Near Miss Reporting Form


A Near Miss Reporting Form is an essential tool for identifying and addressing potential hazards before they result in accidents.

This proactive approach not only enhances the safety and well-being of your employees but also contributes to a culture of vigilance and continuous improvement within your organization. 

By systematically recording and analyzing near-miss incidents, your business can identify trends, implement corrective measures, and prevent future accidents, thereby minimizing downtime and associated costs.

Near Miss Reporting Form

  • Company Name: ___________
  • Project Name: ___________
  • Location: ___________
  • Date: ___________
  • Time: ___________
  • Reporter’s Information:
    • Name: ___________
    • Position: ___________
    • Contact Information: ___________
  • Details of the Near Miss:
    • Description of the incident (What happened?):
    • Exact location of the incident:
    • Potential injury/accident that was narrowly avoided:
  • Possible Causes:
    • What factors contributed to the near miss? (e.g., environmental conditions, equipment failure, procedural errors):
  • Witnesses:
    • Names and contact details of witnesses, if any:
  • Immediate Actions Taken:
    • What immediate action was taken following the near miss?:
  • Photographic Evidence:
    • Attach any photos or videos that capture the scene or contributing factors.
  • Recommendations for Prevention:
    • Suggest measures to prevent the recurrence of a similar incident:
  • Supervisor’s Review:
    • Supervisor’s name:
    • Comments and further actions required:
  • Follow-Up Actions:
    • Description of follow-up actions (e.g., training, equipment checks, procedural revisions):
    • Responsible person(s) for implementation:
  • Signatures:
    • Reporter’s Signature: ___________ Date: ___________
    • Supervisor’s Signature: ___________ Date: __________

This Near Miss Reporting Form is an invaluable asset for your construction business, enabling you to turn every near miss into a learning opportunity.

By actively engaging with this process, you not only bolster your safety record but also demonstrate a commitment to continuous improvement and risk management.

Implementing this form in your daily operations is a proactive step towards fostering a safer workplace, reducing liabilities, and ensuring the long-term success and reputation of your business.

Remember, every near miss reported is a potential accident avoided and a step closer to achieving excellence in safety standards.

Choose Connecteam, the #1 Choice for Safety Managers

Connecteam is the ultimate tool that can significantly enhance your performance, streamlining your tasks and boosting productivity.

With our user-friendly mobile app, you can easily create and access near-miss reporting forms & checklists, ensuring everyone stays safe.

Empower yourself with our real-time incident reporting feature, allowing you to document findings instantly, complete with photos and notes, and enabling efficient communication with project managers and stakeholders.

Plus, our smart scheduling and task management capabilities help you optimize work plans, ensuring timely inspections and minimizing delays.

Experience a game-changing solution tailored to your construction company’s needs!

Get started with Connecteam for free today and enjoy seamless checklists, instant reporting, and efficient collaboration with your team.