This Near Miss Notice template helps teams quickly record and report incidents that nearly caused injury, illness, damage, or environmental impact. It guides users to capture date and time, location (office, plant, terminal, jobsite, or roadway), parties involved including contractors, contributing environmental factors, a description of how the near miss occurred, lessons learned, and immediate corrective actions with completion dates. The form supports safety suggestions to prevent recurrence and promotes a proactive safety culture across jobsites and industrial facilities.
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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.