Incident / Near-Miss Investigation Report

Note on Usage

This report follows OSHA's incident-investigation guidance and captures the data points on OSHA Form 301 (29 CFR 1904). Completing it does not by itself satisfy OSHA recordkeeping or reporting duties, nor does it guarantee a hazard has been eliminated. The employer remains responsible for recording injuries on the OSHA 300/301 forms where required, reporting fatalities and severe injuries to OSHA within the required time limits, and correcting the underlying hazards.