Title Page

  • Client / Site

  • Reported by:

Hazard/Near-miss Identification

  • HAZARD OR NEAR-MISS REPORTING?

HAZARD or NEAR-MISS IDENTIFICATION

Hazard/Near-Miss no. 1

  • Select date

  • Location of Hazard:

  • Hazard/Near-Miss no. 1 description:

  • Add media

  • Follow up & closed?

  • Select date

  • Picture after follow up

HAZARD or NEAR-MISS IDENTIFICATION

Hazard/Near-Miss no. 2

  • Select date

  • Location of Hazard:

  • Hazard/Near-Miss no. 2 description:

  • Add media

  • Follow up & closed?

  • Select date

  • Picture after follow up

HAZARD or NEAR-MISS IDENTIFICATION

Hazard/Near-Miss no. 3

  • Select date

  • Location of Hazard:

  • Hazard/Near-Miss no. 3 description:

  • Add media

  • Follow up & closed?

  • Select date

  • Picture after follow up

HAZARD or NEAR-MISS IDENTIFICATION

Hazard/Near-Miss no. 4

  • Select date

  • Location of Hazard:

  • Hazard/Near-Miss no. 4 description:

  • Add media

  • Follow up & closed?

  • Select date

  • Picture after follow up

HAZARD or NEAR-MISS IDENTIFICATION

Hazard/Near-Miss no. 5

  • Select date

  • Location of Hazard:

  • Hazard/Near-Miss no. 5 description:

  • Add media

  • Follow up & closed?

  • Select date

  • Picture after follow up

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.