Title Page

  • Site

  • Prepared By

  • Date Reported

  • Who is reporting the near miss (Full name and Company)?

  • Who was involved?

  • Describe what happened.

  • Upload Images

  • Hit the 'Notify Case' button to notify the CASE Team.

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.