Based on the Incident Investigation Form provided by OSHA in their Incident Investigation Guide for Employers, this digital near miss form can be used to do the following: 1) Preserve or document the scene, 2) Collect information, 3) Determine root causes, 4) Implement corrective actions.
About author
Free 1,000+ Workplace Checklists & Templates created by the SafetyCulture team.
You might also like
Templateby SafetyCultureIncident Investigation Template
Use this incident investigation template to help conduct a root cause analysis following an incident or near miss at a worksite or workplace. This template can be used to help gather necessary facts and general background information of the incident.
2663 downloadsGet- Templateby SafetyCulture
Quick Near Miss Form
Use this near miss form to quickly record the incident and indicate of work stopped or continued business as usual.
295 downloadsGet - Templateby SafetyCulture
Near Miss Report Form
A near miss is an unplanned event that threatens human safety or health, the environment, or the continued normal operation of the business enterprise, wherein the last protective barrier is challenged, but defeated. Use this near miss form to report a near miss incident.
2375 downloadsGet - Templateby SafetyCulture
Near Miss Template
This near miss template allows providing the description and photos surrounding the incident as well as inclusion of the names of other witnesses of the near miss.
246 downloadsGet