A near miss is a warning - the incident that nearly happened. We want people to report them, so this form is short and can be filled in anonymously, and it captures enough to fix the cause before it bites for real.

Effective Form Templates

This form template is supplied in fully editable MS Word format and can be easily customised and edited. The document uses pre-defined style formatting throughout, with all text in Calibri font for improved readability.
The following document labelling is included in the footer:

• Form number and title
• Information-classification
• Version
• Page number / total pages

alphaZ documents - beautifully designed, tried and tested form templates. No junk, jargon or unnecessary fields. Simple and usable form templates developed over 25 years through practical use in the real world.

Further Reading

Further guidance on near misses and incident reporting:

• Accidents, Incidents and Near Misses
• Managing Health and Safety at Work
• Risk Assessment

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How to Download

This file is included in the alphaZ subscription. This form is also included in the ISO 45001 Toolkit and every alphaZ ISO toolkit that covers health and safety, so if you need the wider set of documents for near miss and incident reporting, the toolkit route gives you this file plus everything else you need in one download.

Need Help Implementing?

If you'd like hands-on help setting up your near miss reporting or your wider health and safety management system, our remote support services provide direct expert input from our team, by the day, by project, or on an ongoing basis.

Near Miss Reporting Form Template

A near miss reporting form for capturing incidents that could have caused harm but did not. It records who was involved, the location and time, a description of what happened, a risk rating, the immediate and root causes, and the actions to prevent recurrence, and can be completed anonymously to encourage reporting.

Learning from incidents and near misses is central to improving health and safety and is an expectation of ISO 45001. This form gives you a simple reporting route and supports the incident investigation and improvement requirements of ISO 45001.

Built for ISO 45001 Incident Learning

The form supports the incident, nonconformity and corrective action requirements of ISO 45001 (clause 10.2):

• Who was involved, and the location, date and time
• A description of the near miss and a rating of the potential risk
• Immediate causes - the unsafe conditions - and secondary or root causes
• Actions to prevent recurrence, with review and close-out

What's Included in this Near Miss Form

The form is short by design, so people actually use it:

• Details - persons involved, location, date / time and a description of what happened
• Risk rating - the potential consequence and likelihood of recurrence
• Causes - immediate (unsafe conditions) and secondary / root causes
• Actions and close-out - actions to prevent recurrence, reviewed by and date closed

Who Needs a Near Miss Reporting Form?

Any organisation building a reporting culture and wanting to learn from close calls - every sector benefits, from manufacturing and construction to offices and services. It is a core record for any business working towards or maintaining ISO 45001 certification.

Included in the ISO 45001 Toolkit

This form is part of the ISO 45001 Toolkit - risk assessments, registers, procedures and guidance for managing health and safety in one download - and is included in every alphaZ ISO toolkit that covers ISO 45001.

Pairs with the Accident Report

Where harm did occur, record it with the F-HS13 Accident Report.