Near Miss Reporting Form

Example Form Template for Reporting Near Misses 

This form is for recording details of near misses, investigations made and corrective action taken. Includes description of incident and causes. 

This file can also be used to monitor whether corrective actions have been effective. A Google Docs version and V2 with root-cause is included. 

Versions available;

This template is a Word Document and is fully editable. It can be implemented as part of a health and safety management system.