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Lumiform

Mobile audits & inspections
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Quick Near Miss Form

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  • Cut inspection time by 50%
  • Uncover more issues and solve them 4x faster
  • Select from over 4000 expert-proofed templates
Rated 4.8/5 stars on Capterra
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Quick Near Miss Form

Instructions: 1. Required to be completed when you experience a Safety Near Miss in the workplace2. To be completed in full and emailed to direct manager or the Health & Safety Manager.

Near Miss DefinedOSHA and the National Safety Council defines a near miss as an “unplanned event that did not result in injury, illness or damage – but had the potential to do so.”

Location of Near Miss. If customer site, please provide address

Date & Time of Near Miss:

Photo/s that can help explain the near miss:

Please explain the near miss that occurred:

Stop work or work business as usual?

Name and Signature (optional)