Electrical Near Miss Report

Use this Electrical Near Miss Report to document electrical hazards, unsafe conditions, and close calls, enabling teams to investigate causes and prevent future electrical accidents.

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Library
Health & Safety
Electrical Near Miss Report

Report Details

Location And Task

Electrical Near Miss Category

Description Of The Near Miss

Potential Severity And Likelihood

Immediate Actions Taken

Contributing Factors And Root Cause

Corrective And Preventive Actions

Sign-off And Distribution

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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Electrical Near Miss Report

Use this Electrical Near Miss Report to document electrical hazards, unsafe conditions, and close calls, enabling teams to investigate causes and prevent future electrical accidents.

1. Report reference number

2. Date and time the near miss occurred

3. Date the near miss was reported

4. Reporter name and role

5. Report submitted anonymously

6. Company or trade of the person reporting

1. Site or location

2. Equipment or system involved (switchboard, panel, MCC, distribution board, overhead line, or other)

3. Voltage level (low voltage or high voltage)

4. Task being carried out at the time

5. Permit to work in place

6. Permit to work reference number

7. Isolation or lockout/tagout in place at the time

1. Contact or near-contact with live or energized parts

2. Arc flash or arc blast

3. Electric shock without injury

4. Isolation or lockout/tagout failure

5. Unexpected re-energization or backfeed

6. Buried or overhead cable or services strike

7. Damaged cable, equipment, or insulation

8. Work on an assumed-dead circuit

9. Static discharge

10. Other (specify)

1. Description of what happened, in sequence

2. Who was involved or exposed

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

4. What could have happened (potential outcome)

5. Any equipment, conditions, or documentation that contributed

1. Potential worst-case outcome (shock, burn, arc flash injury, or fatality)

2. Likelihood of recurrence if no action is taken

3. High-potential near miss

4. Overall risk rating

1. Equipment isolated or de-energized

2. Area made safe or access restricted

3. Permit to work suspended

4. Work stopped

5. Persons in the area warned or informed

6. Supervisor or duty holder notified

1. Inadequate or incomplete isolation

2. Mislabelled or unlabelled equipment

3. Incorrect, missing, or out-of-date documentation

4. Competency or training gap

5. Personal protective equipment not worn or inadequate

6. Unfamiliarity with the site or equipment

7. Time pressure or workload

8. Underlying or root cause of the near miss

1. Recommended corrective actions

2. Action owner

3. Target completion date

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

5. Isolation procedure or arc flash assessment reviewed

6. Toolbox talk or briefing required

1. Reported to (name and role)

2. Investigated by (name and role)

3. Date the report was closed out

4. Photographs or evidence attached

5. Report distributed to (names or roles)