• The Safety Report tool is used to identify Hazards or Risks in the work area. Also used for identifying Near Miss incidents, PSIF Incidents, Injuries/Illnesses and documenting Safety Observations.


  • Area

  • Location


  • Date and Time

  • Select the HSE Report Type

Description and Action Taken

  • Potential

  • Type of HSE hazard (Select all that apply

  • Please describe the type of hazard.

  • Give a description of the Observation, Near Miss, PSIF or Injury/Illness

  • What were the actions taken to address the Observation, Near Miss, PSIF or Injury/Illness?

Follow Up

  • is follow-up needed? - If any deficiencies above have not been addressed select "Yes"

  • By selecting "No" to the previous question I am agreeing that I have fixed all deficiencies noted in this document.

  • By selecting "Yes" to the previous question I am agreeing that I have assigned an action item as noted deficiencies were not been able to fix on the spot.

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.