K Near Miss Form for Construction Sites

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.