F.35.06.30 Safe Work Method Statement - Traffic Management V.2.5 Apr 2014

• Audit Title

Work Details

• Date of job:

  Date

• Work site name:

• What are the current weather conditions:

  Select Sunny Fog Cloudy Overcast Rain Hail Lightening Sleet Other

  • Sunny
  • Fog
  • Cloudy
  • Overcast
  • Rain
  • Hail
  • Lightening
  • Sleet
  • Other
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• Other, please specify:

• Name of GAME level 2 first Aider on site:

• The document is designed to be used to ANTICIPATE - IDENTIFY - ASSESS - EVALUATE & CONTROL hazards on the worksite.
  General risks have been identified for you but as each site has its own risks, this form has space to record site specific risks.
  This document must be completed in consultation with the employees working at the site BEFORE work begins. In the case of an 'Incident', follow the Incident Reporting Procedure O.35.12.

Personal Protective Equipment

• PPE Required for this job:

  Select Hi Vis Reflective Vest (Vic Roads Spec) Long work pants Safety boots Sun Hat Hard Hat Sunscreen Eye protection Ear Protection Other

  • Hi Vis Reflective Vest (Vic Roads Spec)
  • Long work pants
  • Safety boots
  • Sun Hat
  • Hard Hat
  • Sunscreen
  • Eye protection
  • Ear Protection
  • Other
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• Other, please specify:

Plant & Equipment

• Plant and Equipment required for this job:

  Select Utility Stop/Slow Bats 2 way (UHF) radio Whistle Hard Hat Traffic Cones Bollards Traffic signs & legs Sign weights Other

  • Utility
  • Stop/Slow Bats
  • 2 way (UHF) radio
  • Whistle
  • Hard Hat
  • Traffic Cones
  • Bollards
  • Traffic signs & legs
  • Sign weights
  • Other
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• Other please specify:

• The Safe Work Method Statement has been developed in consultation with the GAME Manager and OH&S Area Representatives. It has been developed in response to relevant requirements of the Safety Acts, including Road Management Act 2004 & Code of Practice Work Site Safety - Traffic Management.

Risk Rating Scale I.35.03.02

• When completing the following you must refer to the Risk Rating Scale I.35.03.02 information sheet.

SITE ARRIVAL

• 1. Does the job site involve parking a vehicle on the side of the road?

  Assessed as Safe to proceed

  Action taken to Address Hazard

  Not Applicable for this job
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Potential Hazard

• Muscular/Skeletal injury from impact with worker/vehicle

• Risk Rating Scale = 25 UNACCEPTABLE RISK - preventative action must be taken

Safety Control

• USE: flashing lights on vehicle, exit vehicle from the non traffic side, wear hi-vis vest

• Risk Rating Scale = MED 11

• Responsible for implementation: ALL STAFF

• 2. Did you conduct a Site Safety Induction?

  Assessed as Safe to proceed

  Action taken to Address Hazard

  Not Applicable for this job
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• Site Safety Inductions are a requirement and must be completed!

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Potential Hazard

• Injury from not being aware of the hazards on site, daily changes to possible hazards.

• Risk Rating Scale = 25 UNACCEPTABLE RISK - preventative action must be taken

Safety Control

• Conduct safety induction and ensure daily refresh occurs.

• Risk Rating Scale = 16 HIGH

• Responsible for implementation: SUPERVISOR

• 3. Is there over head obstructions?

  Assessed as Safe to proceed

  Action taken to Address Hazard

  Not Applicable for this job
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Potential Hazard

• Muscular/Skeletal injury from impact with worker

• Risk Rating Scale = 20 UNACCEPTABLE RISK - preventative action must be taken

Safety Control

• Inspect worksite at the beginning of every day and relocate away from the obstruction

• Risk Rating Scale =16 HIGH

• Responsible for implementation: ALL STAFF

• 4. Have you reviewed the Traffic Management Plan?

