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contractorsafety.dellavita.com.au Open in urlscan Pro
13.210.79.157  Public Scan

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URL: https://contractorsafety.dellavita.com.au/
Submission: On November 01 via automatic, source certstream-suspicious — Scanned from AU

Form analysis 2 forms found in the DOM

POST 

<form id="safetyIncidentNotification" class="flex flex-col gap-4 w-full max-w-5xl mx-auto" method="post" data-page-title="Home - Della Vita" data-freeform="" data-id="b12d9e-form-nYQBOAMv9-XxQ5oamqE-xby9KXm71QEiqWFiOqkkBG3hRJFwlNJh5i10rjHw"
  data-handle="safetyIncidentNotification" data-ajax="" data-disable-submit="" enctype="multipart/form-data" data-auto-scroll="" data-success-message="Form has been submitted successfully!"
  data-error-message="Error, please check all required fields are valid." data-scripts-datepicker="" data-has-rules="" data-honeypot="" data-honeypot-name="freeform_form_handle_c07b52" data-honeypot-value="a4b463e0b">
  <div class="freeform_form_handle_c07b52" style="position: absolute !important; width: 0 !important; height: 0 !important; overflow: hidden !important;" aria-hidden="true" tabindex="-1"><label aria-hidden="true" tabindex="-1"
      for="freeform_form_handle_c07b52">Leave this field blank</label><input type="text" value="4cd059" name="freeform_form_handle_c07b52" id="freeform_form_handle_c07b52" aria-hidden="true" autocomplete="off" tabindex="-1"></div><input type="hidden"
    name="freeform_payload"
    value="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">
  <input type="hidden" name="formHash" value="nYQBOAMv9-XxQ5oamqE-xby9KXm71QEiqWFiOqkkBG3hRJFwlNJh5i10rjHw">
  <input type="hidden" name="action" value="freeform/submit">
  <input type="hidden" name="freeform-action" value="submit">
  <input type="hidden" name="CRAFT_CSRF_TOKEN" value="nB8nuttrBt3zkb-DhZNPOBL0vj49WChA5d5ANstbWmgqI67R4cKZSutLf4-ZG3623ujZzfSnYlZXuMoIchoRBq3mGWHyGAIPG2z0kI6N1z8=">
  <div class="w-full bg-black px-4 py-6 sm:px-6">
    <h2 class="text-white">
      <span class="text-white">Safety</span>
      <span class="text-white">Incident</span>
      <span class="text-yellow">Notification</span>
      <span class="text-yellow"> Form</span>
    </h2>
  </div>
  <div class="form-progress-container">
    <div class="flex flex-col gap-2">
      <span class="font-geo font-bold text-black px-4 sm:px-6"> Step 1 of 4 </span>
      <div class="bg-black w-full h-2 overflow-hidden">
        <div class="bg-yellow h-full" style="width: 25%"></div>
      </div>
    </div>
  </div>
  <div class="form-wrapper py-4">
    <div class="freeform-row px-4 sm:px-6">
      <div class="freeform-column  ff-fieldtype-html">
        <div class="pb-6">
          <h3 class="italic text-black mb-2">Personal Details</h3>
          <p>Details of the person involved in the incident.</p>
          <p class="font-semibold">Please ensure this form is submitted within 8 hours of incident occurring.</p>
        </div>
      </div>
    </div>
    <div class="freeform-row px-4 sm:px-6">
      <div class="freeform-column  ff-fieldtype-text">
        <label for="form-input-name" class="freeform-label freeform-required !font-semibold !text-lg !text-black">Name</label>
        <input class="freeform-input w-full rounded shadow-sm border-0 mt-2 min-h-[48px] focus:border-green-della focus:ring-0 bg-white transition-colors duration-300 ease-in-out " name="name" type="text" id="form-input-name" data-required="">
      </div>
      <div class="freeform-column  ff-fieldtype-email">
        <label for="form-input-email" class="freeform-label freeform-required !font-semibold !text-lg !text-black">Email</label>
        <input class="freeform-input w-full rounded shadow-sm border-0 mt-2 min-h-[48px] focus:border-green-della focus:ring-0 bg-white transition-colors duration-300 ease-in-out" name="email" type="email" id="form-input-email" data-required="">
      </div>
    </div>
    <div class="freeform-row px-4 sm:px-6">
      <div class="freeform-column  ff-fieldtype-text">
