Near Miss Report Form Template

Create your document in minutes with this ready to use Near Miss Report Form template. Use the quick and easy editor to add your details, make changes, and download a completed document branded with your business name.

This Near Miss Report Form template can be used to gather near miss information so that the incident may be investigated, and action taken to minimise the risk being repeated.

A near miss is an undesired event that, under slightly different circumstances, could have resulted in harm to people or damage to property, materials or the environment.

Good health and safety management requires monitoring of your health and safety performance. Reporting of near misses can reduce accidents and improve safety.

Research has shown that for every 90 near misses an accident will occur. The ultimate goal of near miss reporting is to address the incident, and take action to prevent reoccurrence and remove the potential of an accident.

The completed Near Miss Report Form template can be used to analyse the number an type of near misses occurring, to carry out an information investigation and identify areas of weakness and improvements needed. It can also be used as a record to show that your business takes health and safety seriously.

You can use the Near Miss Report Form template as it is, in your business, and we will add your business name at the top of each page. The template is ready for you to fill in and complete, you can edit it as much as you need to produce a site specific health and safety document for your projects or workplace.