Template

Near Miss Report and Safety Concern Template

by Zain Gonzalez, from the Community

Use this Near Miss Report and Safety Concern template to record safety hazards before they become incidents. Capture what happened, when and where, who was present, photos of the situation, location details, and suggested improvements. Document whether the issue was corrected, how it was resolved, and attach photos of corrected items. Log the date and time reported and the name of the person reporting. Ideal for factories and worksites to strengthen safety culture and support continuous improvement.

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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
Safety Observation and Near Miss Report
Use this template to document safety observations and near misses in any workplace. Record what happened, where, when, and who was involved, attach notes, and outline corrective actions. Standardize reporting to identify hazards early, reduce risk, and improve compliance.
by Ryan Adia, from the Community
Downloads: 20+
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Template
HSE Near Miss Report Template
This HSE Near Miss Report template helps teams log and analyze near-miss incidents to prevent future harm. Record site, date, observer, and document number, then describe the hazardous act or condition observed. Note whether the issue was corrected, identify root causes, and document corrective actions taken. Indicate if further investigation is required and finalize with a sign-off by the QHSE Manager. Designed to support proactive safety and environmental protection across operations, this template facilitates consistent reporting and action tracking to reduce injuries, illness, and environmental impact.
by Longinus Ike, from the Community
Downloads: 0
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Template
Near Miss Report for CBC Construction
This CBC Construction Near Miss Report template helps teams capture and document near miss events on site. Record the location and date, who is reporting and who was involved, describe what happened, and attach photos for context. The checklist guides users through essential details and includes a prompt to notify the case team for follow up. Designed to streamline incident prevention and improve jobsite safety, this template offers a practical starting point that should be adapted to your organization and local requirements.
by Jason Penney, 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+
Get

Safety Observation and Near Miss Report

Use this template to document safety observations and near misses in any workplace. Record what happened, where, when, and who was involved, attach notes, and outline corrective actions. Standardize reporting to identify hazards early, reduce risk, and improve compliance.

by Ryan Adia, from the Community

20+

Get

Template

HSE Near Miss Report Template

This HSE Near Miss Report template helps teams log and analyze near-miss incidents to prevent future harm. Record site, date, observer, and document number, then describe the hazardous act or condition observed. Note whether the issue was corrected, identify root causes, and document corrective actions taken. Indicate if further investigation is required and finalize with a sign-off by the QHSE Manager. Designed to support proactive safety and environmental protection across operations, this template facilitates consistent reporting and action tracking to reduce injuries, illness, and environmental impact.

by Longinus Ike, from the Community

Get

Template

Near Miss Report for CBC Construction

This CBC Construction Near Miss Report template helps teams capture and document near miss events on site. Record the location and date, who is reporting and who was involved, describe what happened, and attach photos for context. The checklist guides users through essential details and includes a prompt to notify the case team for follow up. Designed to streamline incident prevention and improve jobsite safety, this template offers a practical starting point that should be adapted to your organization and local requirements.

by Jason Penney, 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

Near Miss Report and Safety Concern Template

About author

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Safety Observation and Near Miss Report

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Safety Observation and Near Miss Report

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