KD-SITE-NR-026
Incident and Near-Miss Report
The incident and near-miss report: the event, the people and plant involved, the immediate cause, the immediate action, witnesses, and the hand-off to investigation.
1 page · 35 fillable fields · works in Adobe Reader, Preview, Chrome, or on a phone — or complete it online in your browser and download the finished document.
Page 1 of 1 — click to enlarge
Read all 1 page first — watermarked sample, no email Before you submit: the checklist
Statutory basis, cited on the form
- RIDDOR 2013
- MHSWR 1999 reg 3
What it is not
It is not a completed document and it is not health and safety advice. You must adapt it to your site and have a competent person complete and sign it off. See why we don't say "compliant".
Format
AcroForm fillable PDF. Every field has a tooltip. Tab order follows the reading order. Works on desktop and mobile, in Adobe and non-Adobe readers.
This revision was prepared against legislation current at 10 August 2026. Revision A0. Check kubitdocs.com/revisions for the current revision before use.
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