Template

IMS Hazard and Near-Miss Report V2

by Paul Clarke, from the Community

90+

Report hazards and near-misses efficiently with this IMS V2 form. Designed for field use on smartphones or tablets, it guides workers to record what happened, actions taken, location, task type, area, and responsible managers. Suitable for utilities and construction activities including leak investigation, excavation, streetworks, live gas work, inspections, and more. When complete, export the report as a PDF and email it to the incident desk as directed.

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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
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Use this incident, injury, and near miss report and investigation form to document what happened, capture injured person details, witnesses, causes, treatment, machinery involved, immediate actions, photos, and corrective improvements. Suitable for construction, steel fabrication, and industrial operations to support EHS compliance and continuous safety improvement.
by InFocus Safety Solutions, Inc., from the Community
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Near Miss Incident Report Template
Capture and report near miss events before they become incidents. This ready-to-use template guides workers to record when and where a near miss occurred, describe what happened, attach photos, and note immediate actions taken such as isolating an area, tagging out equipment, or notifying a supervisor. Supervisors can log corrective and preventive actions, follow-up activities, and sign-off dates to close the report. Common hazards covered include slips, trips and falls, falls from height or equipment, electrical shock, hazardous substances, manual handling, falling objects, and more. Locations and departments like production, warehousing, maintenance, QA labs, dispatch, and chemical storage are supported, making it ideal for food and beverage manufacturing and other operations.
by Colin Porter, from the Community
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Near Miss and Hazard Spot Report
Capture and document near misses and hazard observations with this easy-to-use report template. Record key details such as project name and number, date, location, description of the event, and actions taken. Attach media to support the report, assign follow-up tasks, and note who completed the action to close the loop. Designed to standardize incident and hazard reporting across worksites, this template helps teams improve safety awareness, track corrective actions, and prevent future incidents. Suitable for a wide range of workplaces and job sites.
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CMS - H and S - Near Miss, Incident, Hazard Report Form
Near Miss, Incident, Hazard Report Form
by Craig Brown, from the Community
Downloads: 40+
Get

Incident, Injury, Near Miss Report and Investigation Form

Use this incident, injury, and near miss report and investigation form to document what happened, capture injured person details, witnesses, causes, treatment, machinery involved, immediate actions, photos, and corrective improvements. Suitable for construction, steel fabrication, and industrial operations to support EHS compliance and continuous safety improvement.

by InFocus Safety Solutions, Inc., from the Community

20+

Get

Template

Near Miss Incident Report Template

Capture and report near miss events before they become incidents. This ready-to-use template guides workers to record when and where a near miss occurred, describe what happened, attach photos, and note immediate actions taken such as isolating an area, tagging out equipment, or notifying a supervisor. Supervisors can log corrective and preventive actions, follow-up activities, and sign-off dates to close the report. Common hazards covered include slips, trips and falls, falls from height or equipment, electrical shock, hazardous substances, manual handling, falling objects, and more. Locations and departments like production, warehousing, maintenance, QA labs, dispatch, and chemical storage are supported, making it ideal for food and beverage manufacturing and other operations.

by Colin Porter, from the Community

30+

Get

Template

Near Miss and Hazard Spot Report

Capture and document near misses and hazard observations with this easy-to-use report template. Record key details such as project name and number, date, location, description of the event, and actions taken. Attach media to support the report, assign follow-up tasks, and note who completed the action to close the loop. Designed to standardize incident and hazard reporting across worksites, this template helps teams improve safety awareness, track corrective actions, and prevent future incidents. Suitable for a wide range of workplaces and job sites.

by Ian Martin, from the Community

10+

Get

Template

CMS - H and S - Near Miss, Incident, Hazard Report Form

Near Miss, Incident, Hazard Report Form

by Craig Brown, from the Community

40+

Get

IMS Hazard and Near-Miss Report V2

About author

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Incident, Injury, Near Miss Report and Investigation Form

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