Near miss report form
Updated · Reviewed by Israel Margulies, founder and CEO of High Point GPS
A short form to report something that almost caused an injury or damage: what happened, what could have happened, why, and what should change, with an option to report without a name.
A near miss is an incident that didn't hurt anyone this time. Reporting them is one of the cheapest ways to prevent the real thing, because the same causes are behind both.
People report near misses when it's quick and nobody gets blamed. Keep the form short, allow it to be anonymous, and show the crew what was done about each one.
Near miss report
Fields: Date and time · Location · Machine or vehicle involved · Reported by (optional)
The near miss
- What happened
- What could have happened
- Why it happened (cause)
- Immediate action taken
- Corrective action suggested
- Who owns the corrective action
- Follow-up done and date
Fill it in the right way
- Make the area safe first.
- Write what happened and what could have happened.
- Note the cause as you see it and what you did straight away.
- Suggest what would stop it happening again.
- Hand the form to the supervisor or put it in the box; a name is optional.
- The supervisor assigns the corrective action and records the follow-up.
Tips
- Thank people for reporting, every time.
- Review near misses at the next toolbox talk.
- Track them by machine, task and area to spot patterns.
- Never use a near miss report to discipline the person who reported it.
Do it in FleetZap
- If a machine was involved, it can be reported straight away by scanning its QR label, which opens a work order for the shop.
- The machine's history shows recent repairs and checks.
- FleetZap records checks and repairs; it doesn't replace your safety reporting system.
FleetZap Maintenance
Work orders, PM, parts, compliance, assets and KPIs. Explore FleetZap Maintenance.
Frequently asked questions
What is a near miss?
An unplanned event that could have caused injury, illness or damage but didn't, often by chance or a quick reaction.
Why report near misses?
They share causes with real incidents. Fixing those causes after a near miss prevents the injury that would come later.
Can near miss reports be anonymous?
Yes. Many companies allow it so people report freely. The facts matter more than the name.
What's the difference between a near miss and an incident?
An incident causes injury, illness or damage; a near miss could have but didn't.