Near Miss Report – A M Water Services Forms

AMWS — Near Miss / Hazard / Close-Call Report

Quick report form for anyone to flag a near miss, hazard or close call seen on an AMWS job or at the Northampton HQ.

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AMWS — Near Miss / Hazard Report

Use this form to report a near miss, close call or hazard spotted on any AMWS site or at the Northampton HQ.

Reporting is encouraged from anyone — AMWS staff, subcontractors, site visitors or members of the public. You can submit anonymously if you prefer.

If something has injured someone or caused damage, use the Accident & Incident Investigation Report instead.

Document Reference	HS_FM_03 — Near Miss / Hazard / Close-Call Report
Issue Number	2
Issue Date	12 May 2026
Next Review	12 May 2027
Controlled By	Sean Ashton (HSQE Consultant, Onyx Operations)
Approved By	Aaron Mason, Managing Director
Status	Paper / legacy DOCX template (Issue 1) retired on digital go-live.

Date it happened(Required)

Use today if it happened just now.

Approximate time

Roughly is fine.

Exact location(Required)

Site/job name, road, depot area — be as specific as you can.

Severity (your best judgement)(Required)

What could have happened if conditions had been worse?

What happened?(Required)

In your own words — what did you see, what was unsafe, what nearly went wrong?

Action taken at the time (if any)

What was done immediately to make it safe? (Leave blank if nothing was done yet.)

Were any photos taken?

Yes

Upload photos

Drop files here or

Accepted file types: jpg, jpeg, png, pdf, heic, Max. file size: 5 MB, Max. files: 5.

JPG / PNG / PDF up to 5MB per file. Max 5 files.

Your details (optional)

You can leave this section blank if you’d prefer to report anonymously. Filling it in lets us follow up if we have any questions, and lets us close the loop with you on what happened next.

You are…

AMWS staff

Subcontractor working with AMWS

Member of the public / visitor

Prefer not to say

Your name

Company name

Phone number

Optional — only used if we need to clarify something.

Optional — we’ll send you a confirmation receipt and close-out update.

What happens next

Your report is logged with the HSQE Consultant and Operations Supervisor within minutes. If you’ve given an email address, you’ll get a copy of the report and a close-out note when action is complete. If this is an urgent safety risk, call Aaron Mason on 07XXX (placeholder) immediately.