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SafetyCulture
Template

Hazard and Near Miss Report Form

by Vance Schuening, from the Community

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Use this Hazard and Near Miss Report Form to capture incidents, unsafe conditions, and maintenance or IT issues on campus. Students and staff can submit details, attach photos, specify precise locations, and route notifications to the Center Director, Safety Officer, maintenance, or IT for fast resolution. Track work orders, corrective actions, compliance status, and eligibility for recognition. Designed to strengthen campus safety culture with clear follow up and accountability.

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.