Template

Near Miss Report Template for Construction

by Debbie Parker, from the Community

30+

Use this near miss reporting checklist to document incidents on site and prevent future harm. Capture date and time, location, reporter, project name or job number, injury details and affected body area, and any property, plant, vehicle, or utility damage including power, gas, water, or communications. Describe what happened, add photos, identify causes such as inadequate training, poor housekeeping, lack of PPE, or incorrect plans, and note corrective actions. Includes project manager and management review sections and a health and safety committee review.

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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 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
Downloads: 0
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Template
Mech Systems Near Miss Report Template
Use this Mech Systems Near Miss Report template to quickly document near-miss events and drive corrective action. Record audit title, document number, site, date, preparer, location, and personnel involved. Specify the type of near miss and describe what happened, add photos, and note any immediate fixes. Provide suggestions to prevent recurrence, capture team member signatures, and request a safety committee reply. Track committee actions, recommendations, and EHS review to strengthen workplace safety programs.
by aaron Perronne, from the Community
Downloads: 10+
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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
Near Miss and Safety Share Checklist
Use this near miss and safety share template to document incidents and lessons learned across fleet operations. Capture job details, people involved, date and time, location, near-miss type (unsafe act, condition, or equipment), narrative of what happened, supporting photos, and recommendations. Assign corrective actions and a responsible party, record general observations, and share safety insights to prevent future incidents.
by Casey Blackford, from the Community
Downloads: 10+
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Near Miss Report Template for Construction

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Near Miss Report Template

Mech Systems Near Miss Report Template

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Near Miss Report Template

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