Template

Near Miss Report - Blakes Cross, M1, Huntstown

by Kathryn Kennedy, from the Community

Use this near miss report to document unplanned events that could have led to injury, illness, or damage at Blakes Cross, the M1, and Huntstown. The template guides users to describe the hazard, add photos, note who identified it, and confirm notifications to managers. It includes prompts for engaging with unsafe behaviors, and sections for Facilities and Quality, Health, Safety and Environment actions, required training, additional notes, and final sign-off with date and time. Ideal for transport and logistics operations to standardize reporting and improve safety performance.

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
Modebest Near Miss and Unsafe Observation Report
Use this free Modebest Near Miss and Unsafe Observation Report to document unplanned events that could have caused harm on construction sites. Capture report number, date and time, location, detailed description, and add optional photos. Record witnesses, define near miss per OSHA guidance, and include the reporter’s name and signature. Use as part of site safety practices and email to the contract manager and Health and Safety department.
by Michael Gleese, from the Community
Downloads: 20+
Get
Template
Near Miss Report Form Template
Use this Near Miss Report Form template to capture unplanned events that could have led to injury, illness, environmental harm, or disruption. Based on the IOSH definition, it guides users to record date and time, location, incident category (falls, manual handling, electric shock, hazardous substances, and more), detailed incident description, root causes, lessons learned, and corrective actions. Add supporting photos, capture optional employee details and signatures, and include approvals for closure. Designed for construction and general workplace safety teams to strengthen hazard reporting, analyze trends, and prevent future incidents.
by Chris Skelton, from the Community
Downloads: 0
Get
Template
Near Miss Incident Report Form
This near miss form helps teams quickly document unplanned events that could have caused injury, illness, or damage. Capture the location, date and time, photos, and a clear description of what happened, and indicate whether work stopped or continued. Include optional employee name and signature for accountability, then submit to your Health and Safety Manager or Supervisor. Ideal for improving workplace safety and incident reporting across job sites.
by Matthew Oneill, from the Community
Downloads: 0
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
Get

Near Miss Report - Blakes Cross, M1, Huntstown

About author

You might also like

Modebest Near Miss and Unsafe Observation Report

Near Miss Report Form Template

Near Miss Incident Report Form

Near Miss Report Template

You might also like

Modebest Near Miss and Unsafe Observation Report

Near Miss Report Form Template

Near Miss Incident Report Form

Near Miss Report Template