Template

DRS Injury Near Miss Report Template

by Chris Reynolds, from the Community

100+

Use this injury near miss report template to log incident details, affected body parts and severity, and document timelines. Assess causal factors such as procedures, tools, PPE, training, environment, maintenance, and inspections. Capture lessons learned, identify root cause, and define corrective actions, owners, and due dates to strengthen workplace safety programs.

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.

Template
Incident, Accident and Near Miss Report
Use this incident, accident, and near miss report template to document workplace events consistently. Log dates, locations, persons involved, supervisors, and witness statements. Capture injury details, body part affected, treatment given, and whether machinery was involved. Include weather conditions, photos, voluntary statements, and immediate actions taken. Identify contributing factors and define corrective actions to prevent recurrence and strengthen site safety programs.
by William Kidd, from the Community
Downloads: 0
Get
Template
K Near Miss Form for Construction Sites
Use this near miss form to standardize reporting on construction sites. Capture company and contractor details, date and time, weather, location, and the category of the near miss such as falls, trips, electric shock, caught between, falling objects, or equipment. Document the description, hazards, affected employees, property damage, and any machinery involved. Identify root causes across equipment, procedures, training, environment, and tools. Assess severity and possible outcomes, record worker statements, and add photos. Define corrective actions, note follow up, and capture lessons learned with name and signature fields.
by Rick Delmonico, from the Community
Downloads: 0
Get
Template
Incident Report Template (First Report of Incident)
Use this incident report template to document accidents, near misses, hazards, and injuries with speed and accuracy. Capture date, time, location, incident priority and type; describe what happened and site conditions; log causal and contributing factors and lessons learned. Attach photos and evidence, and record vehicle, equipment, damage, and other item details. Document people involved, preliminary statements, injury types and affected body parts. Add corrective actions and follow-up tasks to close the loop and streamline investigations across construction and other worksites.
by Jose Armesto, from the Community
Downloads: 0
Get
Template
Injury, Accident, Incident and Near Miss Report
Use this comprehensive incident reporting template to capture key details after any workplace injury, accident, incident, or near miss. Record staff involved, date, time, location, witnesses, and notifications. Document injuries and treatment, police involvement and tests, property or vehicle damage, and attach photos. Analyze immediate causes and contributing factors, assess potential severity and likelihood of recurrence, and define corrective actions with responsible persons. Include third party details and insurance information to support follow up and compliance.
by Warren Ellison, from the Community
Downloads: 0
Get

Incident, Accident and Near Miss Report

Use this incident, accident, and near miss report template to document workplace events consistently. Log dates, locations, persons involved, supervisors, and witness statements. Capture injury details, body part affected, treatment given, and whether machinery was involved. Include weather conditions, photos, voluntary statements, and immediate actions taken. Identify contributing factors and define corrective actions to prevent recurrence and strengthen site safety programs.

by William Kidd, from the Community

Get

Template

K Near Miss Form for Construction Sites

Use this near miss form to standardize reporting on construction sites. Capture company and contractor details, date and time, weather, location, and the category of the near miss such as falls, trips, electric shock, caught between, falling objects, or equipment. Document the description, hazards, affected employees, property damage, and any machinery involved. Identify root causes across equipment, procedures, training, environment, and tools. Assess severity and possible outcomes, record worker statements, and add photos. Define corrective actions, note follow up, and capture lessons learned with name and signature fields.

by Rick Delmonico, from the Community

Get

Template

Incident Report Template (First Report of Incident)

Use this incident report template to document accidents, near misses, hazards, and injuries with speed and accuracy. Capture date, time, location, incident priority and type; describe what happened and site conditions; log causal and contributing factors and lessons learned. Attach photos and evidence, and record vehicle, equipment, damage, and other item details. Document people involved, preliminary statements, injury types and affected body parts. Add corrective actions and follow-up tasks to close the loop and streamline investigations across construction and other worksites.

by Jose Armesto, from the Community

Get

Template

Injury, Accident, Incident and Near Miss Report

Use this comprehensive incident reporting template to capture key details after any workplace injury, accident, incident, or near miss. Record staff involved, date, time, location, witnesses, and notifications. Document injuries and treatment, police involvement and tests, property or vehicle damage, and attach photos. Analyze immediate causes and contributing factors, assess potential severity and likelihood of recurrence, and define corrective actions with responsible persons. Include third party details and insurance information to support follow up and compliance.

by Warren Ellison, from the Community

Get

DRS Injury Near Miss Report Template

About author

You might also like

Incident, Accident and Near Miss Report

K Near Miss Form for Construction Sites

Incident Report Template (First Report of Incident)

Injury, Accident, Incident and Near Miss Report

You might also like

Incident, Accident and Near Miss Report

K Near Miss Form for Construction Sites

Incident Report Template (First Report of Incident)

Injury, Accident, Incident and Near Miss Report