Fill out a Claim Form

Fill out a Claim Form

ACSF Assessment tasks

Fill out a claim form

Target core skills

This task covers ASCF:
  • Reading and Writing at Level 2
  • Listening (Oral communication) Level 3.

Target audience

This task has been developed for the transport industry.

Content coverage

This task requires candidates to read or listen to a scenario, then interpret that information to complete a routine workplace form.

Instructions to assessor

This task requires the candidate to:
  • read or listen to a scenario about a daily delivery run
  • write information on a ‘Customer loss and damage claim form’, based on the information in the scenario.
This task is a listening and writing task, or a reading and writing task, depending on how it is delivered.
If it is being delivered as a listening task, the candidate will need to have the questions to refer to while listening. It is likely that you will need to read the text to the candidate at least twice.
Ensure the candidate understands the task before commencing.
For the learner to be rated at level 2 in Writing, you would expect to see notes about the storm and water damage to the manuals.

ACSF mapping

Question / ACSF skill level indicator / Domains of Communication
Not numbered / 2.03 2.04 or 2.08
2.05 2.06 / Workplace and employment and/or
Education and training

© Commonwealth of Australia, 2013

Fill out a claim form downloaded from

Fill out a claim form

Miro Peterson is a driver who sub-contracts to a company called Fast Parts.

Miro has a daily run delivering automotive spare parts to a number of service companies all over town. On run number 214, on Tuesday 15th of this month, he had a job to deliver a box of manuals to a company called Fix It Quick in Moonbridge. The manuals were worth about $265. Miro had just picked them up and was on his way to Moonbridge when a bad storm started. Very heavy rain fell. Miro pulled over to the side of the road and waited for about 15 minutes before the worst of the rain passed. When he arrived at his destination he discovered that the tarp on the back of the ute wasn’t tied down properly, so the box of manuals was sopping wet.

Miro went and saw Caitlin Hooper, who works in the office at Fix It Quick. He apologised, showed her the box and explained what had happened. He said that he would complete a ‘Customer loss and damage claim form’ so that the items could be replaced as soon as possible.

Fast Parts

Customer loss and damage claim form

Name of sub-contractor responsible:______
Run number: ______Date of damage or loss: ______
Details of how loss or damage occurred:
______
______
______
______
______
Cost to be claimed:
______
______
______
Note: Ensure supporting evidence is attached (such as invoice, part number, run sheet or quotation for repairs).
Witness name: ______Contact phone number : ______
Sub-contractor signature: ______Date: ______
OFFICE USE ONLY
Date claim received: ______
Supporting documentation attached  Yes  No
Comments:
______
______
Reviewed by management  Yes  No
Further investigation required  Yes  No
Report prepared by: ______Date: ______

Complete the following form, using the details from the previous page.

Name: ______Date: ______

© Commonwealth of Australia, 20131

Fill out a claim form downloaded from