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Template

Hazard and Near Miss Report

by Apurba Saha, from the Community

Downloads: 10+
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This hazard and near miss report template supports mining and exploration teams in documenting safety events. Record date and time, site and rig number, reporter details, and incident descriptions. Classify hazards, potential impacts, and severity using a severity matrix. Capture media evidence, note immediate actions and initial findings, and confirm if risks are controlled. Assign follow‑up actions with owners and due dates, and capture signatures to close the loop. Ideal for CDX Exploration–style operations and general mining safety.

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Digitize any process, procedure or policy
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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

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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 .