Title Page

  • Title

  • Reported by

  • Reported to

  • Worksite Supervisor

  • Workers on location

  • Conducted on

  • Location
  • HAZARD (Add description and take photo)

  • Risk rating and (Control if implemented)

  • Reported by and signature

  • NEAR MISS (Add description of near miss and control if implemented)

  • Reported by and signature

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.