Template

OSHA Near Miss Form

by Eileen Vincent, from the Community

10+

Use this OSHA near miss form to capture critical details of a near miss and prevent future incidents. Based on OSHA's Incident Investigation Guide, it helps teams document the scene, note locations, hazards, and witness accounts, identify equipment or procedure issues, analyze root causes across people, process, tools, and environment, and assign corrective actions. Add photos, record defects or safety device failures, and track follow-up to closure.

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

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
OSHA Near Miss Form
Based on the Incident Investigation Form provided by OSHA in their Incident Investigation Guide for Employers, this digital near miss form can be used to do the following: 1) Preserve or document the scene, 2) Collect information, 3) Determine root causes, 4) Implement corrective actions.
by SafetyCulture
Downloads: 100+
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Template
Near-Miss/Incident Form
Form for reporting near misses or incidents on site
by Mark Taylor, from the Community
Downloads: 60+
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Template
Near Miss Reporting Template
Use this Near Miss Reporting template to document potential hazards and incidents that did not result in injury. Capture audit details, site, department, date and time, who was involved, and whether it involved an unsafe act, condition, or equipment. Describe the near-miss, outline primary and contributing causes, and record corrective actions such as removing hazards, repairing or replacing equipment, or retraining staff. Include management sign-off to close the loop. Standardize near-miss investigations to reduce risk, strengthen safety culture, and prevent future incidents across operations.
by Danny White, from the Community
Downloads: 10+
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Template
ARTC Near Miss / Incident / Hazard Form
Use this form to report a near miss / incident / hazard.
by Simon Hughes, from the Community
Downloads: 300+
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OSHA Near Miss Form

About author

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