Free form template · Word

Near-Miss Incident Report

A near-miss incident report captures a close call, an event that could have caused injury or damage but did not. It is deliberately short so any worker, including contract staff, can fill it in minutes, and it helps the safety team fix hazards before they cause an accident.

Editable Word (.docx)
Made for India
10 fill-in fields highlighted
Free, no sign-up

Download Word (.docx) — free

Preview of the form

[Highlighted] = fill in

[Company Logo][Company Name]

NEAR-MISS REPORT

Report No.:: [Reference Number]
Date:: [DD/MM/YYYY]
Time:: [Time]
Location / Section:: [Work Location]

Reported By (optional)

Name
Employee ID / Contractor Name
Department
Prefer to stay anonymous (Yes / No)

What Did You See?

Unsafe condition (broken guard, spill, exposed wire, blocked exit)
Unsafe act (no PPE, shortcut, bypassing safety device)
Equipment / vehicle near-miss
Falling or flying object
Electrical / fire near-miss
Other: [Details]

Describe what happened or what you saw
What could have happened?
Was anyone at risk? How many people?

Potential Severity

Low – minor first aid at worst
Medium – injury needing medical treatment
High – serious injury, fire or major damage

Your Suggestion

What would prevent this from happening again?
Did you take any immediate action? What?

Safety Team Response

Action Taken	Owner	Date Closed	Feedback Given to Reporter
[Action]	[Owner Name]	[DD/MM/YYYY]	[Yes / No]
[Action]	[Owner Name]	[DD/MM/YYYY]	[Yes / No]
[Action]	[Owner Name]	[DD/MM/YYYY]	[Yes / No]

Thank you for reporting. Near-miss reports are used only to improve safety. No one will be penalised for reporting a near-miss honestly.

Reviewed by
[Safety Officer Name]
Safety Officer
Date: [Date]

Download Word (.docx) — free

What this template includes

One-page format to keep reporting quick
Option to report anonymously
Unsafe act versus unsafe condition classification
Potential severity rating, to prioritise fixes
Suggestion box for the reporter's own fix idea
Safety team response and feedback to the reporter

When to use it

A load slips from a crane or forklift but no one is under it
Someone nearly trips over a cable or slips on an oily floor
A worker notices a missing machine guard or a sparking switch
A vehicle nearly hits a pedestrian in the yard or parking area
A worker observes an unsafe act such as working at height without a harness

How to customise this template

1Print pads and keep them at each section and the canteen
2Add a QR code linking to an online version
3Translate into the language spoken on the shop floor
4Set a target response time of [Number] days for the safety team
5Display monthly near-miss counts and fixes on the notice board

HR tips

Thank every reporter; recognition drives more reports
Never use a near-miss report to discipline the reporter
Treat repeated near-misses at the same spot as an urgent fix
Review near-misses in the monthly safety committee meeting

Near-miss reporting is a good-practice tool; some dangerous occurrences must still be notified under the OSH Code, 2020 and state rules, so verify which events need statutory reporting.

For HR & hiring managers

Experienced and fresher candidates across India — blue, grey and white collar. Post a job in 5 minutes and start receiving applications.

Post a job free See plans

Post in 5 minutesDescribe the role in one line — we write the job description.
Verified applicantsEvery applicant has a verified mobile number.
Resume databaseSearch experienced candidates by skill, city and experience.

Frequently asked questions

What is a near-miss at the workplace?+

A near-miss is an unplanned event that did not cause injury, illness or damage but had the potential to do so. Reporting it helps prevent a future accident.

Should near-miss reports be anonymous?+

Allowing anonymous reports increases reporting, especially where workers fear blame. Keep a name option so the safety team can follow up when needed.

What is the difference between an unsafe act and an unsafe condition?+

An unsafe act is something a person does, like bypassing a guard; an unsafe condition is a state of the workplace, like a broken railing. Classifying them helps target fixes.

All 50 posh, workplace safety & compliance →

[Company Logo][Company Name]
INQUIRY REPORT OF THE INTERNAL COMMITTEE
Complaint Ref. No.:
[Reference Number]
Complainant:
[Complainant Name], [Designation]
Respondent:
[Respondent Name], [Designation]
Date of Complaint:
[DD/MM/YYYY]
Date of Report:
[Date]
Classification:
Strictly Confidential
1. Committee Members Who Conducted the Inquiry
Name Role Sittings Attended
[Member Name] Presiding Officer [Number]
[Member Name] Member [Number]
[Member Name] Member [Number]
[Member Name] External Member [Number]
2. Summary of the Complaint
The complainant alleged that [brief factual summary of each allegation, with dates and places]. The complainant sought [relief requested].
3. Reply of the Respondent
Report · Word
POSH Investigation Report
Download .docx

Name	Role	Sittings Attended
[Member Name]	Presiding Officer	[Number]
[Member Name]	Member	[Number]
[Member Name]	Member	[Number]
[Member Name]	External Member	[Number]

[Company Logo][Company Name]

ANNUAL REPORT OF THE INTERNAL COMMITTEE

Reporting Period:: [DD/MM/YYYY] to [DD/MM/YYYY]
Date of Report:: [Date]
Submitted To:: The Employer and the District Officer, [District Name]

1. Establishment Details

Name of Organisation	[Company Name]
Address	[Company Address]
Nature of business
Total employees (Men / Women / Others)
Locations covered by this report

2. Composition of the Internal Committee

Name	Role	Gender	Appointed On	Remarks (changes during year)
[Member Name]	Presiding Officer	Female	[DD/MM/YYYY]	[Remarks]
[Member Name]	Member	[Gender]	[DD/MM/YYYY]	[Remarks]
[Member Name]	Member	[Gender]	[DD/MM/YYYY]	[Remarks]
[Member Name]	External Member	[Gender]	[DD/MM/YYYY]	[Remarks]

