This health and safety communication form helps workers, visitors, and contractors report near misses or non-injury incidents on site. Record the incident date and time, precise location, and reporter details, then describe what happened, immediate actions taken, and further actions to prevent recurrence. Add supporting photos of the area or outcomes. Completed reports can be exported and emailed to a health and safety manager for review and follow-up. This form is intended for general workplace safety communication and should not be used for injury accidents, which require a separate accident report form.
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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.