Template

Apex Near Misses

by Tim Scott, from the Community

10+

Use this Apex Near Misses template to capture and investigate near-miss events before they become incidents. Document unsafe conditions and behaviors, challenges to safety barriers (such as bypassed machine guards), and potential property or environmental impacts. Prioritize follow-up actions, allocate resources, define the depth of analysis, and determine root causes to improve workplace safety and prevent future events.

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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
Near Miss Report Template
This Near Miss Report template helps construction teams quickly capture and investigate near-miss events before they cause harm. Record key details such as document number, client or site, date and time, location, personnel, and department. Identify factors including unsafe acts, unsafe conditions, unsafe equipment, or improper equipment use. Describe the incident or hazard, attach photos, and capture employee signatures and dates. The investigation section guides users to document the near-miss condition, identify primary and contributing causes, and define corrective actions such as removing hazards, replacing or repairing equipment, or retraining staff. Includes management sign-off to close the loop and improve site safety and HSE compliance.
by Chris Graydon, from the Community
Downloads: 0
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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
Johansen Near Miss Report
Use the Johansen Near Miss Report to record and analyze near-miss events before they become incidents. This customizable checklist captures client or site, date and time, preparer, and location, along with a clear description of the event. Classify the type of incident (unsafe act, unsafe condition, act of nature, or third party), assess risk potential by severity and probability, and propose corrective actions. Log witnesses and supporting notes to aid investigation and prevention. Ideal for construction job sites and field operations to improve safety awareness and reduce future risk.
by Ryan Lancaster, from the Community
Downloads: 40+
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Template
ASB-SF-012 Near Miss Report v3
Use this ASB-SF-012 Near Miss Report v3 to document and investigate near-miss events before they become incidents. Capture details such as location, time, unsafe acts or conditions, narrative description, photos, and employee signatures. Guide investigations to identify primary and contributing causes and assign corrective actions like removal, replacement, repair, or retraining. Designed to standardize safety reporting and improve workplace safety across operations.
by Dan Albert, from the Community
Downloads: 0
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Near Miss Report Template

This Near Miss Report template helps construction teams quickly capture and investigate near-miss events before they cause harm. Record key details such as document number, client or site, date and time, location, personnel, and department. Identify factors including unsafe acts, unsafe conditions, unsafe equipment, or improper equipment use. Describe the incident or hazard, attach photos, and capture employee signatures and dates. The investigation section guides users to document the near-miss condition, identify primary and contributing causes, and define corrective actions such as removing hazards, replacing or repairing equipment, or retraining staff. Includes management sign-off to close the loop and improve site safety and HSE compliance.

by Chris Graydon, from the Community

Get

Template

Near-Miss/Incident Form

Form for reporting near misses or incidents on site

by Mark Taylor, from the Community

60+

Get

Template

Johansen Near Miss Report

Use the Johansen Near Miss Report to record and analyze near-miss events before they become incidents. This customizable checklist captures client or site, date and time, preparer, and location, along with a clear description of the event. Classify the type of incident (unsafe act, unsafe condition, act of nature, or third party), assess risk potential by severity and probability, and propose corrective actions. Log witnesses and supporting notes to aid investigation and prevention. Ideal for construction job sites and field operations to improve safety awareness and reduce future risk.

by Ryan Lancaster, from the Community

40+

Get

Template

ASB-SF-012 Near Miss Report v3

Use this ASB-SF-012 Near Miss Report v3 to document and investigate near-miss events before they become incidents. Capture details such as location, time, unsafe acts or conditions, narrative description, photos, and employee signatures. Guide investigations to identify primary and contributing causes and assign corrective actions like removal, replacement, repair, or retraining. Designed to standardize safety reporting and improve workplace safety across operations.

by Dan Albert, from the Community

Get

Apex Near Misses

About author

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Near Miss Report Template

Near-Miss/Incident Form

Johansen Near Miss Report

ASB-SF-012 Near Miss Report v3

You might also like

Near Miss Report Template

Near-Miss/Incident Form

Johansen Near Miss Report

ASB-SF-012 Near Miss Report v3