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Near Miss Incident

Author: Novade Solutions

A Near Miss Incident Report documents an event that was avoided before causing harm, including descriptions, potential risks, and preventive actions.

Published on: 1/24/2025

Near Miss Incident

Report

Incident Date

Accident/Incident Category

Accident/Incident Title

Description

Exact Location

Work Activity

Name:

Company:

Occupation

Birthdate

Citizenship

Man Days Lost

Light Duty Mandays

Nature of Injury

Body Part

Work Factor

Human Factor

Weakness

Detailed Description

Root Cause Description

Corrective Action

Preventative Action

Root Cause Type

Photo(s), if any:

Reporter Name:

Reporter Designation:

Reporter Signature:

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Near Miss Incident

Report

Incident Date

Accident/Incident Category

Accident/Incident Title

Description

Exact Location

Work Activity

Name:

Company:

Occupation

Birthdate

Citizenship

Man Days Lost

Light Duty Mandays

Nature of Injury

Body Part

Work Factor

Human Factor

Weakness

Detailed Description

Root Cause Description

Corrective Action

Preventative Action

Root Cause Type

Photo(s), if any:

Reporter Name:

Reporter Designation:

Reporter Signature:

Effortlessly log and track near-miss incidents with Novade Lite. Improve workplace safety by documenting potential risks, identifying hazards, and preventing future accidents in seconds