Incident Report Form
Capture an incident properly on the day, in the affected person's own words, with the witness details and equipment notes that become impossible to gather later.
IN-03 2 pages
Site and construction · SI-10
Near Miss Report Form
A free printable near miss form — what happened, what could have happened at worst, and the actions agreed, with reporting optionally anonymous.
Download Free · no sign-up
One page. Choose your paper size — both versions are laid out identically, so neither one gets shrunk to fit.
Print it and write on it
Fill it in type and save
The fillable versions have real form fields — open them in any PDF reader, type into them and save. Printing help.
What this sheet is for
Capture the things that nearly went wrong, in a form that asks what happened rather than who was at fault.
Who it is for
Sites, workshops, farms, warehouses, kitchens, care services and any workplace that would rather find out early.
How to use it
- Make reporting easy and make it clear it is not a disciplinary process.
- Write what happened factually and what could have happened at worst.
- Agree actions with owners and dates, and close them out.
- Review near misses together — patterns show up across reports, not within one.
- Leave the reporter's name optional if that is what gets them filled in.
What is on the sheet
One page, top to bottom:
Printed under the title: Something that nearly went wrong, written down while it is still fresh and before it happens properly.
What happened, not who is to blame. Near misses are free information. The only thing that stops people reporting them is the fear that it becomes a disciplinary matter, so the form asks what happened rather than who is at fault.
Write-on lines: Site or location · Date · Time · Reported by (optional) · Exactly where · What was being done at the time
What happened
Ruled lines
What could have happened, at worst
Ruled lines
What has been done already, and what should change
Table, 2 rows: Action · Owner · By when · Done
Write-on lines: Reviewed by · Date
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