Safety & Compliance

Near Miss Report

A near miss reporting form built to be quick: what happened, potential consequence, hazard category, photo and suggested fix. Two minutes on a phone, straight to the safety team. Free to start.

19 fields across 2 pages ~3 min to complete Works offline

Use this template with your own crew

Start a free trial, open it in the builder, and send it to a technician today. No card required.

Start free trial →

30 days free · no card · cancel yourself any time. No seat minimum.

Would rather ask a person first? Email us — a human answers.

What happens when it's submitted

Send to the safety teamNotifies the office
Flag unresolved hazardsFlags for review · Notifies the office
Flag high-potential near missesFlags for review · Notifies the office

Near Miss Report, on a phone and as a PDF

On the technician's phone. All 2 screens, in order — tap to step through them. Photos, signatures and repeat rows are captured on the device, and it all works with no signal.

The PDF your customer receives. Your logo and your layout, with repeat sections tabulated and photos laid out — emailed the moment it's submitted.

Both panels are drawn from this template's actual fields, so they change when the form does. Sample values shown; branding and layout are yours to change in the PDF designer.

What's on the form

All of this is customizable to your process. Delete the fields you don't need, add the ones you do — and every lookup is powered by your customer list and your own data.

The near miss

Two minutes now saves an investigation laterinstructions
Site / customercustomer lookup
Site addressaccount field
DateRequireddate
Timetime
Reported byemployee lookup
Report this anonymouslytoggle
Location stampGPS stamp
Where on siteRequiredtext
What happenedRequiredtextarea
What could have happenedRequiredtextarea

Hazard & fix

Hazard categoryRequireddropdown
Potential severityRequireddropdown
How likely is it to happen againRequireddropdown
Photo of the hazardphoto
Was it fixed on the spotRequireddropdown
What was donetextarea
What would stop this happeningRequiredtextarea
Supervisor told at the timeRequiredtoggle

Use this template with your own crew

Start a free trial, open it in the builder, and send it to a technician today. No card required.

Start free trial →

30 days free · no card · cancel yourself any time. No seat minimum.

Would rather ask a person first? Email us — a human answers.