Report events that could have caused injury or damage but did not, so the cause is fixed before next time.
Near misses are free lessons. Every serious injury tends to follow many near misses that were never reported.
People report when it is easy and nothing bad happens to them for it. Thank reporters and show the fixes.
12 items. Fill it in on screen or print a copy.
A stocker reports that a box nearly fell from a top shelf when a forklift turned. The supervisor finds overhanging loads in the aisle, re-stacks them and adds an overhang check to the daily walk.
Near misses share the causes of injuries without the harm, so a written report lets you remove the cause before someone gets hurt. Federal law bars retaliation against workers who report safety concerns, and a form with a follow-up line shows reports lead to action.
| Date and time | July 11, 2:40 pm |
|---|---|
| Location | Dock door 4 |
| What happened | Picker’s foot slid on wet dock plate while pushing pallet jack |
| What could have happened | Fall off the 4 ft dock edge with a loaded jack |
| Immediate action | Plate dried, cones placed, door closed |
| Cause | Torn door seal letting rain blow in |
| Fix | Replace seal; owner Dana, due July 18 |
Sample for Valley Home Supply’s distribution center in Fresno, California. The cause traces the water to a torn seal rather than stopping at a wet floor, so the fix stops the next slip instead of the last one.
An event that could have caused harm but did not.
Allow it; named reports help follow-up.
It should not; blame stops reporting.
Incident reports cover events with injury or damage.
No, the 300 log is only for work-related injuries and illnesses that meet the recording criteria. Near misses go on your own form, and nothing needs to be sent to OSHA.
On the same shift, while the scene and memories are fresh, even if the cause and fix sections are finished later. A report written days afterward often loses details like where a pallet jack was or how wet the floor was.
More for the same job
EZTime’s digital employee file keeps documents such as certificates and sends reminders before they expire.