        <label for="form-input-address" class="freeform-label freeform-required !font-semibold !text-lg !text-black">Address</label>
        <input class="freeform-input w-full rounded shadow-sm border-0 mt-2 min-h-[48px] focus:border-green-della focus:ring-0 bg-white transition-colors duration-300 ease-in-out " name="address" type="text" id="form-input-address" data-required="">
      </div>
    </div>
    <div class="freeform-row px-4 sm:px-6">
      <div class="freeform-column  ff-fieldtype-text">
        <label for="form-input-suburb" class="freeform-label freeform-required !font-semibold !text-lg !text-black">Suburb</label>
        <input class="freeform-input w-full rounded shadow-sm border-0 mt-2 min-h-[48px] focus:border-green-della focus:ring-0 bg-white transition-colors duration-300 ease-in-out " name="suburb" type="text" id="form-input-suburb" data-required="">
      </div>
      <div class="freeform-column  ff-fieldtype-text">
        <label for="form-input-postCode" class="freeform-label freeform-required !font-semibold !text-lg !text-black">Post Code</label>
        <input class="freeform-input w-full rounded shadow-sm border-0 mt-2 min-h-[48px] focus:border-green-della focus:ring-0 bg-white transition-colors duration-300 ease-in-out " name="postCode" type="text" id="form-input-postCode"
          data-required="">
      </div>
    </div>
    <div class="freeform-row px-4 sm:px-6">
      <div class="freeform-column  ff-fieldtype-phone">
        <label for="form-input-contactNumber" class="freeform-label freeform-required !font-semibold !text-lg !text-black">Contact Number</label>
        <input data-validate="phone" class="freeform-input w-full rounded shadow-sm border-0 mt-2 min-h-[48px] focus:border-green-della focus:ring-0 bg-white transition-colors duration-300 ease-in-out " name="contactNumber" type="tel"
          id="form-input-contactNumber" data-required="">
      </div>
      <div class="freeform-column  ff-fieldtype-text">
        <label for="form-input-occupation" class="freeform-label freeform-required !font-semibold !text-lg !text-black">Occupation</label>
        <input class="freeform-input w-full rounded shadow-sm border-0 mt-2 min-h-[48px] focus:border-green-della focus:ring-0 bg-white transition-colors duration-300 ease-in-out " name="occupation" type="text" id="form-input-occupation"
          data-required="">
      </div>
    </div>
    <div class="freeform-row px-4 sm:px-6">
      <div class="freeform-column  ff-fieldtype-text">
        <label for="form-input-employer" class="freeform-label freeform-required !font-semibold !text-lg !text-black">Employer</label>
        <input class="freeform-input w-full rounded shadow-sm border-0 mt-2 min-h-[48px] focus:border-green-della focus:ring-0 bg-white transition-colors duration-300 ease-in-out " name="employer" type="text" id="form-input-employer"
          data-required="">
      </div>
      <div class="freeform-column  ff-fieldtype-number">
        <label for="form-input-age" class="freeform-label freeform-required !font-semibold !text-lg !text-black">Age</label>
        <input class="freeform-input w-full rounded shadow-sm border-0 mt-2 min-h-[48px] focus:border-green-della focus:ring-0 bg-white transition-colors duration-300 ease-in-out " name="age" type="number" id="form-input-age" step="0"
          data-required="">
      </div>
    </div>
    <div class="freeform-row px-4 sm:px-6">
      <div class="freeform-column  freeform-column-content-align-right ff-fieldtype-submit">
        <button
          class="ff-submit-button flex items-center justify-center bg-black text-white hover:bg-opacity-90 !text-sm transition-all flex gap-2 items-center justify-center duration-300 no-underline px-5 py-3 min-w-[9.25rem] h-[48px] w-auto text-center uppercase font-bold whitespace-nowrap active:translate-y-[2px] group pointer-events-auto"
          data-freeform-action="submit" type="submit" name="form_page_submit" data-original-text="Continue" data-loading-text="null">Continue</button>
      </div>
    </div>
  </div>
</form>

