Template

Mini Near Miss Report

by Alan Jones, from the Community

20+

Capture near-miss incidents fast with this concise report form. Record date and time, location, unsafe acts or conditions, equipment issues, environmental risks, corrective actions, and photos. Encourage proactive reporting and address hazards before they become incidents. Suitable for facilities, construction, manufacturing, and other operations aiming to improve safety culture and compliance.

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

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

About author

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
Near Miss Report
Use this template to report and document near-miss incidents, promoting a proactive safety culture by identifying and addressing potential workplace hazards.
by SafetyCulture
Downloads: 2,000+
Get
Template
Near Miss Report Template
This Near Miss Report template helps construction teams quickly capture and investigate near-miss events before they cause harm. Record key details such as document number, client or site, date and time, location, personnel, and department. Identify factors including unsafe acts, unsafe conditions, unsafe equipment, or improper equipment use. Describe the incident or hazard, attach photos, and capture employee signatures and dates. The investigation section guides users to document the near-miss condition, identify primary and contributing causes, and define corrective actions such as removing hazards, replacing or repairing equipment, or retraining staff. Includes management sign-off to close the loop and improve site safety and HSE compliance.
by Chris Graydon, from the Community
Downloads: 0
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Template
Near-Miss Report Form (DACC)
This DACC near-miss report form helps teams quickly document potential incidents before they become accidents. Capture key details including site or area location, job number, date, reporter name and role, contact information, and a clear description of the near miss. Add photos and sign to verify the report. Ideal for field operations and site work, it supports consistent incident reporting and continuous improvement across safety programs.
by megan.spice@dacceurope.com, from the Community
Downloads: 0
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Template
Near Miss Reporting Template
Use this Near Miss Reporting template to document potential hazards and incidents that did not result in injury. Capture audit details, site, department, date and time, who was involved, and whether it involved an unsafe act, condition, or equipment. Describe the near-miss, outline primary and contributing causes, and record corrective actions such as removing hazards, repairing or replacing equipment, or retraining staff. Include management sign-off to close the loop. Standardize near-miss investigations to reduce risk, strengthen safety culture, and prevent future incidents across operations.
by Danny White, from the Community
Downloads: 10+
Get

Near Miss Report

Use this template to report and document near-miss incidents, promoting a proactive safety culture by identifying and addressing potential workplace hazards.

by SafetyCulture

2,000+

Get

Template

Near Miss Report Template

This Near Miss Report template helps construction teams quickly capture and investigate near-miss events before they cause harm. Record key details such as document number, client or site, date and time, location, personnel, and department. Identify factors including unsafe acts, unsafe conditions, unsafe equipment, or improper equipment use. Describe the incident or hazard, attach photos, and capture employee signatures and dates. The investigation section guides users to document the near-miss condition, identify primary and contributing causes, and define corrective actions such as removing hazards, replacing or repairing equipment, or retraining staff. Includes management sign-off to close the loop and improve site safety and HSE compliance.

by Chris Graydon, from the Community

Get

Template

Near-Miss Report Form (DACC)

This DACC near-miss report form helps teams quickly document potential incidents before they become accidents. Capture key details including site or area location, job number, date, reporter name and role, contact information, and a clear description of the near miss. Add photos and sign to verify the report. Ideal for field operations and site work, it supports consistent incident reporting and continuous improvement across safety programs.

by megan.spice@dacceurope.com, from the Community

Get

Template

Near Miss Reporting Template

Use this Near Miss Reporting template to document potential hazards and incidents that did not result in injury. Capture audit details, site, department, date and time, who was involved, and whether it involved an unsafe act, condition, or equipment. Describe the near-miss, outline primary and contributing causes, and record corrective actions such as removing hazards, repairing or replacing equipment, or retraining staff. Include management sign-off to close the loop. Standardize near-miss investigations to reduce risk, strengthen safety culture, and prevent future incidents across operations.

by Danny White, from the Community

10+

Get

Mini Near Miss Report

About author

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