Title Page

  • Name (OPTIONAL)

  • Type

  • Please describe type of Near Miss:

  • Site/Location:

  • Explain in detail what happened (task, operation, weather, time of day, equipment used, potential hazards, etc...)

  • Please upload any relevant files (images/video) (OPTIONAL):

  • What preventative action was taken AFTER the incident?

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.