Salarybox

Sign In
Start Free Trial

Near Miss Reporting Form

Customize our near-miss form template

Near Miss Incident Report Form

Near Miss Incident Report Form

A Near Miss Incident Report Form is a vital tool for detecting and resolving potential risks before they lead to actual accidents.

Through the consistent documentation and evaluation of near-miss events, your company can spot patterns, apply corrective actions, and avoid future incidents, which helps reduce downtime and related expenses.

General Information

Reporter’s Details

Incident Details

Analysis & Witnesses

Actions & Prevention

Assessment & Follow-Up

Signatures

This Near Miss Incident Report Form is a valuable resource for your construction company, allowing you to transform each near miss into an opportunity for improvement.

By fully participating in this procedure, you strengthen your safety performance while showing dedication to ongoing progress and effective risk management.

Declaration: I confirm that the information provided is accurate and that immediate actions have been taken to secure the area.

What Is Near Miss Reporting?

Near miss reporting is the process of identifying, documenting, and analyzing incidents that could have resulted in injury, illness, property damage, or operational disruption—but didn’t. Although no harm occurs, near misses are early warning signs of potential hazards and system failures.

Why Near Miss Reporting Matters

Near miss incidents provide valuable insights into workplace risks before they turn into serious accidents. By encouraging employees to report these events, organizations can proactively improve safety, reduce costs, and prevent future incidents.

Key Benefits of Near Miss Reporting

  • Prevents accidents and injuries by addressing hazards early

  • Strengthens workplace safety culture through employee involvement

  • Reduces downtime and operational losses

  • Supports regulatory compliance and safety audits

  • Improves risk assessment and process controls

Examples of Near Miss Incidents

  • A worker slips but regains balance without falling

  • Machinery malfunctions without causing injury

  • Objects fall near employees but miss contact

  • Electrical faults detected before causing damage

How Near Miss Reporting Works

Employees report near miss incidents using a structured reporting system or form. Each report is reviewed, investigated, and followed by corrective actions to eliminate or control the identified risks.

Best Practices for Effective Near Miss Reporting

  • Encourage prompt and blame-free reporting

  • Keep the reporting process simple and accessible

  • Analyze trends and recurring risks

  • Communicate corrective actions to employees

  • Integrate near miss data into safety training programs

Building a Proactive Safety Culture

A strong near miss reporting program shifts safety from a reactive approach to a preventive one. When employees feel safe reporting near misses, organizations gain the insights needed to continuously improve workplace safety and operational efficiency.