1

Near Miss Reporting Form

PRIMARY SOURCE

Before you use this tool, you may want to read the further analysis presented here.

BENEFITS

Near misses are a valuable source of information for safety coordinators because they provide an opportunity for you to identify hazards or weaknesses in your OHS program and make corrections to prevent future incidents. But near misses are only valuable if you know about them. So you should require workers to report near misses immediately to their supervisors.

HOW TO USE THIS TOOL

Adapt this near miss reporting form and instruct workers to use it to report all near misses. The form can also be used to document the investigation into a reported near miss.