Incident form

Near-miss report for construction sites (England, Scotland, Wales)

This template helps construction sites in England, Scotland, and Wales report near-miss incidents, identify potential risks, and implement corrective actions to improve safety.

Fill it in online - free, no account needed. 25 questions.

What it is for

This template provides a structured way to record and manage near-miss incidents on construction sites.

The full question list

1. Incident Details

  1. Date and time of the near-miss incident *
  2. Location of the near-miss on site (e.g., 'Scaffolding area, Block C') *
  3. Brief description of what nearly happened *
  4. What was the potential outcome if the near-miss had resulted in an incident? *
  5. Immediate actions taken to secure the area or prevent recurrence *

2. People Involved

  1. Name(s) of person(s) directly involved or witnessing the near-miss
  2. Contact details for involved person(s) (e.g., phone number, company)
  3. Was anyone put at risk of injury or ill-health? *

3. Contributing Factors

  1. What equipment or machinery was involved? *
  2. Was the equipment involved in good working order and properly maintained? *
  3. What environmental factors contributed (e.g., weather, lighting)? *
  4. Were safe working procedures being followed? *
  5. Was appropriate Personal Protective Equipment (PPE) being used? *
  6. Any other contributing factors identified (e.g., lack of training, poor communication)

4. RIDDOR Assessment

  1. Could the near-miss have resulted in a 'dangerous occurrence' as defined by RIDDOR 2013 (England, Scotland, Wales)? *
  2. If 'Yes' to the above, specify which type of dangerous occurrence (e.g., collapse of scaffolding, contact with overhead power lines)
  3. Has the incident been reported to the enforcing authority (HSE or local authority) if it meets RIDDOR criteria? *

5. Follow-up Actions

  1. Recommended corrective actions to prevent recurrence *
  2. Person responsible for implementing corrective actions *
  3. Target completion date for corrective actions *
  4. Have all relevant personnel been informed of the near-miss and corrective actions? *
  5. Has this near-miss been reviewed as part of the site's overall risk assessment? *

6. Sign-off

  1. Name of person completing this report *
  2. Date and time of report completion *
  3. Signature of person completing this report *

References

How the score works

The score is the share of scored questions that pass. N/A is left out of the score; text, dates and signatures are recorded but not scored. A completed template is a record of what you checked; it is not an inspection by a regulator or an accreditation body.

Questions

What is a near-miss?

A near-miss is an unplanned event that did not result in injury, illness, or damage but had the potential to do so. Reporting them helps prevent future incidents.

Why is it important to report near-misses?

Reporting near-misses allows for the identification of hazards and weaknesses in safety procedures before they lead to actual harm, fulfilling an employer's duty under health and safety law.