Template

Hazard / Near-Miss Reporting

by Ling Gim Jian, from the Community

1,000+

A structured template designed for safety professionals and managers to document and track workplace hazards and near-miss incidents. The form allows for detailed reporting of up to five separate incidents, including location details, incident descriptions, and media attachments. Each entry includes fields for follow-up documentation and closure confirmation, enabling comprehensive incident management and resolution tracking. The template supports safety compliance efforts and helps organizations maintain detailed records of potential workplace safety issues, their remediation, and preventive measures implemented. Ideal for businesses looking to improve their safety protocols and maintain thorough documentation of hazard identification and resolution processes.

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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
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Initial Employee Incident Report
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by Harry Miles, from the Community
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Incident Reporting Form
This Incident Reporting Form helps teams capture the full details of workplace incidents and near misses. Record date, time, location, weather conditions and whether it was an incident or near miss. Add photos, note injuries, treatment provided and any police incident number. Include witness contact details and signatures. Use HSE near miss guidance, reflect on risk assessment, and propose preventive actions to avoid recurrence. Ideal for standardizing safety reporting and facilitating follow up.
by David Jones, from the Community
Downloads: 10+
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Hazard / Near-Miss Reporting

With SafetyCulture you can

Digitize team workflows

Reduce manual errors

Create and share inspection reports

About author

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