Use this near miss form to standardize reporting on construction sites. Capture company and contractor details, date and time, weather, location, and the category of the near miss such as falls, trips, electric shock, caught between, falling objects, or equipment. Document the description, hazards, affected employees, property damage, and any machinery involved. Identify root causes across equipment, procedures, training, environment, and tools. Assess severity and possible outcomes, record worker statements, and add photos. Define corrective actions, note follow up, and capture lessons learned with name and signature fields.
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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.