Incident and Near Miss Investigation Report

Use this comprehensive form to investigate incidents and near misses, capture injury details, and document findings for corrective action. Sections include identification and location, job role and shift details, injury type and medical treatment, employee and witness statements, equipment involved and any mechanical failure, environmental or weather factors, training and refresher dates, PPE usage and failures, and corrective or preventative actions with completion dates. Management sign-offs, OSHA recordable status, notifications, and insurance reporting are covered to ensure compliance and follow-up. Ideal for plant and operations teams seeking a consistent EHS process.