Near miss report form 2025

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The process of addressing near misses at work involves the following general steps: The employee logs the incident and the potential hazard. The employee notifies their superiors about the near miss. The responsible people investigate the incident to find the cause.
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.
Its an unpredicted event that had the potential of creating a mild to serious injury to an employee, though it didnt fully happen. 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.
An employee nearly slips on a recently mopped floor that was not marked with a wet floor sign. A worker trips over a small pile of boxes left in a walkway but manages to catch themselves on a nearby table. Loose carpeting on an office floor causes an employee to stumble, narrowly avoiding a fall.
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.
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