Incident and Near-Miss Report Forms

Know what to do when something goes wrong at work, write a clear factual report the same day, and find the real cause so it does not happen again, with five editable forms and filled-in examples.

Who it is for

• Business owners who have never had to handle an incident and want to be ready.

• Managers, shift leads and supervisors who are the first person called when someone is hurt.

• Office managers and operations staff who keep records and deal with insurers.

• HR and training staff who want one simple, consistent reporting process across the business.

The problem it solves

When someone is hurt or something almost goes wrong, the first hour is busy and stressful. Facts are forgotten, reports are written days later, and reviews end with "be more careful," so the same thing happens again to someone else. This kit gives you a clear order of what to do first, forms that capture the right facts, a simple way to find the real cause without blame, and a log that shows repeat problems.

Please note: these forms and this guide cover general workplace basics. They are not a complete safety program, and using them does not show that your business meets any legal or insurance requirement. Check the safety and reporting rules that apply to your location and industry. This is not legal advice. If someone is seriously hurt, call your local emergency number first.

What is inside

• How to use this kit (page 1; 1 page)

• Copyright and License (page 2; 1 page)

• Guide: reporting and reviewing incidents (pages 3 to 6; 4 pages)

• Form 1: Incident report (pages 7 to 8; 2 pages)

• Form 2: Near-miss report (page 9; 1 page)

• Form 3: Witness statement (page 10; 1 page)

• Form 4: Incident review and action plan (page 11; 1 page)

• Form 5: Incident and near-miss log (page 12; 1 page)

• Examples: incident report, near miss and review (pages 13 to 16; 4 pages)

• Editable Word version of everything above (17 pages)

• Editable forms-only Word file (8 pages: the five forms, without the guide)

How to use it

1. Read the guide once, before you need it.

2. Print copies of each form, or save the Word forms where staff can find them.

3. When something happens, deal with people and safety first, then complete the incident or near-miss report the same day and collect witness statements separately.

4. Within a week, review it with the incident review form, choose the strongest fix, record it in the log and tell staff what is changing.

Formats and file types

• Printable PDF (16 pages), US Letter.

• Editable Word file (.docx, 17 pages) with the full guide, all five forms and the examples.

• Editable forms-only Word file (.docx, 8 pages) with just the five forms.

Frequently asked questions