Near-miss and hazard report form
One side of paper, because the form is the part that stops people reporting. What happened, what could have happened, and what was done about it.
Regulatory status A near miss is not an OSHA-recordable event. This is an internal reporting form, not an OSHA record, and it is not a substitute for OSHA Form 301.
Use this to capture a close call or an unsafe condition while the detail is still fresh. It is deliberately short: one page, ten fields, no approval block. Anything longer gets postponed until the end of the shift, and then until tomorrow.
Type into the form below, then print — what you enter prints with it. Or print it blank and fill it in by hand. Nothing you type is saved, sent to EHSTEC, or stored on this device; refresh the page and it is gone.
Near-miss / hazard report
Near-miss and hazard report form — ehstec.com/resources/near-miss-report-form · Published 23 September 2026. An internal report, not an OSHA record and not OSHA Form 301. Customize before use.
Choosing the type
One line each, enough to tick the right box: a near miss is an event that could have caused harm but did not; a hazard is a condition or practice with the potential to cause harm, whether or not anything has happened yet; an incident is an event that did cause harm or loss — and if that is what you have, this form is the wrong one. Where these overlap, and why the distinction changes what happens next, is set out in near miss vs hazard vs incident.
Why the reporter name is optional
The largest obstacle to near-miss reporting is not the form. It is the reasonable belief that filing one will go badly for the person who filed it. A form that requires a name collects fewer reports, and the ones it loses are disproportionately the ones about someone's own mistake — which are the most useful reports there are.
So the field is optional here. If your organization wants attribution, make that an explicit, stated policy people can see and argue with, rather than a default buried in a form. And if you do collect names, the thing that determines whether reporting survives is what visibly happens to the first person who reports their own error.
What this form does not do
- Near misses are not OSHA-recordable. Recording criteria under 29 CFR 1904.7 turn on an outcome — death, days away, restricted work or transfer, medical treatment beyond first aid, loss of consciousness, or a significant diagnosis. An event where nobody was hurt meets none of them. This form is not OSHA Form 301 and is not a substitute for it.
- It does not determine recordability. If someone was hurt, whether the case is recordable is a separate judgement on separate criteria, and this page does not make it.
- It does not replace an investigation. Where harm occurred, or where the potential outcome was severe, a form is the start of the work and not the end of it.
- A form does not create a reporting culture. What people do with the twentieth report decides whether there is a twenty-first.
Sources
This is a form, not legal advice
Nothing here is endorsed, approved or reviewed by OSHA, and filing a report does not make an employer compliant with any standard. Whether a specific case is recordable, and what your own reporting obligations are, depend on facts this page cannot see. See our editorial standards for how this content is written and reviewed.
Capturing near misses in EHSTEC
The same form ships in EHSTEC, submitted from a phone with a photo attached rather than carried back to an office. A report that needs follow-up becomes a corrective action with an owner and a due date, and the action keeps a link back to the report that raised it — so the twentieth report is something you can show people the outcome of. See how near-miss reporting works in EHSTEC.