Template

Near-Miss Report & Learning Card Template

Interactive near-miss capture form plus a one-page learning card template to record hazards, capture immediate actions, assign ownership, and share concise learning across the site.

Interactive Tool

Near-Miss Report & Learning Card

This simple, non-punitive near-miss report captures hazards quickly, records immediate actions, and generates a one-page learning card for site sharing. Keep entries factual; if you're unsure, report it — learning prevents incidents. Use the Learning Card on daily boards and keep reports in a searchable log for trend analysis.

How to use

  • Record the near miss as soon as practical.
  • Note any immediate actions that reduced risk.
  • Assign a safety owner and due date for corrective actions.
  • Fill the Learning Card Summary for quick site sharing.
  • Use the searchable log for trends, metrics, and follow-up.
Name helps follow-up but reporting is non-punitive; you may leave blank.
Date of the near miss (YYYY-MM-DD recommended)
Building, line, cell, or work area
What happened? Be factual and concise.
What did you or others do right away to reduce risk?
1 = very unlikely, 5 = very likely
1.0 10.0
Name or role who will own corrective actions.
Use 5 Whys or brief analysis. If unknown, write 'TBD'.
What will be done to prevent recurrence? Include who and by when.
YYYY-MM-DD
Short summary suitable for posting at daily boards: what happened, cause, fix, how to spot it.
Name, role, or team and contact method.
If photos exist, paste a file path or link. Attachment upload may be supported in future.
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