Farm Safety & Emergency Preparedness
Farm Near-Miss Reporting Form
A farm near-miss reporting form for workers to quickly record events that could have caused injury or damage so owners can fix the cause before someone is hurt.
Download free PDF1 page, US Letter, prints clean in black and white
FormFarm Safety & Emergency PreparednessFree PDF
What you fill in
- Date and time
- Location or machine
- What almost happened
- What stopped it
- People involved
- Possible cause
- Suggested fix
- Reported by
- Follow up notes
How to use this form
Fill in each labeled line, sign and date it, and keep a copy. Write clearly, since someone else may need to read it later.
Where to check the details
This sheet is a general template, so confirm specifics with your own manuals, labels and local rules. For current official guidance, start with OSHA and eXtension.
For more in this area, see the farm safety guides. Between chores, farm.FM has farm humor, including Google Search for “Farm Petting Zoo Near Me” Leads to Goat That Eats Every Complaint, and farming farm stories.