Near-miss report form template (PDF & Excel) with analysis register
One-page reporting form for near misses – what happened, what could have happened, cause, immediate action and suggestion, name optional – plus an Excel register that makes reports analysable by area, type of event and priority.
As of PDF and ExcelAMS Go editorial team
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In Germany, near misses (Beinaheunfälle) do not have to be reported to the Berufsgenossenschaft or Unfallkasse – but within the company they are the earliest warning signs of hazards. Employees must in any case report any immediate significant danger they identify and any defect in protective systems without delay (Section 16 of the Occupational Safety and Health Act, ArbSchG; Section 16 DGUV Regulation 1). A simple form lowers the barrier to writing down the “nothing actually happened” moments too.
The template has two parts: a one-page reporting form that takes a few minutes to fill in – the name is optional – with a processing section for assessment, action and feedback. It is accompanied by an Excel register into which you transfer all reports so you can analyse them by area, type of event and priority and keep track of open actions.
What the template contains
- One-page PDF reporting form: what happened, where and when, what could have happened, suspected cause, immediate action and suggestion for improvement
- Tick boxes for the type of event and optional name
- Processing section with assessment, action, deadline and feedback to the reporting person
- Excel register with drop-down lists for area, type of event, type of cause, severity, likelihood of recurrence and status, plus automatic priority and an overdue flag
- Two analysis sheets that count reports by type of event and by area
How to use the template
- 1
Make the form available
Put reporting forms in easily accessible places, for example in break rooms, on the notice board or with the safety representatives (Sicherheitsbeauftragte). Explain in the next safety briefing what they are for and who handles them.
- 2
Process every report
Secure the area if a hazard still exists. Then assess severity and likelihood of recurrence, clarify the cause and decide on an action with an owner and deadline. Give the reporting person feedback – even if no action is needed.
- 3
Analyse in the register
Transfer every report to the Excel register without names. The analysis sheets show where near misses cluster – discuss the results in the safety committee (Arbeitsschutzausschuss) and update the risk assessment (Gefährdungsbeurteilung).
Legal basis
- Section 16(1) of the Occupational Safety and Health Act (ArbSchG): employees report identified immediate significant dangers and defects in protective systems without delay
- Section 16 DGUV Regulation 1: reporting dangers and defects, eliminating or reporting identified deficiencies
- Sections 3 and 5 ArbSchG: risk assessment, effectiveness checks and adjustment of measures
- DGUV Information 206-045: error culture – dealing properly with near misses
- ISO 45001 clause 10.2: process for reporting, investigating and acting on incidents, which include near misses
Frequently asked questions
Does a near miss have to be reported to the Berufsgenossenschaft?
No. The accident report (Unfallanzeige) under Section 193 SGB VII is only mandatory if an insured person is killed or unable to work for more than three days. Near misses are reported and analysed within the company – which is exactly what this template is for.
Should anonymous near-miss reports be allowed?
Anonymous reporting lowers the barrier but makes follow-up questions and feedback harder. That is why the name is optional on this form. What matters is that reports are discussed without names and nobody has to fear sanctions – as DGUV Information 206-045 also recommends.
How is the priority calculated in the Excel register?
From potential severity and likelihood of recurrence: high severity, or medium severity with frequent recurrence, gives priority A (act immediately); medium severity or frequent recurrence gives priority B; everything else C. The classification is a suggestion – adapt the formula to your own assessment scheme.
You may use and adapt the template freely in your own company and for your own clients. It reflects the regulations named as they stand.
Never search a spreadsheet for a deadline again
In AMS Go, what this template covers lives in one system with reminders, history and records at the push of a button – mobile and with AI support.
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