Free near miss report form
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Free near miss report form (PDF-ready). Hazard observed, potential consequences, risk level, location details and recommended controls. Download free.
Last updated: 2026-02-21
Commercial Director
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See the first part of the near miss report form below. Download the full version above.
What is a near miss report form?
A near miss report is a record of an unplanned event that did not cause injury, illness or damage but had the potential to do so. It captures what happened, what could have happened, the hazard category (e.g. fall, struck by, electrical, chemical), potential severity, likelihood of recurrence, and the risk level. Near miss reporting is a leading safety indicator - organisations that actively report and act on near misses experience fewer serious incidents. In Australia, near miss reporting is widely considered best practice under WHS legislation and many principal contractor management systems mandate it.
Benefits of using this near miss report form
- Prevent incidents before they happen: - identifying and controlling hazards revealed by near misses stops them becoming injuries.
- Build a proactive safety culture: when workers see near miss reports lead to action, they are more likely to report hazards.
- Identify trends and patterns: aggregate near miss data reveals recurring hazards across sites, shifts or activities.
- Regulatory compliance: demonstrate due diligence and continuous improvement to regulators and principal contractors.
- Reduce costs: preventing injuries avoids workers' compensation claims, downtime, equipment damage and reputational harm.
Benefits of digitising forms in MapTrack
When you move your reports from paper to MapTrack, you get:
- Field users can easily scan a QR code to complete a form on mobile. Unlimited users.
- Automatically get alerts when faults are identified.
- Link every form digitally as a PDF to the relevant asset, location or person.
- Receive a digital PDF copy with every submission to your email.
- Ability to share forms digitally.
- Build conditional logic (show or hide questions based on answers).
- Take pictures or attach photos. Not possible with a paper-based form.
- Electronic signatures.
- Edit forms later without reprinting.
- Restrict permissions (who can view, complete or approve).
- Build forms with AI (describe what you need and MapTrack suggests the form).
- Escalate critical hazards instantly to safety managers via push notification.
- Maintain an auditable safety register that satisfies WHS regulator requests.
- Correlate incident trends across sites with built-in safety analytics.
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What to include in a near miss report form
This near miss report form covers 11 key areas:
- Reporter details: name, role, date and time of the near miss.
- Location/site: specific area where the event occurred.
- Near miss description: what happened and what could have happened.
- Potential severity: first aid, medical treatment, lost time or fatality.
- Likelihood of recurrence: how likely the event is to happen again.
- Risk level matrix: severity x likelihood to determine risk rating.
- Hazard category: fall, struck by, electrical, chemical, manual handling, etc.
- Immediate actions taken: what was done to control the hazard on the spot.
- Recommended controls: additional controls to prevent recurrence.
- Photos/sketches area: space for visual evidence or diagrams.
- Supervisor review and sign-off: supervisor acknowledgement with date.
How to use this near miss report form
- Complete reporter details. Your name, role, date and time of the near miss.
- Record the location or site area where the event occurred.
- Describe what happened and what could have happened if the situation had been slightly different.
- Assess the potential severity (first aid, medical, lost time, fatality) and the likelihood of recurrence to determine the risk level.
- Select the hazard category (fall, struck by, electrical, chemical, etc.).
- Record any immediate actions you took to control the hazard.
- List recommended controls to prevent recurrence.
- Attach photos or sketches if available. Sign and date the form and submit to your supervisor for review.
In MapTrack, you can digitise safety inspections and compliance forms. Each submission is stored as a timestamped PDF against the asset record.
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Back to download formHow often should you complete this report?
A near miss should be reported as soon as it occurs or is observed - ideally before the end of the shift. The sooner a near miss is reported, the sooner the hazard can be controlled and the more accurate the details will be. There is no "too minor" threshold - if an event had the potential to cause harm, it should be reported. Encourage all workers, contractors and visitors to report near misses without fear of blame. A strong near miss reporting culture is one of the best predictors of overall safety performance.
Frequently asked questions
- What is a near miss report?
- A near miss report is a record of an unplanned event that did not result in injury, illness or damage but had the potential to do so. It captures what happened, what could have happened, the hazard category, potential severity, likelihood of recurrence, risk level, immediate actions taken and recommended controls. Reporting near misses is a proactive way to identify hazards and prevent future incidents before someone is hurt.
- Why report near misses?
- Near misses are leading indicators of safety performance - they reveal hazards and weaknesses in controls before an actual injury or damage occurs. Research shows that for every serious injury there are hundreds of near misses. Reporting and acting on near misses reduces the likelihood of a more serious incident in the future. Many WHS codes of practice and principal contractor requirements mandate near miss reporting as part of an effective safety management system.
- What is the difference between a near miss and an incident?
- A near miss is an event where no injury, illness or damage occurred, but it had the potential to cause harm, for example a tool falling from height that misses a worker. An incident is an event where actual injury, illness, property damage or environmental harm has occurred. Both should be reported and investigated. The investigation process is similar, but an incident report also captures injury or damage details, medical treatment and return-to-work information.
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