Near miss report form
A near miss is free information: the incident happened, nobody paid for it. Use this form to capture what nearly went wrong, decide whether it was actually a notifiable dangerous incident, and record the fix. Sites that record near misses catch the pattern before it catches someone.
Near miss report form
Company: ____________
Site: ____________
Date: ____________
Event details
| Date, time and exact location: ____________ | N/A · Action | |
| Task being performed: ____________ | N/A · Action | |
| Who was involved or nearby: ____________ | N/A · Action |
What nearly happened
| Describe the event and what stopped it becoming an injury | N/A · Action | |
| Worst credible outcome if it had connected (first aid / hospital / fatality) | N/A · Action | |
| Hazards involved (plant, height, electricity, ground, load) | N/A · Action |
Check: was it actually notifiable?
| A dangerous incident is NOTIFIABLE even with no injury: a collapse, an uncontrolled release of energy, a fall of plant and similar near misses with the potential to seriously hurt someone | N/A · Action | |
| If yes: notify your WHS regulator immediately and preserve the site (use the incident report form) | N/A · Action |
Fix and follow-up
| Immediate action taken on the day: ____________ | N/A · Action | |
| Root cause (why was this possible): ____________ | N/A · Action | |
| Corrective action, owner, due date: ____________ | N/A · Action | |
| Raised at the next toolbox talk | N/A · Action | |
| SWMS reviewed if the work method or controls changed | N/A · Action |
Completed by: ____________________
Signature: ____________________
swmspack.com · Free printable checklist. Not legal advice; adapt to your site.
Common questions
▸Do near misses have to be reported to the regulator?
Only if the near miss was a dangerous incident: an event with the potential to seriously hurt someone, like a structural collapse, an uncontrolled release of energy, or a fall of plant. Those are notifiable under the WHS Act even though nobody was hurt.
▸Why record near misses at all?
Because the same conditions produce the injury next time. A recorded near miss is the cheapest corrective action you will ever get, and builders increasingly ask subbies how near misses are captured.
A near miss that changes your work method means the SWMS needs reviewing. Regenerate yours in minutes.
A checklist confirms controls are in place; a SWMS is the document the law requires before high risk construction work starts. Generate a site-specific one for your trade.