Near Miss Report Form

Investigating and documenting near misses is an important element of incident management. While these types of incidents don’t immediately cause injuries and illnesses, they can in the future. If you don’t take the time to investigate the root cause of a near miss, you’ll likely encounter the same situation down the road.

A near miss report is a relatively simple document that includes information like the:

• Incident date, time, and location
• Names of involved parties
• Witness names
• Incident description
• Root cause analysis
• Corrective actions

This downloadable template makes it easy to fill out the near miss report manually or digitally. So, if you use EHS software to organize your documents, you can upload and update your report without ever having to manage paper files.