Near Miss Report Template

Educational workplace-safety awareness — connected to industries, occupations, employment law, employment documents and company types. Informational only — not legal advice and not a substitute for mandatory workplace safety training; employers remain responsible for compliance, training and worker authorization.

What this template is for

A near miss is an event that could have led to injury or damage but happened not to. Capturing near misses gives an early warning of hazards before they cause harm, and a simple report makes it easy for anyone to raise one.

This template is a free, editable starting point to adapt to your workplace. It supports a positive reporting culture but is not a substitute for a proper risk assessment, for acting on the hazards it reveals, or for legally required training. The employer remains responsible for reviewing near misses and improving controls.

What a good version typically covers

• Date, time and location of the near miss.
• A short factual description of what happened and what could have resulted.
• The activity at the time and any equipment or substances involved.
• What stopped it from becoming an injury or damage this time.
• Immediate action taken to make the area safe.
• An option to report anonymously, to encourage open reporting.
• Suspected contributing factors and any suggested improvement.
• Who reviewed it and any follow-up actions with owners and dates.

How to use and adapt it

• Make reporting quick and easy, and encourage it without blame.
• Focus on what happened and what could improve, not on who to blame.
• Review near misses regularly to spot patterns and act early.
• Feed the findings back into your risk assessment and controls.
• Tell people what changed as a result, to keep reporting alive.
• Keep reports as supporting records of your safety culture.

Common mistakes to avoid

• Treating near misses as trivial and not recording them.
• Blaming the reporter, which discourages future reporting.
• Collecting reports but never reviewing them or acting on them.
• Assuming a near miss report system replaces a risk assessment or training.
• Failing to feed lessons back into controls and instruction.

Preparing and sharing the report

You can export the template, adapt it to your workplace, complete it and share it as a PDF so close calls are captured and reviewed consistently. Where reports name individuals, store and share them securely.

A near miss report supports awareness and early action; it does not replace your risk assessment, the duty to act on hazards, or required training. The employer remains responsible for reviewing reports and improving controls — confirm any reporting requirements with the official authority.