POST 

<form id="hazardAlertNotification" class="flex flex-col gap-4 w-full max-w-5xl mx-auto" method="post" data-page-title="Home - Della Vita" data-freeform="" data-id="0c5dad-form-4RXbq8MLo-Dlg7BxJ4G-J6ZPqZaVx3TNVSrv5vj0TCgGjO1jVSqIRfQG0HEw"
  data-handle="hazardAlertNotification" data-ajax="" data-disable-submit="" enctype="multipart/form-data" data-auto-scroll="" data-success-message="Form has been submitted successfully!"
  data-error-message="Error, please check all required fields are valid." data-scripts-datepicker="" data-honeypot="" data-honeypot-name="freeform_form_handle_48d471" data-honeypot-value="30c3a8a97">
  <div class="freeform_form_handle_48d471" style="position: absolute !important; width: 0 !important; height: 0 !important; overflow: hidden !important;" aria-hidden="true" tabindex="-1"><label aria-hidden="true" tabindex="-1"
      for="freeform_form_handle_48d471">Leave this field blank</label><input type="text" value="c0bec1" name="freeform_form_handle_48d471" id="freeform_form_handle_48d471" aria-hidden="true" autocomplete="off" tabindex="-1"></div><input type="hidden"
    name="freeform_payload"
    value="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">
  <input type="hidden" name="formHash" value="4RXbq8MLo-Dlg7BxJ4G-J6ZPqZaVx3TNVSrv5vj0TCgGjO1jVSqIRfQG0HEw">
  <input type="hidden" name="action" value="freeform/submit">
  <input type="hidden" name="freeform-action" value="submit">
  <input type="hidden" name="CRAFT_CSRF_TOKEN" value="nB8nuttrBt3zkb-DhZNPOBL0vj49WChA5d5ANstbWmgqI67R4cKZSutLf4-ZG3623ujZzfSnYlZXuMoIchoRBq3mGWHyGAIPG2z0kI6N1z8=">
  <div class="w-full bg-black px-4 py-6 sm:px-6">
    <h2 class="text-white">
      <span class="text-white">Hazard</span>
      <span class="text-white">Alert</span>
      <span class="text-yellow">Notification</span>
      <span class="text-yellow"> Form</span>
    </h2>
  </div>
  <div class="form-progress-container">
    <div class="flex flex-col gap-2">
      <span class="font-geo font-bold text-black px-4 sm:px-6"> Step 1 of 3 </span>
      <div class="bg-black w-full h-2 overflow-hidden">
        <div class="bg-yellow h-full" style="width: 33.333333333333%"></div>
      </div>
    </div>
  </div>
  <div class="form-wrapper py-4">
    <div class="freeform-row px-4 sm:px-6">
      <div class="freeform-column  ff-fieldtype-html">
        <div class="pb-6">
          <h3 class="italic text-black mb-2">Personal Details</h3>
          <p>Details of the person reporting the hazard.</p>
        </div>
      </div>
    </div>
    <div class="freeform-row px-4 sm:px-6">
      <div class="freeform-column  ff-fieldtype-text">
        <label for="form-input-fullname" class="freeform-label freeform-required !font-semibold !text-lg !text-black">Name</label>
        <input class="freeform-input w-full rounded shadow-sm border-0 mt-2 min-h-[48px] focus:border-green-della focus:ring-0 bg-white transition-colors duration-300 ease-in-out " name="fullname" type="text" id="form-input-fullname"
          data-required="">
      </div>
      <div class="freeform-column  ff-fieldtype-phone">
        <label for="form-input-contactNumber" class="freeform-label freeform-required !font-semibold !text-lg !text-black">Contact Number</label>
        <input data-validate="phone" class="freeform-input w-full rounded shadow-sm border-0 mt-2 min-h-[48px] focus:border-green-della focus:ring-0 bg-white transition-colors duration-300 ease-in-out " name="contactNumber" type="tel"
          id="form-input-contactNumber" data-required="">
      </div>
    </div>
    <div class="freeform-row px-4 sm:px-6">
      <div class="freeform-column  ff-fieldtype-email">
        <label for="form-input-email" class="freeform-label freeform-required !font-semibold !text-lg !text-black">Email</label>
        <input class="freeform-input w-full rounded shadow-sm border-0 mt-2 min-h-[48px] focus:border-green-della focus:ring-0 bg-white transition-colors duration-300 ease-in-out" name="email" type="email" id="form-input-email" data-required="">
      </div>
    </div>
    <div class="freeform-row px-4 sm:px-6">
      <div class="freeform-column  ff-fieldtype-text">
        <label for="form-input-occupation" class="freeform-label freeform-required !font-semibold !text-lg !text-black">Occupation</label>
        <input class="freeform-input w-full rounded shadow-sm border-0 mt-2 min-h-[48px] focus:border-green-della focus:ring-0 bg-white transition-colors duration-300 ease-in-out " name="occupation" type="text" id="form-input-occupation"
          data-required="">
      </div>
      <div class="freeform-column  ff-fieldtype-text">
        <label for="form-input-employer" class="freeform-label freeform-required !font-semibold !text-lg !text-black">Employer</label>
        <input class="freeform-input w-full rounded shadow-sm border-0 mt-2 min-h-[48px] focus:border-green-della focus:ring-0 bg-white transition-colors duration-300 ease-in-out " name="employer" type="text" id="form-input-employer"
          data-required="">
      </div>
    </div>
    <div class="freeform-row px-4 sm:px-6">
      <div class="freeform-column  freeform-column-content-align-right ff-fieldtype-submit">
        <button
          class="ff-submit-button flex items-center justify-center bg-black text-white hover:bg-opacity-90 !text-sm transition-all flex gap-2 items-center justify-center duration-300 no-underline px-5 py-3 min-w-[9.25rem] h-[48px] w-auto text-center uppercase font-bold whitespace-nowrap active:translate-y-[2px] group pointer-events-auto"
          data-freeform-action="submit" type="submit" name="form_page_submit" data-original-text="Continue" data-loading-text="null">Continue</button>
      </div>
    </div>
  </div>
</form>

