Near Miss Report Form

Published 06/12/2022

A workplace is a document that records statements of near-miss events in a workplace that could have resulted in accidents or damage to properties. Safety officers use a near-miss report form to record near misses to reduce or eliminate reoccurring risks.

Fatal accidents start with near misses that people ignore and assume it was bad luck. However, fatal accidents can be mitigated by using a near-miss report form.

Near miss reporting can help to prevent future incidents by identifying potential hazards and risks before they become accidents. By recording and analyzing near miss incidents, organizations can identify any underlying causes and put measures in place to reduce the risk of a similar incident occurring in the future.

Common fields of a near-miss report form

- Building
Near misses mainly occur in workstations. It is essential to note the building where the near-miss happened. The building number, location, the exact office or room where the near-miss happened, and office number are recorded under building details.

- Department
Workplaces are divided into departments, and each department has its unique functions. Near misses differ among departments because the equipment mainly causes near misses. The department name, department head, department location, and the number of employees in that department are crucial in recording a near miss. The department details help evaluate risky departments to formulate ways of mitigating the near misses.

- Date of incident
Every entry has to be supported by the date of occurrence. The date helps establish when the near-miss happened and the interval of occurrence.

- Description of the near-miss
A precise outline of the flow of events is detailed to help the safety officers track where the near-miss might have started. The description of the near-miss include; the order of occurrences resulting in the near-miss, an explicit description of the employees or property involved in the near-miss, a description of the setting surrounding the near-miss, equipment on use amid the near-miss, and possible mitigation measures on how to correct the near-miss.

- Parties involved
Details of the parties involved are recorded to track them to shed more light on the near-miss. The parties involved may include; staff members, administrators, cleaners, visitors, security guards, and the equipment in use.

- Witnesses
People involved in near-miss may get confused because they cannot recall what happened before the near-miss occurred. Witnesses chip into records of the events that led to the near-miss.

Witnesses give the correct information about the near-miss. For example, a worker who misses the steps in the stairs while making a call and the phone falls may forget what happened. The person involved in the near-miss may concentrate on the phone and lose the memory of the events.

- Brief statement
A brief description of the near-miss is essential as it helps safety officers to gain more knowledge of what happened. The brief statement explains the safety measures that were violated. It also helps in future reference by safety officers who were not present at the time of the near-miss. They can follow the statement to understand it faster.

Example Near Miss Report Form

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Importance of a Near Miss Report Form

- Limit major accidents

Although misfortunes in a workplace cannot be avoided entirely, using a near-miss report form to document near misses helps predict major accidents. Limiting major accidents means a healthy workplace.

- Awareness tool

Employees become aware of departments with high chances of near misses and become careful when working in those departments. When new employees are hired, they are given the near miss report form to go through and learn more about workplace safety.

Future reference tool

The safety team will have a reference for past near misses and how they were mitigated. They will evaluate whether the correct measures were taken or not.

- Examples of near misses

- Slip that did not result in injury
- Spilling of droplets of acid that could be harmful if landed on open skin
- The slippery floor could result in falling if workers could not have safety boots
- Loose bolts in a machine could lead to breakage if switched on.

Bottom line

Tracking events in the workplace that can lead to injuries, accidents, and the breaking of machines is essential. As prevention is better than cure, preventing major incidences by finding solutions to mitigate near misses is appropriate to ensure a healthy workplace.

Near Miss Reports are also known as Close Call Reports

In some regions a near miss is known as a close call

Tips for establish a Near Miss Report Workflow

- Document the incident accurately and in detail. Include the date, time, location, and any other relevant information.

- Describe the events leading up to and during the incident, including what employees were doing and any mitigating actions taken.

- Ask witnesses to provide their accounts of the incident.

- Identify any contributing factors that may have influenced the incident, such as inadequate training, lack of safety equipment, or organizational policies.

- Make recommendations on how to prevent similar incidents from happening in the future.

- Ensure that the report is reviewed and signed off by the appropriate personnel.

- Follow up on the report to ensure that the recommendations are implemented.

View Near Miss Templates, Forms and Examples

TRY CREATING YOUR OWN NEAR MISS FORM

Using our near miss form builder and template library, you can either pick an existing incident report form template and customise its fields to suit your organisations requirements or you can build your own incident report form from scratch. Try it out and see how easy it is to create an incident report form!