Construction Near Miss Report

Use this Construction Near Miss Report Form to capture site close calls, hazard category, potential severity, and corrective actions to act on near misses.

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Construction Near Miss Report



Report Details

1. Report reference number


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2. Date and time the near miss occurred


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3. Date the near miss was reported


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4. Reporter name and role


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5. Report submitted anonymously


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6. Company or subcontractor of the person reporting


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Site And Location

1. Project or site name


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2. Principal contractor


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3. Specific location on site (level, zone, or grid reference)


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4. Area or work zone where the near miss occurred


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5. Weather or site conditions at the time (if relevant)


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Task And Activity

1. Task being carried out at the time


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2. Permit to work in place


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3. Permit to work reference number


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4. Method statement or risk assessment reference


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5. Plant, equipment, or tools involved


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6. Trade or work package involved


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Near Miss Category

1. Fall from height (scaffold, ladder, platform, opening, or edge)


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2. Dropped or falling object (tools, materials, or debris)


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3. Slip, trip, or fall on the same level


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4. Plant, machinery, or vehicle (including struck-by or caught-between)


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5. Electrical or buried or overhead services strike


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6. Excavation, ground movement, or collapse


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7. Manual handling


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8. Hazardous substance or exposure


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9. Fire or explosion


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10. Environmental release (spill, leak, or discharge)


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11. Other (specify)


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Description Of The Near Miss

1. Description of what happened, in sequence


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2. Who was involved or exposed


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3. What the person was doing at the moment it occurred


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4. What could have happened (potential outcome)


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5. Any equipment, materials, or conditions that contributed


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Potential Severity And Likelihood

1. Potential worst-case outcome (first aid, minor injury, major injury, or fatality)


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2. Likelihood of recurrence if no action is taken


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3. High-potential near miss


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4. Overall risk rating


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Immediate Actions Taken

1. Action taken to make the area safe


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2. Area isolated, barriered, or exclusion zone established


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3. Work stopped


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4. Persons in the area informed or warned


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5. Supervisor or site management notified


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Contributing Factors And Root Cause

1. Unsafe conditions that contributed


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2. Unsafe acts or behaviours that contributed


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3. Equipment, design, or planning factors that contributed


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4. Underlying or root cause of the near miss


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Corrective And Preventive Actions

1. Recommended corrective actions


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2. Action owner


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3. Target completion date


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4. Action status (open, in progress, or closed)


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5. Toolbox talk or briefing required


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6. Method statement or risk assessment update required


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Sign-off And Distribution

1. Reported to (name and role)


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2. Investigated by (name and role)


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3. Date the report was closed out


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4. Photographs or evidence attached


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5. Report distributed to (names or roles)


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Checklist by GoAudits.com – Please note that this checklist is intended as an example. We do not guarantee compliance with the laws applicable to your territory or industry. You should seek professional advice to determine how this checklist should be adapted to your workplace or jurisdiction.

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