Near Miss Investigation Report Template

Use this near miss investigation report template to capture critical details following a near miss event. Record the incident title and number, time and location, a clear description of what occurred, and any immediate actions taken with outcomes. Attach photos or other visual evidence, assess effectiveness of the response, and propose practicable changes. Document implementation steps, supporting documents, and how information will be communicated. Schedule a review, add further evidence if needed, and confirm closure with H and S authorization to prevent recurrence and improve safety performance.