Near Miss Report Form

Use this near miss report form to tell RAM Multi Invest about a workplace event or unsafe situation that could have caused harm. A clear account helps the team understand what happened, identify the conditions involved and consider ways to prevent a similar event.

What to include in your near miss report

Start with the facts you observed. Describe the activity taking place, the people or equipment involved and the sequence of events. Explain what could have happened, even if nobody was injured and no damage occurred. Use plain language and distinguish what you saw from what you think may have caused the situation.

• Location: give the project, site, work area or equipment reference so the team can identify the place.
• Date and time: record when the event happened. If you are unsure, state that the time is approximate.
• Immediate action: explain what was done at the location and whether the relevant site contact was informed.
• Suggested measures: describe any practical changes you believe could help. You do not need to determine the final solution before reporting.

Completing the form

Enter your name and contact details in the fields below. This gives the team a way to ask for clarification if needed. Then describe the situation, location, timing, action taken and proposed measures in the corresponding fields. Include enough detail for someone who was not present to understand the circumstances.

Before submitting, check that your description is accurate and that the contact information is correct. Focus on relevant work facts and avoid unrelated personal information. Complete the verification step and use the submit button to send the form.

A useful near miss report records the event while the details are still clear. Read the reporting policy linked below for more information about RAM’s approach to identifying hazards and learning from workplace observations.