Near miss report form
21 reviews
78K+
Installs

Use our readymade template to create this Google form. Customize it further using our form builder.

Get near miss reports using Google Forms

Consent form builder
  • navigate_next Use our prebuilt template to create your near miss report form
  • navigate_next Collect employee details such as Employee Name, Email, Department, and Job Title
  • navigate_next Specify incident details such as Type of Concern, Date and Time of the near miss
  • navigate_next Capture a description of the potential incident/hazard/concern including actions taken and witness details
  • navigate_next Get legally binding signatures from the employee and supervisor

Collect signatures from the employee and supervisor

Consent form builder
  • navigate_next Embed the form on your website or use the share link to collect responses
  • navigate_next Provide a user-friendly, secure and seamless signing experience
  • navigate_next Enable employees and supervisors to sign and submit the form from any device
  • navigate_next Send a confirmation email with the signed copy of the near miss report form
  • navigate_next 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
  • navigate_next Sync the signed near miss report form to your Google Drive for record keeping
  • navigate_next Easily track and manage your form responses using the Kanban board
  • navigate_next Automatically receive a copy of the signed near miss report form by email
  • navigate_next Sync form responses with signatures to Google Sheets for further analysis
  • navigate_next Notify your team by email when a near miss report is submitted

These reviews are reproduced without modification from Google Workspace Marketplace.

July 23, 2023

5 stars

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

October 31, 2023

5 stars

We needed a way to create forms with e-signatures and this app made it very easy. Support is also very quick and always helpful. Cannot recommend enough!

— Chris Henesy

July 12, 2023

5 stars

It very friendly to used. I love it. For my case multiple signature needed. it's supporting

— Senthil Kumar

February 16, 2024

1 stars

Does not work

— Myles Sicuro

November 27, 2023

5 stars

Yeah this is good for all

— luqman Khan

July 10, 2023

5 stars

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

More...
close