Use this Significant Near Miss Report template to record incidents that did not result in harm but had the potential to cause injury or ill health. The form guides users to capture incident date and time, location, summary, photos of the scene, workplace conditions, witnesses and statements, and supervisor details. It also covers equipment and MHE involved, isolation status, operator authorization, and follow-up actions. Additional sections include re-enactment notes, external notifications, supporting comments, and signatures to close out the report. Ideal for strengthening hazard identification and preventing future incidents.
With SafetyCulture you can
With SafetyCulture you can
About author
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.
