Near Miss Incident Report

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Health & Safety
Near Miss Incident Report

General Information

Details Of Person Reporting

Incident Details

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Near Miss Incident Report

1. Date and time of the Incident.

2. Location (please be as accurate as possible).

1. First Name

2. Surname

3. Category of Person – staff, student, contractor or visitor

4. If other, give more details

5. Name of the contractor (if applicable)

1. Description of the Incident

2. Describe what happened?

3. What immediate actions were taken at the time?

4. List additional actions which could be taken to prevent a similar occurrence?

5. Photograph(s) of the area and/or results of the near-miss or incident

6. Additional comments / observations

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Near Miss Incident Report

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1. Date and time of the Incident.

2. Location (please be as accurate as possible).

1. First Name

2. Surname

3. Category of Person – staff, student, contractor or visitor

4. If other, give more details

5. Name of the contractor (if applicable)

1. Description of the Incident

2. Describe what happened?

3. What immediate actions were taken at the time?

4. List additional actions which could be taken to prevent a similar occurrence?

5. Photograph(s) of the area and/or results of the near-miss or incident

6. Additional comments / observations

Get started on a free trial

Is GoAudits right for you?

Trusted by 600+ businesses globally

Book Intro Call