Near miss report form
A near miss is the incident that happened without the injury: free information. Use this form to capture what nearly went wrong, how bad it could have been, and the fix. Crews that record near misses catch the pattern before it catches someone, and prequal reviewers increasingly ask how near misses are tracked.
Near miss report form
Company: ____________
Jobsite: ____________
Date: ____________
Event details
| Date, time and exact location: ____________ | N/A · Action | |
| Task being performed: ____________ | N/A · Action | |
| Who was involved or nearby: ____________ | N/A · Action |
What nearly happened
| Describe the event and what stopped it becoming an injury | N/A · Action | |
| Worst credible outcome if it had connected (first aid / ER / fatality) | N/A · Action | |
| Hazards involved (height, electricity, equipment, trench, load) | N/A · Action |
Fix and follow-up
| Immediate action taken on the day: ____________ | N/A · Action | |
| Root cause (why was this possible): ____________ | N/A · Action | |
| Corrective action, owner, due date: ____________ | N/A · Action | |
| Shared at the next toolbox talk | N/A · Action | |
| JHA updated if the task steps or controls changed | N/A · Action |
Completed by: ____________________
Signature: ____________________
tailgatedocs.com · Free printable form. Not legal advice; adapt to your jobsite.
Common questions
▸Are near misses OSHA-recordable?
No. The OSHA 300 log records injuries and illnesses that meet recording criteria; a near miss with no injury does not go on it. Recording near misses internally is voluntary and worth it: it is the cheapest corrective action you will ever get.
▸Why do GCs and prequal platforms ask about near-miss tracking?
Because it is the best leading indicator of safety culture. A sub that captures near misses is finding hazards before they become recordables, which is exactly what a controlling employer wants on their site.
A near miss that changes how a task is done means the JHA needs updating. Generate a fresh one for $29.
Forms record what happened on the job; the JHA, safety plan, or written program is what a GC, prequal portal, or inspector asks to see. Generate a verified, job-specific one in minutes.