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Accident and Near Miss Report Template

by Hatoa Paul, from the Community

Downloads: 10+
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Use this accident and near miss report template to document workplace incidents comprehensively. Capture when and where it happened, hours at work, nature of injury, training status, hazards involved, vehicle details, and severity. Record treatment given, initial needs assessment, and whether light duties or time off is required. Assign responsible persons, list corrective actions with due dates and completion dates, and note whether hazards are on the register. Includes signatures for employee, management, and treating doctor to formalize the investigation and prevention plan.

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.