Near Miss or Learning Event Report

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 or Learning Event Report

Part 1. To be completed and handed to site management

Company name

Location

Name

Date & Time

Classification

Details of the learning event (include all relevant information)

Part 2. To be completed by site management

Classification

Details of the learning event (include all relevant information)

Potential outcome

If Other, please state

Potential severity

Lessons learned (consider immediate and root causes) - Work environment

Lessons learned - Management

Lessons learned - Plant/equipment

Lessons learned - Human factors

Lessons learned - Personal protective equipment (PPE)

Lessons learned - Other

If Other, please state

Follow up Actions required

Responsible PIC

Completed

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Near Miss or Learning Event Report

Part 1. To be completed and handed to site management

Company name

Location

Name

Date & Time

Classification

Details of the learning event (include all relevant information)

Part 2. To be completed by site management

Classification

Details of the learning event (include all relevant information)

Potential outcome

If Other, please state

Potential severity

Lessons learned (consider immediate and root causes) - Work environment

Lessons learned - Management

Lessons learned - Plant/equipment

Lessons learned - Human factors

Lessons learned - Personal protective equipment (PPE)

Lessons learned - Other

If Other, please state

Follow up Actions required

Responsible PIC

Completed

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