Construction Site Safety Near-Miss Report — Form Fields
This feedback template includes 9 fields. Document near-miss incidents on construction sites for safety improvement and record keeping. Free to customize and use on ZenBuild.
Reporter Name (text, required)
Site Name or Address (text, required)
Date and Time (text, required)
Incident Category (dropdown selection, required) — options: Fall Hazard, Struck By, Caught In/Between, Electrical, Chemical, Equipment, Other
Location on Site (text, required)
Describe What Happened (long text, required)
What Was the Potential Injury? (long text, required)
Corrective Action Taken Immediately (long text, optional)
Did Anyone Witness the Incident? (multiple choice, required) — options: Yes, No
