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Near-Miss Incident Report Form

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Near misses are warnings that come before an occupational accident happens. The Regulation on OHS Risk Assessment lists near-miss incidents among the situations that require the risk assessment to be renewed. Keep this form somewhere easy to reach on site, and leave the “reported by” field optional to make reporting easier.

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Near-Miss Incident Report Form

Document no.
Issue / rev.
Page: 1 / 1

Date of incident

Time

Department / area

Reported by (optional)

Job title

What happened? (brief description of the incident)

What could the outcome have been if the incident had occurred?

Condition or behavior that caused the incident

Suggestion of the person reporting

Type of incident

Fall / slip
Machinery / equipment
Electrical
Chemical
Fire / explosion
Vehicle / forklift traffic
Falling / toppling material
Other

Measures to be taken (completed by the OHS specialist / unit supervisor)

Measure	Responsible	Deadline	Completed

Department supervisorFull name · Date · Signature

OHS specialistFull name · Date · Signature

Using the form correctly

Keep the form at an easy-to-reach point in the production area, and share an online copy as well.
Do not blame the person reporting: a near-miss culture grows where reporting carries no penalty.
Have the OHS specialist assess every report and, where necessary, add it to the risk assessment.
Check on site that the measure has been completed before closing the form, and follow up open reports monthly.

Frequently asked questions

What is a near miss?

A near miss is an event that did not cause injury or damage but had the potential to harm employees, the workplace or work equipment. Near misses are treated as warnings that come before an accident.

Is recording near misses mandatory?

Article 14 of Law No. 6331 requires the employer to examine events with the potential to cause harm and to prepare reports on them. The Risk Assessment Regulation also lists near misses among the events that require the risk assessment to be renewed.

Do near misses have to be reported to the SGK?

No. The duty to notify the Social Security Institution (SGK) applies to occupational accidents and diseases; an accident must be reported within 3 working days. Near misses are recorded and investigated within the workplace, and the resulting measures are followed up.

How can I encourage employees to report near misses?

Keep the form somewhere easy to reach, never blame the reporter and leave the “reported by” field optional. Sharing the outcome of each report with employees keeps the reports coming.

Near-Miss Incident Report Form

Using the form correctly

Frequently asked questions

Let’s get a clear picture of your workplace’s OHS status together.