Free Workplace Near Miss Report

Mitigate potential hazards effectively with Template.net’s Workplace Near Miss Report Template. This report documents near misses, vital for preventing future incidents. A proactive tool for safety officers, it identifies risk areas. Utilize this report template to track and analyze near misses, proactively addressing hidden dangers and creating a safer workplace environment.

Incident Information
Date and Time:	[Month Day, Year] / [Time]
Location of the Incident:
Description of the Near Miss:

Employee Information
Employee(s) Involved:	[Name]
Job Title(s):
Department:
Supervisor’s Name:

Witness Information
Name of Witness(es):	[Name]
Contact Information:
Witness Statement(s):

Investigation and Recommendations
Initial Assessment:	The primary cause was identified as inadequate signaling of pedestrian pathways in the warehouse.
Recommendations:	Implement periodic checks to ensure pathways are clear and properly marked. Consider additional training for forklift operators on navigating busy areas.
Assigned Responsibility:	The warehouse supervisor is responsible for implementing these corrective actions.

Free Workplace Near Miss Report

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Immediate Actions Taken
The area was immediately cleared of the obstruction, and additional signage was put up to signal the pedestrian walkway more clearly. The forklift driver was reminded of the importance of maintaining clear lines of sight.