This Near Miss Report template by Waverly helps field service technicians and operations teams document and investigate near-miss events. Capture core details including site, location, team member and supervisor, type of near miss, and a narrative description. Assess Serious Injury or Fatality (SIF) precursors such as falls from height, hazardous energy/lockout, hot work, crushing or entanglement, electrical contact, vehicle interactions, and handling long or heavy objects. Add photos, record immediate corrective actions, and complete a 5 Whys analysis to identify root causes and prevent recurrence. Designed as a starting point within SafetyCulture’s Public Library and intended for general informational use.
With SafetyCulture you can
With SafetyCulture you can
About author
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.