Safety Forms
Safety Concern Report Form
A single report form covering six related event types - safety concern, near miss, hazard, unsafe act, incident, and noteworthy event - so a worker reports what they saw the moment they see it, without stopping to decide which of several similar forms applies, delivered as a real fillable PDF.
- Fillable PDF — type into it on any device, or print it blank
- Single page, 8.5" x 11" (Letter)
- Add your company logo at checkout — no extra charge
- Written by Canadian safety professionals to provincial OHS standards
- Instant download after purchase
Written by certified COR auditors · Trusted by Canadian contractors for 17+ years · Secure Stripe checkout · Instant delivery + re-download any time from your purchases page
Pairs with online training
Certificates issue instantly through our online training portal.
ONE FORM FOR SAFETY CONCERNS, NEAR MISSES, HAZARDS, AND UNSAFE ACTS
What you get
- A fillable PDF - every checkbox, field, and signature line is a real form field, typed or handwritten
- A single 'Report of' checkbox row covering all six event types, plus an eight-category event-type breakdown for more detail
- Reporter and incident details: date, supervisor, job number, name, age, years of experience, date/time/position/location/client
- Weather and potential-risk fields for outdoor or field-based events
- A description section, employee and supervisor signatures, supervisor's comments, and a findings/causes and controls section (direct/indirect/root cause, interim and remedial action, remediation sign-off)
- Your company logo added to the form, at no extra charge
How to fill it out and keep it. Open it in Adobe Acrobat Reader (free) or a desktop browser like Chrome or Edge, then use that program's own Save or Download button, not just closing the tab, so your entries are kept in the saved copy. On a phone, most PDF apps will let you view the form but not type into it - fill it out on a computer, or print it and use a pen.
Specifications
- Size
- 8.5" x 11" (Letter)
- Format
- Fillable PDF - type into it on any device, or print it blank
- Company logo
- Included - upload at checkout, or we print your company name instead
- Delivery
- Instant download after purchase
Why crews use it
- One form for six related event types means a worker reports something the moment they notice it, instead of hesitating over which specific form applies
- The findings and controls section carries a report through to a documented root cause and a completed remedial action, not just a description of what happened
- Weather and risk-level fields matter for field and site work, where conditions are often part of why something became a concern in the first place
- A supervisor's signature and comments field on the same page as the report means follow-up doesn't depend on a separate email thread
Built for
- Workers and site supervisors reporting safety concerns, near misses, hazards, and unsafe acts as they happen
- Safety coordinators tracking findings through to root cause and closed-out corrective action
- Companies across all industries building a COR/SECOR-ready hazard and near-miss reporting system
Why it matters
Most safety concerns and near misses never get reported, not because nobody noticed, but because reporting felt like more trouble than it was worth. A single form that covers concerns, near misses, hazards, and unsafe acts in one place - and carries through to a documented cause and a completed fix - is what turns 'I meant to mention that' into a record that actually closes the loop.
Try it right here
Click a box. Type a line. See how it feels before you buy.
This is the real form layout - what you type here isn't saved or sent anywhere, it's just so you can see the fields work before you pay.
Common questions
Before you buy
What people ask us about the Safety Concern Report Form.
What is the Safety Concern Report Form used for?
Safety Concern Report Form for Canadian worksites. Professionally designed, print-ready format. Supports compliance with provincial OHS regulations. Delivered in both formats - an editable Word file to add your company name and customise for your worksite, plus a print-ready PDF. All required fields, signature lines, and dates included. Written by Canadian safety professionals. Instant download after purchase. It is written for Canadian workplaces and formatted so it can go straight into your safety program.
Is it editable, or print-ready only?
It is supplied in an editable format, so you can add your company name, adjust the wording to match how your crews actually work, and issue it under your own program.
Does using this form make us compliant?
No single form makes a company compliant. A form is the evidence half of a safety program - it records that something was checked and by whom. It carries weight at audit time when the written program behind it says the check is required and how often. If that program does not exist yet, that is the part we write.
What format is it, and when do I get it?
It is a digital download available immediately after checkout, and you can print as many copies as your own crews need.
From the team that wrote it
These forms come from a bigger program.
Inspection and competency forms are the evidence half of a safety program. If the program they belong to does not exist yet, or has not been updated in a few years, that is the part we write.