Medication Reporting – A M Water Services Forms

Comments

This field is for validation purposes and should be left unchanged.

AMWS — Medication Reporting Form (HR_FM_03)

Confidential disclosure of prescribed / non-prescribed medication being taken that may affect work. Used to assess any safety-critical risks (e.g. driving, operating plant).

Document Reference	HR_FM_03 — Medication Reporting Form
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	Legacy DOCX retired on digital go-live.

Employee name(Required)

Occupation(Required)

Date(Required)

Medication(s) being taken

List each medication separately.

If yes — what activities should be restricted while taking this medication?

Sign-off

Signature(Required)

Email(Required)