Template

Visionstream Near Miss Reporting Template

by Mel Dawson, from the Community

30+

Use this Visionstream Near Miss Reporting template to document incidents that almost caused harm during telecom maintenance and UFB build activities. Capture who reported the event, the location, date and time, what was observed, supporting photos, work type, contractor details, and actions taken on site. Standardizing near miss reporting helps identify hazards, share learnings, and prevent future incidents across field teams.

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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 and Safety Share Checklist
Use this near miss and safety share template to document incidents and lessons learned across fleet operations. Capture job details, people involved, date and time, location, near-miss type (unsafe act, condition, or equipment), narrative of what happened, supporting photos, and recommendations. Assign corrective actions and a responsible party, record general observations, and share safety insights to prevent future incidents.
by Casey Blackford, from the Community
Downloads: 10+
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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+
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Template
HSE Near Miss Report Template
This HSE Near Miss Report template helps teams log and analyze near-miss incidents to prevent future harm. Record site, date, observer, and document number, then describe the hazardous act or condition observed. Note whether the issue was corrected, identify root causes, and document corrective actions taken. Indicate if further investigation is required and finalize with a sign-off by the QHSE Manager. Designed to support proactive safety and environmental protection across operations, this template facilitates consistent reporting and action tracking to reduce injuries, illness, and environmental impact.
by Longinus Ike, from the Community
Downloads: 0
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Template
Near-Miss/Incident Form
Form for reporting near misses or incidents on site
by Mark Taylor, from the Community
Downloads: 70+
Get

Near Miss and Safety Share Checklist

Use this near miss and safety share template to document incidents and lessons learned across fleet operations. Capture job details, people involved, date and time, location, near-miss type (unsafe act, condition, or equipment), narrative of what happened, supporting photos, and recommendations. Assign corrective actions and a responsible party, record general observations, and share safety insights to prevent future incidents.

by Casey Blackford, from the Community

10+

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

Template

HSE Near Miss Report Template

This HSE Near Miss Report template helps teams log and analyze near-miss incidents to prevent future harm. Record site, date, observer, and document number, then describe the hazardous act or condition observed. Note whether the issue was corrected, identify root causes, and document corrective actions taken. Indicate if further investigation is required and finalize with a sign-off by the QHSE Manager. Designed to support proactive safety and environmental protection across operations, this template facilitates consistent reporting and action tracking to reduce injuries, illness, and environmental impact.

by Longinus Ike, from the Community

Get

Template

Near-Miss/Incident Form

Form for reporting near misses or incidents on site

by Mark Taylor, from the Community

70+

Get

Visionstream Near Miss Reporting Template

About author

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Near Miss and Safety Share Checklist

Near Miss Reporting Template

HSE Near Miss Report Template

Near-Miss/Incident Form

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Near Miss and Safety Share Checklist

Near Miss Reporting Template

HSE Near Miss Report Template

Near-Miss/Incident Form