Template

Modebest Near Miss and Unsafe Observation Report

by Michael Gleese, from the Community

20+

Use this free Modebest Near Miss and Unsafe Observation Report to document unplanned events that could have caused harm on construction sites. Capture report number, date and time, location, detailed description, and add optional photos. Record witnesses, define near miss per OSHA guidance, and include the reporter’s name and signature. Use as part of site safety practices and email to the contract manager and Health and Safety department.

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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
Near Miss Template
This near miss report template helps teams capture and share important details about unplanned events that could have caused harm. Based on OSHA and National Safety Council guidance, it prompts workers to record the date and time, location, a clear description of what happened, and add photos if available. It also includes fields for witnesses, employee details, and a signature, with instructions to email the report to a direct manager or Health and Safety Manager. Use this template to improve hazard awareness, enable timely corrective actions, and prevent future incidents. Templates in the Public Library are examples only; always seek professional advice to ensure suitability for your workplace and jurisdiction.
by Andrea Boccabella, from the Community
Downloads: 0
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Template
Near Miss Incident Report Form
This near miss form helps teams quickly document unplanned events that could have caused injury, illness, or damage. Capture the location, date and time, photos, and a clear description of what happened, and indicate whether work stopped or continued. Include optional employee name and signature for accountability, then submit to your Health and Safety Manager or Supervisor. Ideal for improving workplace safety and incident reporting across job sites.
by Matthew Oneill, from the Community
Downloads: 0
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Template
CM Near Miss
Quick near miss report
by Val Wright, from the Community
Downloads: 40+
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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

Get

Template

Near Miss Template

This near miss report template helps teams capture and share important details about unplanned events that could have caused harm. Based on OSHA and National Safety Council guidance, it prompts workers to record the date and time, location, a clear description of what happened, and add photos if available. It also includes fields for witnesses, employee details, and a signature, with instructions to email the report to a direct manager or Health and Safety Manager. Use this template to improve hazard awareness, enable timely corrective actions, and prevent future incidents. Templates in the Public Library are examples only; always seek professional advice to ensure suitability for your workplace and jurisdiction.

by Andrea Boccabella, from the Community

Get

Template

Near Miss Incident Report Form

This near miss form helps teams quickly document unplanned events that could have caused injury, illness, or damage. Capture the location, date and time, photos, and a clear description of what happened, and indicate whether work stopped or continued. Include optional employee name and signature for accountability, then submit to your Health and Safety Manager or Supervisor. Ideal for improving workplace safety and incident reporting across job sites.

by Matthew Oneill, from the Community

Get

Template

CM Near Miss

Quick near miss report

by Val Wright, from the Community

40+

Get

Modebest Near Miss and Unsafe Observation Report

About author

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