Near Miss Incident Report

Form Template

Incident reports should be completed within 24 hours of the event and with this Near Miss Incident Report app it can be completed and submitted all from your mobile device.

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The near-miss report form includes incident details such as date and location, worker involved, employee supervisor, incident description, type of incident and more. The near miss accident report app also includes image capture for all accident incidents and events.

Key benefits of this app: 

• This investigation report and incident report template app is ideal for risk management and worker's compensation claims for any work-related injury requiring incident reporting

• Safety officers can use this app for incident investigations and developing corrective actions to minimize future risks and hazards

• Use this health and safety app not only for personal injury accident reporting but also for property damage and adverse event incident reporting

For a different incident form, take a look at our incident reporting app or our field incident report.

  • Signature Capture
  • Image Capture
  • Submission Editing
  • Reference Data
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  • iPhone
  • iPad
  • Android
  • Windows
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  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
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Don't take our word for it...

“I’m not a tech guy and I was able to pick this thing up in probably an hour, and actually start to build apps. I’ve done them over lunch when I’ve gotten frustrated with a process that didn’t exist in our company. So for non tech people who’ve got a problem, the support here is awesome and I’d recommend it to anybody, not just in our industry.”

Dave Kramer, PennLine Service

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