Text Content

DELLA VITA SAFETY PORTAL


 * Online Inductions
   Login
 * Safety Management Plan
   Download
 * Safety Incident Notification
   Show
 * Hazard Alert Notification
   Show
 * Emergency Response Details
   Show

Leave this field blank


SAFETY INCIDENT NOTIFICATION FORM

Step 1 of 4



PERSONAL DETAILS

Details of the person involved in the incident.

Please ensure this form is submitted within 8 hours of incident occurring.

Name
Email
Address
Suburb
Post Code
Contact Number
Occupation
Employer
Age
Continue
Leave this field blank


HAZARD ALERT NOTIFICATION FORM

Step 1 of 3



PERSONAL DETAILS

Details of the person reporting the hazard.

Name
Contact Number
Email
Occupation
Employer
Continue


LOCAL EMERGENCY LOCATIONS

 * NORTH - JOONDALUP HEALTH CAMPUS
   
   Grand Boulevard and Shenton Avenue, Joondalup

 * SOUTH - PEEL HEALTH CAMPUS
   
   110 Lakes Road, Mandurah

 * EAST - ST JOHN OF GOD MIDLAND PUBLIC HOSPITAL
   
   1 Clayton Street, Midland


EMERGENCY RESPONSE DETAILS

FIRE - POLICE - AMBULANCE
000 or 112 (from a mobile)

Note: First response is Emergency Response, once emergency situation has been
reported the incident must be reported to the site supervisor as soon as
possible if this has not been done already. The following authorities / support
organisations may also need to be contacted.


AUTHORITIES AND AGENCIES

 * WorkSafe WA (Accident Notification)
   
   1800 678 198

 * Police (Non-emergency)
   
   131 444

 * DEC (Pollution Watch)
   
   1300 784 782

 * Poisons Information Centre
   
   131 126

 * Electrical Emergency
   
   131 351

 * Gas Emergency
   
   131 352

 * Water Emergency
   
   131 375