Templates / Near Miss Report Card
Near Miss Report Card
The Near Miss Report Card is designed to be quick to complete and easy to adapt to your own workplace. Start from the template rather than a blank page, tailor the hazards, controls and responsibilities to your site, and keep a completed copy on file as evidence that the right checks were made.
Download the template
The PDF is free once you have an account. The editable Word file is included too, so you can adapt and issue it under your own document control.
Every template is a starting point, not a finished document. Replace the headings and fields with your own project detail before you issue it.
A quick-capture card template for reporting near-miss events.
A short near-miss reporting card designed to make it quick and blame-free to raise a concern.
About this template
How it links to the standards
Where this template names protective equipment or a control measure, the equipment itself is governed by a published standard that defines what it must withstand and how it is tested. The full EN standards library covers each one in plain language so you can confirm you are specifying the right level of protection.
Related guidance
Filling the template in is easier when you know the reasoning behind each control. These notes cover the practical detail:
- Tips and Tricks — the full technique-note library for this kind of work
A blame-free process encourages people to actually report near misses.
Frequently asked questions
What does the Near Miss Report Card cover?
A short near-miss reporting card designed to make it quick and blame-free to raise a concern before it becomes an incident.
Why does a near-miss report need to be blame-free?
A blame-free process encourages people to actually report near misses, since a genuine near miss represents a hazard that was caught in time and is valuable exactly because it teaches a lesson before anyone was hurt.
What makes a near-miss report card different from a full incident report?
It is intentionally short and quick to complete, since a near miss did not result in harm and a lengthy form would discourage the reporting this template is designed to encourage.
What should happen after a near miss is reported?
The underlying hazard should be reviewed and addressed, not just logged, otherwise the same near miss is likely to recur until it eventually results in an actual incident.