HSE / QHSE — All Industries
Near Miss Incident Report Template
Near-miss reporting is a cornerstone of HSE prevention. This template makes it easy to report quickly, so you can identify root causes before a real accident happens.
What this template includes
Every field below is part of the free template and the mobile version — nothing is locked behind a paywall for filling out a single report.
- Report number and date/time of the incident
- Location or site
- Reporter's name and role
- Severity (minor, moderate, or critical)
- Person(s) involved — name, role, contact
- Witness(es) — name, phone
- Description of events
- Immediate action taken and root cause (if known)
- Up to 3 timestamped photographs
- Reporter signature
- Witness or supervisor signature
Common use cases
- Fall narrowly avoided
- Equipment failure caught in time
- Risky behavior observed
- Near-collision between a vehicle and a pedestrian
Frequently asked questions
Why encourage near-miss reporting?
Every reported near miss is an opportunity to fix a risk before it causes a real accident. A centralized log helps you spot recurring trends by site or activity type.
For the federal recordkeeping rules referenced above, see OSHA's recordkeeping requirements.
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