Near-Miss Report

The short form for things that nearly happened — gold for a no-blame learning culture.

A near-miss is something that nearly went wrong but didn't. Near-misses are gold — they reveal system weaknesses without anyone being hurt. This form makes them easy to log so they actually get logged.

Sister to the Incident Report (KS-02) but designed for the much higher frequency of near-misses. Keep the bar low — overreporting is fine. File these alongside incident reports but keep them categorised separately so trends are visible.

What's included

• Editable 3-page near-miss form (Word .docx)
• Factual capture sections
• What prevented the incident analysis
• Likely-consequence rating
• Action to prevent recurrence
• Link to Continuous Improvement Register

FAQs

Q. How does this differ from an Incident Report?
A. Near-misses didn't actually cause harm. They reveal where systems nearly failed. Reporting them is voluntary culture, not mandatory.

Q. Format?
A. Editable Word (.docx).

Q. Affiliated with NDIS Commission?
A. No. Independent.

Q. Refund policy?
A. Non-refundable once accessed.

Format: Single .docx (3 pages)

Template by Northform Health. Not legal, regulatory or clinical advice. Not affiliated with the NDIS Quality and Safeguards Commission. Single-user licence. Digital downloads are non-refundable once accessed.