Near miss report form template 2025

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A near miss on a ship could be a crew member working without a safety helmet near an overhead crane in the engine room or entering an enclosed space without ventilation.
What are the five rules of incident report writing? Timeliness: Always report the incident as soon as possible. Accuracy: Make sure all information provided is accurate and detailed. Completeness: Be thorough and provide all important details. Confidentiality: Handle sensitive and personal information carefully.
In general, here is the information you should include in a near miss report: Date, time, and location of the incident. Department. Incident description. Root cause (behavior, equipment, etc.) Supporting documents (photos, hazard analyses, etc.) Next steps and specific action items.
Poor lighting resulting in an employee tripping, and almost falling over an undetected extension cord. A leaky air conditioner drips onto a walkway resulting in an employee slipping and nearly falling. A missing or worn step marker resulting in an employee tripping over a step.
A near-miss is a potential hazard or incident in which no property was damaged and no personal injury was sustained, but where, given a slight shift in time or position, damage or injury easily could have occurred. Near misses also may be referred to as close calls, near accidents, or injury-free events.
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Workers must report all workplace incidents, hazardous conditions, near misses, and property and environmental damage to their immediate supervisor as soon as possible.
For example, if an employee steps on condensation by a freezer and almost slips but theyre able to recover their balance before falling, its a near miss. If the employee fell and suffered an injury, that would be an incident or accident.

near miss report form template