Template

Near Miss and Safety Share Checklist

by Casey Blackford, from the Community

10+

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.

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 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
Visionstream Near Miss Reporting Template
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.
by Mel Dawson, from the Community
Downloads: 30+
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Template
C2SC Near Miss Report
Capture and report near miss incidents quickly with this C2SC Near Miss Report template. Record the date and time, job location, people involved, and a clear description of what occurred. Document contributing working or environmental conditions, actions taken, and lessons learned, and attach photos or other media as evidence. Export the completed report and share it with your Area Safety Supervisor to drive corrective actions. Designed to improve construction site safety by identifying root causes and preventing reoccurrence. Templates are examples only and not a substitute for professional advice.
by Jordan Ludwig, from the Community
Downloads: 10+
Get
Template
Johansen Near Miss Report
Use the Johansen Near Miss Report to record and analyze near-miss events before they become incidents. This customizable checklist captures client or site, date and time, preparer, and location, along with a clear description of the event. Classify the type of incident (unsafe act, unsafe condition, act of nature, or third party), assess risk potential by severity and probability, and propose corrective actions. Log witnesses and supporting notes to aid investigation and prevention. Ideal for construction job sites and field operations to improve safety awareness and reduce future risk.
by Ryan Lancaster, from the Community
Downloads: 40+
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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

Visionstream Near Miss Reporting Template

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.

by Mel Dawson, from the Community

30+

Get

Template

C2SC Near Miss Report

Capture and report near miss incidents quickly with this C2SC Near Miss Report template. Record the date and time, job location, people involved, and a clear description of what occurred. Document contributing working or environmental conditions, actions taken, and lessons learned, and attach photos or other media as evidence. Export the completed report and share it with your Area Safety Supervisor to drive corrective actions. Designed to improve construction site safety by identifying root causes and preventing reoccurrence. Templates are examples only and not a substitute for professional advice.

by Jordan Ludwig, from the Community

10+

Get

Template

Johansen Near Miss Report

Use the Johansen Near Miss Report to record and analyze near-miss events before they become incidents. This customizable checklist captures client or site, date and time, preparer, and location, along with a clear description of the event. Classify the type of incident (unsafe act, unsafe condition, act of nature, or third party), assess risk potential by severity and probability, and propose corrective actions. Log witnesses and supporting notes to aid investigation and prevention. Ideal for construction job sites and field operations to improve safety awareness and reduce future risk.

by Ryan Lancaster, from the Community

40+

Get

Near Miss and Safety Share Checklist

About author

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Near Miss Reporting Template

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Near Miss Reporting Template

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