Use our readymade template to create this Google form. Customize it further using our form builder.
Get near miss reports using Google Forms
- Use our prebuilt template to create your near miss report form
- Collect employee details such as Employee Name, Email, Department, and Job Title
- Specify incident details such as Type of Concern, Date and Time of the near miss
- Capture a description of the potential incident/hazard/concern including actions taken and witness details
- Get legally binding signatures from the employee and supervisor
Collect signatures from the employee and supervisor
- Embed the form on your website or use the share link to collect responses
- Provide a user-friendly, secure and seamless signing experience
- Enable employees and supervisors to sign and submit the form from any device
- Send a confirmation email with the signed copy of the near miss report form
- Allow users to save progress & complete the near miss report later
Track signed responses in Google Sheets and Drive
| A | B | C | D | E | |
|---|---|---|---|---|---|
| 1 | Employee Name | Type of Concern | Incident Date & Time | Description of the potential incident/hazard/concern | Signed PDF |
| 2 | Ava Thomas | Unsafe Act | 2025-08-08 14:32 | Employee was seen not wearing safety goggles while operating machinery. Potential for eye injury. | Signed PDF |
| 3 | Liam Wilson | Unsafe Condition of Area | 2025-08-07 09:15 | Slippery floor near the entrance due to water spill. Potential for slip and fall accidents. | Signed PDF |
| 4 | Noah Patel | Unsafe Condition of Equipment | 2025-08-06 11:00 | Damaged electrical cord noticed on a power tool. Risk of electrical shock. | Signed PDF |
| 5 | Emma Johnson | Unsafe Use of Equipment | 2025-08-05 08:25 | Employee was seen using a ladder without securing it properly. Risk of falling. | Signed PDF |
| 6 | Oliver Lee | Safety Policy Violation | 2025-08-04 16:45 | Employee was seen not wearing a hard hat in a designated hard hat area. Risk of head injury. | Signed PDF |
| 7 | Sophia Kim | Unsafe Act | 2025-08-03 12:10 | Employee was seen lifting heavy boxes without using proper lifting techniques. Risk of back injury. | Signed PDF |
| 8 | Mason Rodriguez | Unsafe Condition of Area | 2025-08-02 13:50 | Observed cluttered walkway in the warehouse. Potential for trip and fall accidents. | Signed PDF |
| 9 | Isabella Garcia | Unsafe Condition of Equipment | 2025-08-01 10:00 | Noticed a forklift with a broken safety guard. Risk of injury. | Signed PDF |
| 10 | Elijah Brown | Unsafe Use of Equipment | 2025-07-31 15:30 | Employee was seen using a power tool without proper training. Risk of injury. | Signed PDF |
| 11 | Mia Anderson | Safety Policy Violation | 2025-07-30 17:20 | Employee was seen smoking in a non-smoking area. Risk of fire. | Signed PDF |
- Sync the signed near miss report form to your Google Drive for record keeping
- Easily track and manage your form responses using the Kanban board
- Automatically receive a copy of the signed near miss report form by email
- Sync form responses with signatures to Google Sheets for further analysis
- Notify your team by email when a near miss report is submitted
These reviews are reproduced without modification from Google Workspace Marketplace.
May 30, 2025
Besides the fact that one gets billed $216 monthly, Support took a long time to try and get things to work. Trying to get things signed on a form was such an issue and through out formatting. Way over priced, support that you have to wait till the next day to get one thing sorted and not sorted, back and forth the whole time. Frustrating customers and damage to business. I will not reccommend this company to anyone. Try JotForms so much better, and you can do much more for a fraction of the cost per year not per month.
— Francois Ohsiek
June 3, 2025
Hi Francois, sorry you had a frustrating experience with the formatting. Just to clarify, the plan you’re on is $216 per year, not per month. You signed up for the Formesign Esignature paid plan on May 8, 2024, and since you also needed to sign agreements, we provided access to our Formesign - Fillable PDF add-on at no extra cost. Regarding formatting: when working with Google Docs templates, we recommend using lists instead of indents and setting up layouts with tables for images, rather than inserting images directly. This helps maintain proper formatting. To assist, we also created and shared a sample template as a reference. You had asked us to make edits on your behalf, which we’re not able to do for security reasons. However, we did reach out and invited you to join a scheduled Zoom call to walk through the process — as we’ve done several times over the past year — but we didn’t receive a response. Update: To make things easier for all users, we have just launched the new document editor in Formesign that will allow agreements to be created directly, without relying on Google Docs.
— Formfacade
July 23, 2023
I am not tech savvy. I chose formesign to help create registration links for clients. Vipid has been great in assisting me. He goes above and beyond. My company now has moved from the stone age to modern age through the ability to use this feature. Of the many features I am impressed with, the ability to update a form without needing to regenerate a link is amazing. I often make mistakes and that ability allows me to fix mistakes without needing to change everything. Thank you!!!
— Sol Evans
July 12, 2023
It very friendly to used. I love it. For my case multiple signature needed. it's supporting
— Senthil Kumar
February 16, 2024
Does not work
— Myles Sicuro
November 27, 2023
Yeah this is good for all
— luqman Khan
July 10, 2023
We were looking for a way to have a signature option in our form. Formesign addon allowed us to collect signatures for the acknowledgment and consent forms. It was simple and easy to setup. Very useful addon for google forms.
— Joan S