Site forms

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.

Statutory basis, cited on the form

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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