal for standardizing safety reporting and facilitating follow up.
by David Jones, from the Community
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Template
Vindex Systems Incident and Near Miss Report Form
Use this incident and near miss report form to capture essential details after an event on site. Sections include site and job information, person involved, employment status (employee, subcontractor, public), PPE and site induction checks, event date, location, and narrative. Rate severity including near miss, minor, medium, or major injury (RIDDOR), document corrective actions, and record signatures and consent. Designed to streamline reporting and support safety and compliance reviews.
by Mark Fenton, from the Community
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Template
Near Miss Report Template
This Near Miss Report template helps construction teams quickly capture and investigate near-miss events before they cause harm. Record key details such as document number, client or site, date and time, location, personnel, and department. Identify factors including unsafe acts, unsafe conditions, unsafe equipment, or improper equipment use. Describe the incident or hazard, attach photos, and capture employee signatures and dates. The investigation section guides users to document the near-miss condition, identify primary and contributing causes, and define corrective actions such as removing hazards, replacing or repairing equipment, or retraining staff. Includes management sign-off to close the loop and improve site safety and HSE compliance.
by Chris Graydon, from the Community
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Incident and Near Miss Report

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