CSA Hazard Report

Hazard Reporting Form
Name*
CSA ID*
Date*

DayMonthYear
DateHourMinutesAM/PM Option
Subcontractor*
CSA email address for feedback*
Contractor email address*
Customer Order number*
Address of Hazard*
If at dock or unsafe order/tote condition/overloaded tote, please enter "Dock"
State*
Name of store*
Is this a temporary or permanent hazard?*

TemporaryPermanent
Is this a B2B Delivery?*

YesNoN/A
Hazard type*

Injury HazardCustomer ConflictStore ConflictUnsafe Order/Tote condition/Overloaded ToteDock Area Housekeeping/Obstacle Blocking Dock/Fire exit not clearUnsafe Driving conditionsDelivery conditions/Inaccessibility/Poor visibilityUn-restrained PetWooliesGO app navigation issuesRoute HazardsIce Brick Related Hazard eg. Melted, Insufficient or Missing Ice BricksTote Return Hazards eg. Storage Location, Delays Returning or Safe UnloadingCCIP/Three compartment truck hazard
Injury Hazard

Hazard that can or has caused Injury (excluding pet related - please go to Pet Injury type)

Do not raise an injury via this form, raise as an incident.
What were the contributing conditions? (rain/obstacles/footwear/equipment).Any other comments to support desired outcome/resolution*
Did you talk to the customer or Woolies staff regarding the Hazard/potential plan B?*

YesNo
Photos of Hazard*

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Photos of the environment if applicable e.g. perspective of location in relation to truck. (surroundings)*

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Customer conflict

Conflict hazard that occured at either the store with the HD Customer
Delivery address*
Explanation of events/names if possible/date and time of occurrence*
Was there racial abuse?*

YesNo
Store conflict

Conflict hazard that occured at either the store with team members.
Store name*
Explanation of events/names if possible/date and time of occurrence*
Was there racial abuse?*

YesNo
Unsafe order/Tote condition/Overloaded Tote 15kg+

Unsafe order - risk of one product damaging another during transit due to packing of order
Tote condition - Tote falling apart / broken
Overloaded Tote - Weight exceeds 15kg
Did dock staff attempt to assist/rectify?*

YesNo
Photos of the tote/bag with as much detail of the product as possible.(packing of products inside tote/bags)*

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Provide a detailed description of the tote contents*
Photos of the tote label.*

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Dock area housekeeping/Obstacle blocking dock/Fire exit not clear
Did you notify the store team of the Hazard?*

YesNo
Was the Hazard resolved while you were on dock?*

YesNo
Photos of the environment if applicable e.g. perspective of location in relation to truck.*

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Hazard Description*
detail what makes theconditions unsafe and specify location/s of hazard/s. List your suggestedsolution/s
Unsafe Driving conditions

On road between Store/CFC and Delivery address.
Did you attempt to contact the customer or CHT to meet/support in finding alternate access route?*

YesNo
If a delivery or deliveries were not completed, were DA number/s obtained?*

YesNo
Photos of the environment: conditions, light, weather e.g. conditions in relation to truck*

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If a delivery or deliveries were not completed, were DA number/s obtained?*

YesNo
Hazard description
detail what makes the conditions unsafe and location/s asfound on a map
Delivery conditions/Inaccessibility/Poor visibility

Hazard at point of delivery (customers home/business)
Photos of the delivery point and access route from truck/road to that location*

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Photos of the delivery point and access route from truck/Photos of the environment. (showing the hazard e.g. tree, mud, narrow gate etc)*

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Image of alternate delivery point if recommended. (side door/gate, front gate, carpark next door, next street).*

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Image of traffic/parking signage (main road/yellow line/no parking, 5mins only etc.*

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Images of site instructions/hours of operations (signs) - Business/loading dock/loading zone etc.*

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DCI Hazard Description
detail what makes theconditions unsafe and specify location/s of hazard/s
Un-restrained Pet

Un-restrained pet causing difficult access / potential injury caused by an unrestrained pet at delivery address.

Do not use this form for injury or near miss incidents involving pets.
Photos of any injuries incurred and medical treatment.*

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Description of any injuries incurred and medical treatment. Description to include delivery instructions, time of delivery and delivery window times.*
Photos of the location/boundaries (if possible)

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Photos of the pet (if possible)

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Woolies GO APP Navigation issues Form

The Woolies GO APP navigation is a third party API (Here maps) restricted to follow routes suitable for our vehicle spec.

There have been some identified issues with the routing.
The "From" and "To" addresses as per WooliesGO App Routing*
A screenshot of the Woolies Go APP navigating through these roads. So WW can raise with their provider (where safe and practical to do so)*

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Alternate correct route detail ("From" and "To" addresses)*
Additional supporting comments supporting why the routing is incorrect and solution requested*
Additional evidence (if required)

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Route Hazards

Routing Time Allocated (Insufficient time at drop and/or insufficient time on route between Drop A and Drop B).

Note – Amount of time allocated is a guide only. Some drops/routes will be allocated more time than required, some will give less time than what is required.

The intent of this form is to advise Woolworths of Routing Time where the remaining run is affected and/or unachievable due to the reported factor/s.
Description of issue. Include customer address and order number for each affected route/drop. You must also state whether it is insufficient timing on route, at delivery point or both.*
What clear suggestions do you have to mitigate the issue/s? Include time allocated, vs recommended time for each issue notated above.*
Evidence (if applicable)

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Tote Return Hazards

Tote return hazards include:
- Improper placement of the totes leading to an unsafe workplace
- Delayed or extended waits to return totes
- No help provided by store to unload totes
- Unsafe are to unload totes
What tote return hazards are present?*

Unsafe storage locationDelays at store due to unloading totesUnsafe unloading at storeOther
Ice Brick Related Hazards

Ice Brick related hazards include:
- Melted Ice bricks
- Ice bricks not cold
- Insufficient ice bricks placed into totes
- Missing ice bricks
- Mouldy or excessively wet tote sleeves
- Leaking totes causing slippery surfaces in the truck or dock
What Ice Brick hazards are present?*

Melted/ambient temperature ice bricksInsufficient/missing ice bricksMouldy or excessively wet totes/tote sleeves/ice bricksLeaking totesOther
Comments
Photos of the tote/bag/ice bricks*

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Photos of the tote label of affected order/s*

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Photos of hazard (where applicable)

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Description*
What outcomes would you like pursued with Woolworths/Linfox/Customer to achieve satisfactory resolution?*
Please ensure that you wait until you receive the "Thank You" message before you close this page.
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Hazard Reporting Form