1. Templates
  2. Advertising
  3. Agency Operations
  4. Incident & Near-Miss Report Form

Incident & Near-Miss Report Form

An incident and near-miss report template — capture what happened, where, who was involved and any action taken, for your safety records.

Description

Near misses are free lessons — if you capture them. This incident and near-miss report template gives everyone a simple, no-blame way to log accidents, injuries, damage, data incidents and hazards, so you can fix the cause before someone gets hurt.

The reporter records what type of event it was, when and where it happened, and a clear description of what took place. It captures whether anyone was injured and the details, whether first aid or medical help was needed, the action taken at the time, what could prevent a recurrence, and the names of anyone involved or witnesses.

Suitable for offices, studios, shoots, events and any workplace with a duty of care. Use it to build a proper incident log, spot patterns, and show you take health and safety seriously. Customize the categories, add your branding, and embed it internally or share a link in minutes.

Form fields

Everything the Incident & Near-Miss Report Form above collects — 13 fields, so you can see exactly what it captures before you make it your own.

Incident & Near-Miss Report Form

  • What are you reporting?

    Dropdown Icon
    Dropdown

  • Date it happened

    Date Icon
    Date

  • Approximate time

    Time Icon
    Time

  • Where did it happen?

    Short Answer Icon
    Short Answer

  • Describe what happened

    Long Answer Icon
    Long Answer

  • Was anyone injured?

    Yes/No Icon
    Yes/No

  • If yes, who and what were the injuries?

    Long Answer Icon
    Long Answer

  • Was first aid or medical help needed?

    Yes/No Icon
    Yes/No

  • What action was taken at the time?

    Long Answer Icon
    Long Answer

  • What could prevent this happening again?

    Long Answer Icon
    Long Answer

  • Names of anyone involved or witnesses

    Short Answer Icon
    Short Answer

  • Reported by

    Name Icon
    Name

  • Email address

    Email Icon
    Email
Use Template Arrow Right Icon

Template FAQs

Common questions about the Incident & Near-Miss Report Form — what it captures, when to use it, and how to make it your own.

What is an incident and near-miss report form?

It’s a form for logging workplace incidents, accidents, injuries, damage and near-misses — events that could have caused harm but didn’t. Capturing near-misses matters as much as incidents, because they reveal a hazard before it causes real harm, giving you the chance to fix it first.

What should an incident report include?

The type of event, the date, time and location, a description of what happened, whether anyone was injured, what action was taken, what could prevent a recurrence, and the names of those involved or witnesses.

Why report near-misses if no one was hurt?

Because a near-miss reveals a hazard for free — the warning without the harm. Logging and acting on them is one of the most effective ways to prevent future accidents, and a record of near-misses also demonstrates a proactive safety culture if you’re ever asked.

Who should fill in an incident report?

Anyone who witnessed or was involved in the incident, ideally as soon as possible while the details are fresh and accurate. The form records who was involved and any witnesses; a manager or safety lead then reviews it and decides what action prevents a repeat.

Is this suitable for offices, shoots and events?

Yes — the report categories cover injuries, near-misses, property or equipment damage, data or security incidents and general hazards, so the same form works across office, studio, location and event settings. You can add or rename categories to fit the environments your team actually works in.

Is this incident report template free and editable?

Completely free. Adjust the incident types and fields to match your safety policy, restyle it, and embed it internally or share a link in minutes. No coding needed — just a free Fun Forms account to collect responses.

Make a free Fun Form Arrow Right Icon

Related templates

IT & Software Access Request Form

IT & Software Access Request Form

An IT and software access request template — request the software, systems, hardware or accounts a …

Job Application Form

Job Application Form

A job application template for agencies — collect a candidate’s details, CV, portfolio and …

Kit & Equipment Loan-Out Form

Kit & Equipment Loan-Out Form

A kit and equipment loan-out template — sign cameras, laptops and gear in and out for a shoot, with …

NDA / Confidentiality Agreement Form

NDA / Confidentiality Agreement Form

A non-disclosure agreement template for agencies — capture the parties, terms and a signature to get …

New Starter Onboarding Form

New Starter Onboarding Form

A new starter onboarding template for agencies — gather everything you need to set a new employee …

New Supplier & Vendor Setup Form

New Supplier & Vendor Setup Form

A new supplier and vendor setup template — capture a supplier’s company, contact, payment and tax …

Overtime & TOIL Request Form

Overtime & TOIL Request Form

An overtime and TOIL request template — log extra hours worked and request time off in lieu, with …

Performance Review & Appraisal Form

Performance Review & Appraisal Form

A performance review and appraisal template — structure a review of goals, achievements and …