Use this near miss notification form to quickly capture and report workplace safety near miss events. Record date and time, location or customer site, company cell and vehicle number, a clear description of what happened, contributing factors, and what was learned or changed. Attach photos for clarity and sign to confirm accuracy, then email the completed form to the Health and Safety Manager or Claims Manager for follow up.
With SafetyCulture you can
Digitize team workflows
Turn your workflows into digital templates or checklists so your team can conduct inspections efficiently and access them from any device.
Reduce manual errors
Help your team complete tasks more accurately with digital templates that minimize errors from manual processes.
Create and share inspection reports
Generate inspection reports and share them with your team and stakeholders to keep everyone informed.
About author
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.