Template

ASB-SF-012 Near Miss Report v3

by Dan Albert, from the Community

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.

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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
Next Energy Near Miss Report
Streamline near miss reporting with this customizable template built for energy and utility worksites. Capture incident details, site and department, time, and descriptions of unsafe acts, conditions, or equipment. Add photos, investigate primary and contributing causes, and record corrective actions such as removal, replacement, repair, or retraining. Include management sign-off with signature and date to close the loop and improve safety performance.
by Richard Jones, from the Community
Downloads: 0
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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
Mini Near Miss Report
Capture near-miss incidents fast with this concise report form. Record date and time, location, unsafe acts or conditions, equipment issues, environmental risks, corrective actions, and photos. Encourage proactive reporting and address hazards before they become incidents. Suitable for facilities, construction, manufacturing, and other operations aiming to improve safety culture and compliance.
by Alan Jones, from the Community
Downloads: 20+
Get

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

Next Energy Near Miss Report

Streamline near miss reporting with this customizable template built for energy and utility worksites. Capture incident details, site and department, time, and descriptions of unsafe acts, conditions, or equipment. Add photos, investigate primary and contributing causes, and record corrective actions such as removal, replacement, repair, or retraining. Include management sign-off with signature and date to close the loop and improve safety performance.

by Richard Jones, from the Community

Get

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

10+

Get

Template

Mini Near Miss Report

Capture near-miss incidents fast with this concise report form. Record date and time, location, unsafe acts or conditions, equipment issues, environmental risks, corrective actions, and photos. Encourage proactive reporting and address hazards before they become incidents. Suitable for facilities, construction, manufacturing, and other operations aiming to improve safety culture and compliance.

by Alan Jones, from the Community

20+

Get

ASB-SF-012 Near Miss Report v3

About author

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Near Miss Report Template

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Near Miss Report Template

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