A near miss is the moment something went wrong and nobody got hurt — the pallet that slid off the forks and landed where someone had been standing a second before, the ladder that kicked out with nobody on it yet. It is the cheapest safety lesson a workplace will ever get, and most of them are never written down because the form takes too long. This one is built to be filled in where you are standing, in a couple of minutes: what happened, where, how bad it could have been, a photo, what you did about it and what you think caused it. You can leave your name off. The second part is for the supervisor, who records the follow-up and closes the report once the fix is in. Fill it in here and download a PDF without creating an account.
Near miss, hazard or incident?
Three forms, three moments. A hazard report is for something that could hurt someone but has not done anything yet — a frayed cord, a blocked exit. A near miss report is for an event that actually happened but caused no injury, illness or damage. An incident report is for when someone was hurt or something was broken.
If you are unsure, use this form. A supervisor can always move it up to an incident; a near miss that was never reported cannot be recovered.
What to write, in the order it asks
Start with the kind of event, then describe it in a few plain sentences, in the order things happened: what you or others were doing, what moved or gave way, and what stopped it turning into an injury. Add a photo of the spot as it was. Then pick how bad it could have been if luck had gone the other way — that answer matters more than anything else on the form, because it decides how quickly the follow-up has to happen.
The contributing factors are ticks, not essays: clutter, missing guards, rushing, poor light, unclear instructions. Tick everything that played a part. Patterns across many reports come from these ticks.
Reporting without your name
Some people will not report a near miss if their name goes on it, especially when the cause was a shortcut they were told to take. Answer Yes where the form asks about leaving your name off, and the name fields disappear from the form and the report. Everything else still gets recorded and followed up.
The supervisor's half
Once the report is in, the supervisor opens the follow-up section, talks to the people involved and records the underlying cause — not "worker was careless" but why the situation allowed it. Actions get an owner and a due date. Anything rated Serious or Life-threatening is flagged at the top of the report and should be investigated as if someone had been hurt. The report closes when the actions are done and checked, and the person who reported it has been told what changed.
On the phone, speak while you walk, and the document writes itself: say what happened while you are still at the spot and take the photo, and the form fills in.
Common questions
What counts as a near miss?
An unplanned event at work that could have caused an injury, illness or damage but did not — usually by luck or by a split second. If someone was hurt, even slightly, or something was damaged, report it as an incident instead.
Do near misses have to be reported to OSHA?
No. OSHA's recordkeeping and reporting rules cover work-related injuries and illnesses, not near misses. OSHA does encourage employers to collect near miss reports as part of a safety program, and many company policies require them.
Who should fill in a near miss report?
Whoever saw it or was involved, as soon as the area is safe. Anyone on site can raise one — staff, contractors or temps. A supervisor completes the follow-up section.
Can I report a near miss anonymously?
Yes. Answer Yes to the question about leaving your name off and the name fields are hidden. The supervisor will not be able to tell you what was done about it directly, so check the notice board or team briefing.
What happens after I submit it?
A supervisor reviews it, works out why it happened, sets actions with owners and dates, and closes it once the fix is in and checked. Reports with a serious potential outcome are treated with the same urgency as an injury.