Template

Near Miss Template

by Andrea Boccabella, from the Community

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.

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Digitize any process, procedure or policy

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Create and share professional reports instantly

Confirm accountability and compliance with a digital log

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

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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
Modebest Near Miss and Unsafe Observation Report
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.
by Michael Gleese, from the Community
Downloads: 20+
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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
Near Miss Report Form Template
Use this Near Miss Report Form template to capture unplanned events that could have led to injury, illness, environmental harm, or disruption. Based on the IOSH definition, it guides users to record date and time, location, incident category (falls, manual handling, electric shock, hazardous substances, and more), detailed incident description, root causes, lessons learned, and corrective actions. Add supporting photos, capture optional employee details and signatures, and include approvals for closure. Designed for construction and general workplace safety teams to strengthen hazard reporting, analyze trends, and prevent future incidents.
by Chris Skelton, from the Community
Downloads: 0
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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 Template

About author

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Modebest Near Miss and Unsafe Observation Report

Near Miss Incident Report Form

Near Miss Report Form Template

Near Miss and Safety Share Checklist

You might also like

Modebest Near Miss and Unsafe Observation Report

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