Incident & Near-Miss Report: write it down while it is fresh, in Word or on paper

Incident & Near-Miss Report

CA$19
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Incident & Near-Miss Report: write it down while it is fresh, in Word or on paper
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  • Incident & Near-Miss Report: write it down while it is fresh, in Word or on paper
  • What's included: the report form in Word, blank and worked example, the printable PDF and the Start Here guide
  • Record what happened, find the causes and assign the follow-up actions
  • Close-up of the report details: date and time, project, location on site, weather and light
  • Close-up of the kind of event: injury, near miss, damage, spill, unsafe condition or other
  • Close-up of the actions: each with an owner by role, a due date and a done date
  • How it works: download, open the report in Word and enter your company details, then the event
  • Example and blank versions of the report
  • Incident & Near-Miss Report: write it down while it is fresh, in Word or on paper
  • What's included: the report form in Word, blank and worked example, the printable PDF and the Start Here guide
  • Record what happened, find the causes and assign the follow-up actions
  • Close-up of the report details: date and time, project, location on site, weather and light
  • Close-up of the kind of event: injury, near miss, damage, spill, unsafe condition or other
  • Close-up of the actions: each with an owner by role, a due date and a done date
  • How it works: download, open the report in Word and enter your company details, then the event
  • Example and blank versions of the report
Incident & Near-Miss Report
Back-Office

Incident & Near-Miss Report

CA$19

Prices in Canadian dollars. Any tax that applies is shown at checkout.

An editable Word incident and near-miss report: what happened, who was involved, what led to it and the actions that stop it happening again. A filled-in example and a PDF to print are included.

Record incidents and near misses while the details are fresh. Page one covers the date, project, location, the kind of event, a plain account of what happened, the people involved by role and the immediate actions taken. Page two covers what led to it, why it happened, actions with who does them and when, witness accounts, reports and follow-up, and sign-off.

Add your company details and logo once and save it as your template. The worked example shows a near miss at a floor opening from start to finish. The report supports your safety program; it is not a statutory form, and the guide reminds you to check required reports where you work with a qualified adviser.

  • Report editable Word form, 2 pages, letter
  • Causes and actions what led to it, why, who fixes it and by when
  • Worked example a near miss filled in from start to finish
  • Print 2-page PDF to fill in by hand
  • Start Here 4-page PDF guide

Instant download after checkout, with the link also sent by email

30-day money-back guarantee, no questions asked

Secure checkout through Shopify

One business, unlimited use on its own projects

What's inside

Incident and near-miss report, Word (.docx), 2 pages. Page 1: date and time, project, location, weather, the kind of event, what happened, people involved by role, and immediate actions. Page 2: what led to it, why it happened, actions to stop it happening again, witness accounts, reports and follow-up, and sign-off.

Worked example, Word (.docx). The same report filled in for a near miss at a floor opening.

Blank report, 2-page PDF. For filling in by hand.

Start Here guide, 4-page PDF. What is included, filling in the report, editing in Word, a safety note and your licence.
Formats
  • Word (.docx): blank and example versions, not protected, so you can change any wording and add or remove rows. Made for Microsoft Word: desktop Word 2016 or later for Windows or Mac, and Word for the web.
  • PDF, letter size: the blank report (2 pages) and the Start Here guide (4 pages).
  • Fonts: the PDF guide uses Cormorant Garamond and Inter, built into the file. The report uses Georgia and Arial, which come with Windows and macOS.
  • Not included: statutory forms, legal advice, PowerPoint or Canva files, and page-preview images.
  • Delivery: one ZIP file (about 0.17 MB) holding all four files, on the order page right after checkout and by email.
Licence

One purchase covers one business, with unlimited use on that business's own projects. Your employees may use it for the business's work. Edit it freely and give your clients the finished documents. Reselling, sharing or uploading the template files, edited or not, is not permitted. Read the full licence.
Refunds

If the report isn't right for you, email support@thebuildersledger.com within 30 days of purchase with your order number for a full refund, no questions asked. After a refund the licence ends and the download link is turned off, so please delete your copies of the files. Refund policy.
FAQ

Is this the official form I must file?

No. It records what happened so it can be prevented, and supports your safety program. Where you work there may be required reports, deadlines and forms for injuries and serious incidents. Check them with a qualified adviser.

Why report near misses?

A near miss is an event where no one was hurt but could have been. Recording them is how the next injury is prevented.

Can I change the form?

Yes. The Word file is not protected, so you can change any wording, add your logo and add or remove rows.

Should I write names?

Use roles such as framing crew lead where the report is shared beyond those involved.
A note on safety

The report records what happened so it can be prevented, and supports your safety program. It is not a statutory form and does not replace any required report. Where you work there may be required reports, deadlines and forms for injuries and serious incidents, so check them with a qualified adviser. The worked example is a sample only. Not legal or safety advice.