INCIDENT & NEAR MISS REPORT —

About this tool: Use this form to record workplace incidents, near misses, hazards, and dangerous occurrences. Under OSHA (29 CFR 1904), employers must record and report work-related injuries and illnesses and consult with workers on corrective actions.

Select a report type below, complete the relevant fields, optionally upload site photos, then click "Generate Report". The AI will produce investigation findings and corrective action recommendations based on the details you provide. Each report costs 1 credit.

🚨 If someone has been seriously injured or a life-threatening emergency has occurred — call 911 first. OSHA requires fatalities to be reported within 8 hours and in-patient hospitalizations, amputations, or eye losses within 24 hours. Call OSHA at 1-800-321-OSHA (6742) or report at osha.gov. Do not disturb the incident scene without OSHA authorization.

Supervisor / Safety Manager:

Ph:

Email:

Company / Business Name:

Person Responsible — Report Review:

Date for Review:

Address / Site Location:

Date of Report:

Report Number:

📷 Evidence Photos — Optional

Upload photos of the incident scene, hazard, or damaged equipment. Photo upload is optional.

🖼️Upload Photo

📷Take Photo

Select Report Type

Select the type of incident or hazard you are reporting. Relevant fields will appear below.

✅ Selected: None selected

⚠️ Near Miss Report

Date of Near Miss:

Time:

Specific Location:

Person(s) Involved:

What Happened — Describe the Near Miss Event:

Immediate Cause:

Underlying / Root Cause:

Witnesses:

🩺 Work-Related Injury / Illness

🚨

Potential OSHA Reportable Incident

If this injury involves a work-related fatality — report to OSHA within 8 hours. If it involves an in-patient hospitalization, amputation, or loss of an eye — report within 24 hours. Call 1-800-321-OSHA (6742) or report online at osha.gov/reporting. Record on OSHA Form 300 (Log) and 301 (Incident Report) as required under 29 CFR 1904.

Injured Person's Name:

Role / Trade:

Date & Time of Incident:

Location on Site:

Nature of Injury / Illness:

Body Part Affected:

Treatment Provided:

Days Away From Work (estimated):

Witnesses:

How Did the Incident Occur?

🏚️ Property Damage Report

Date & Time of Damage:

Location on Site:

Item / Property Damaged:

Description of Damage:

Estimated Repair / Replacement Cost ($):

Witnesses:

Cause of Damage:

🌿 Environmental Incident Report

Date & Time of Incident:

Incident Type:

Substances / Materials Involved:

Estimated Volume / Quantity:

Area / Environment Affected:

Immediate Containment Actions Taken:

EPA / State Environmental Agency Notified?

Agency Reference / Notification No.:

🔒 Security Incident Report

Date & Time of Incident:

Incident Type:

Location:

Person(s) Involved:

Description of Incident:

Items Stolen / Damaged (if applicable):

Police Report / Event Number: Police / Law Enforcement Notified?

Witnesses:

🔍 Hazard Identification

Date & Time Hazard Identified:

Specific Location:

Hazard Identified By:

Hazard Type:

Describe the Hazard:

Risk Rating:

Low Medium High Extreme

Immediate Action Taken:

Persons at Risk:

🚨 OSHA Reportable Event — Mandatory Reporting

🚨

Mandatory OSHA Reporting — Stop Work if Unsafe

Under 29 CFR 1904.39, employers must report: Work-related fatalities within 8 hours and in-patient hospitalizations, amputations, or eye losses within 24 hours to OSHA. Call 1-800-321-OSHA (6742) or your nearest OSHA Area Office. Do not disturb the incident scene until authorized. See osha.gov/reporting for more information.

Date & Time of Occurrence:

Type of Reportable Event:

Description of the Event:

Persons Injured / Exposed:

Nature of Injuries / Fatalities:

Immediate Actions Taken:

OSHA Notified?

OSHA Notification / Reference No.:

📋 Investigation Findings & Recommendations

✅ Corrective Actions Register

Record the corrective actions to be taken as a result of this incident. Assign responsibility and set target completion dates.

#	Corrective Action Required	Person Responsible	Target Date	Status

Authorisation & Sign-Off

Role	Printed Name	Signature	Date
Investigating Supervisor
Site Superintendent / Manager
EHS Representative

Record Keeping: OSHA 300 Log, OSHA 300A Summary, and OSHA 301 Incident Report records must be retained for a minimum of 5 years following the end of the calendar year they cover (29 CFR 1904.33). If this was an OSHA reportable event, the employer must maintain documentation for 5 years from the date of reporting. Records are subject to inspection by OSHA compliance officers at any time.