Title Page

  • Document No.

  • Audit Title

  • Farm

  • Conducted on

  • Prepared by

  • Location
  • Personnel involved

  • Was anyone injured?

  • Was any equipment damaged?

  • If you answered yes to any of the above then it was an incident not a near miss. Please submit full report to your manager.

  • Brief description of near miss incident.

  • Take photo of any issues or upload one from your device

  • Has hazard been added to hazard board and reported?

  • Signature of employee reporting

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.