3. Complaints Summary

Report · Word

POSH Annual Report Format

Download .docx

[Company Logo][Company Name]
WORKPLACE SAFETY INCIDENT REPORT
Incident No.:
[Reference Number]
Date of Report:
[Date]
Reported by:
[Employee Name], [Designation]
Part 1 – Incident Details
Date of incident [DD/MM/YYYY]
Time
Shift
Location / area / machine
Department
- Fire / smoke / explosion
- Electrical incident
- Chemical / gas / oil leak or spill
- Equipment, vehicle or machine failure
- Structural failure / falling object
- Injury to person (attach injury report)
- Property damage only
- Other: [Details]
Description: what happened, in sequence
Persons involved (name, ID, employee / contractor / visitor)
Witnesses (name, contact)
Part 2 – Immediate Action
Form · Word
Workplace Safety Incident Form
Download .docx
[Company Logo][Company Name]
ACCIDENT REPORT FORM
Report No.:
[Reference Number]
Establishment:
[Company Name], [Work Location]
Date of Report:
[Date]
A. Injured Person
Name
Employee ID / Contractor Name
Designation
Department
Age
Gender
UAN
ESI IP Number (if covered)
Contact Number
Emergency Contact informed (name, time)
B. Accident Details
Date of accident [DD/MM/YYYY]
Time
Shift and hours worked before accident
Exact place
Activity being performed
Machine / tool / vehicle involved
How the accident happened
PPE being worn at the time
C. Injury Details
Form · Word
Accident Report Form
Download .docx

Date of incident [DD/MM/YYYY]
Time
Shift
Location / area / machine
Department

Description: what happened, in sequence
Persons involved (name, ID, employee / contractor / visitor)
Witnesses (name, contact)

Date of accident [DD/MM/YYYY]
Time
Shift and hours worked before accident
Exact place
Activity being performed
Machine / tool / vehicle involved
How the accident happened
PPE being worn at the time

[Company Logo][Company Name]

EMPLOYEE INJURY REPORT

Report No.:: [Reference Number]
Date Submitted:: [Date]

1. Employee Details

Employee Name
Employee ID
Designation
Department
Reporting Manager
Work Location / Work from Home
ESI IP Number (if applicable)

2. Your Account of the Injury

Date and time of injury or when symptoms started
Where were you and what task were you doing?
Describe how it happened in your own words
Was it a sudden event or gradual (over days or weeks)?
Body part affected and symptoms
Did anyone see it happen? Names

3. Reporting

Report · Word

Employee Injury Report

Download .docx

[Company Logo][Company Name]
FIRST AID INCIDENT FORM
Form No.:
[Reference Number]
Date:
[DD/MM/YYYY]
Time:
[Time]
Location:
[Work Location]
Person Treated
Name
Employee ID / Visitor / Contractor
Department / Company
Age
Contact Number
Complaint or Injury
- Cut / abrasion
- Burn
- Sprain / strain
- Eye irritation / foreign body
- Fainting / dizziness
- Headache / fever
- Allergic reaction / insect bite
- Other: [Details]
Brief description of what happened
Work-related? (Yes / No)
Body part affected
Form · Word
First Aid Incident Form
Download .docx

Brief description of what happened
Work-related? (Yes / No)
Body part affected

[Company Logo][Company Name]

ANNUAL HR COMPLIANCE REPORT

Company:: [Company Name]
Period:: [DD/MM/YYYY] to [DD/MM/YYYY]
Prepared by:: [HR Name], [Designation]
Submitted to:: [Board of Directors / Management Committee]
Date:: [Date]

1. Executive Summary

During the period, [Company Name] operated [Number] establishments across [Number] states with [Number] employees and [Number] contract workers. Overall HR compliance status is [Green / Amber / Red]. Key highlights: [highlight 1], [highlight 2]. Key concerns: [concern 1], [concern 2].

2. Statutory Payments and Filings

Area	Status (RAG)	Delays / Exceptions	Remarks
PF contributions and returns	[G / A / R]	[Number] months delayed	[Remarks]
ESI contributions	[G / A / R]	[Details]	[Remarks]
Professional tax and LWF	[G / A / R]	[Details]	[Remarks]
TDS on salaries and returns	[G / A / R]	[Details]	[Remarks]
Bonus and gratuity payments	[G / A / R]	[Details]	[Remarks]
Registrations and licence renewals	[G / A / R]	[Details]	[Remarks]

3. POSH Summary

Report · Word

Annual HR Compliance Report

Download .docx

[Company Logo][Company Name]
POLICY ON PREVENTION OF SEXUAL HARASSMENT (POSH)
Policy No.:
[Reference Number]
Version:
[Version Number]
Effective Date:
[Date]
Policy Owner:
Human Resources / Internal Committee
1. Purpose
[Company Name] is committed to a workplace free of sexual harassment. This policy is framed under the Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act, 2013 and its Rules, to prevent sexual harassment and provide a fair redressal mechanism.
2. Scope
It applies to all employees, interns, trainees, consultants, contract staff and visitors at all locations of the company, including [Work Location]. 'Workplace' includes offices, sites, company transport, places visited during work, and work-related online spaces. As company policy, [the protections are extended to employees of all genders].
3. Definitions
Policy · Word
POSH Policy
Download .docx

Name
Employee ID / Visitor / Contractor
Department / Company
Age
Contact Number

Near-Miss Incident Report

Preview of the form

Reported By (optional)

What Did You See?

Potential Severity

Your Suggestion

Safety Team Response

What this template includes

When to use it

How to customise this template

HR tips

Hire top talent from BetterJobs

Frequently asked questions

Related HR templates