  Assessed as Safe to proceed

  Action taken to Address Hazard

  Not Applicable for this job
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Potential Hazard

• Injury from team not knowing the work plan to follow

• Risk Rating Scale = 25 UNACCEPTABLE RISK - preventative action must be taken

Safety Control

• Conduct a review with all staff on site

• Risk Rating Scale = 16 HIGH

• Responsible for implementation : SUPERVISOR

SITE SET UP

• 5. Are you posting and erecting road signs?

  Assessed as Safe to proceed

  Action taken to Address Hazard

  Not Applicable for this job
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Potential Hazard

• Muscular/Skeletal injury from back strain

• Risk Rating Scale = 22 UNACCEPTABLE RISK - you must take preventative action

Safety Control

• Use correct manual handling

• Risk Rating Scale = 4 LOW

• Responsible for implementation : ALL STAFF

Potential Hazard

• Muscular/Skeletal injury from impact with worker / vehicle

• Risk Rating Scale = 23 UNACCEPTABLE RISK - preventative action must be taken

Safety Control

• Follow Traffic Management Plan, hold correct qualifications, wear hi-vis vest

• Risk Rating Scale = 11 MED

• Responsible for implementation : ALL STAFF

• 6. Are you placing Traffic Cones in the work site?

  Assessed as Safe to proceed

  Action taken to Address Hazard

  Not Applicable for this job
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Potential Hazard

• Muscular/Skeletal injury from impact with worker / vehicle

• Risk Rating Scale = 22 UNACCEPTABLE RISK - preventative action must be taken

Safety Control

• Follow the Traffic Management Plan and wear a hi-vis vest

• Risk Rating Scale = 14 MED

• Responsible for implementation : ALL STAFF

Potential Hazard

• Fall/Trip/Slip on road surface

• Risk Rating Scale = 22 UNACCEPTABLE RISK - preventative action must be taken

Safety Control

• Wear safety boots and observe work area

• Risk Rating Scale = 14 MED

• Responsible for implementation : ALL STAFF

OPERATIONS

• 7. Are staff crossing the road?

  Assessed as Safe to proceed

  Action taken to Address Hazard

  Not Applicable for this job
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Potential Hazard

• Muscular/Skeletal injury from impact with worker / vehicle

• Risk Rating Scale = 23 UNACCEPTABLE RISK - preventative action must be taken

Safety Control

• Use flashing lights on the vehicle and spotter for employee crossing roadway, wear hi-vis vest

• Risk Rating Scale = 16 HIGH

• Responsible for implementation : ALL STAFF

Potential Hazard

• Fall/Trip/Slip on road surface

• Risk Rating Scale = 22 UNACCEPTABLE RISK - preventative action must be taken

Safety Control

• Wear safety boots & observe work area

• Risk Rating Scale = 14 MED

• Responsible for implementation : ALL STAFF

• 8. Have you established a correct traffic control position?

  Assessed as Safe to proceed

  Action taken to Address Hazard

  Not Applicable for this job
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Potential Hazard

• Muscular/Skeletal injury from impact with worker / vehicle

• Risk Rating Scale = 25 UNACCEPTABLE RISK - preventative action must be taken

Safety Control

• Hold relevant qualifications, stand on shoulder of road, stand in well lit position, wear hi-vis vest

• Risk Rating Scale = 20 HIGH

• Responsible for implementation : ALL TRAFFIC CONTROLLERS

Potential Hazard

• Fall/Trip/Slip on road surface

• Risk Rating Scale = 22 UNACCEPTABLE RISK - preventative action must be taken

Safety Control

• Wear safety boots & observe work area

• Risk Rating Scale = 14 MED

• Responsible for implementation : ALL STAFF

• 9. Slowing the traffic

  Assessed as Safe to proceed

  Action taken to Address Hazard

  Not Applicable for this job
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Potential Hazard

• Muscular/Skeletal injury to the worker / vehicle from impact with motorists

• Risk Rating Scale = 25 UNACCEPTABLE RISK - preventative action must be taken

Safety Control

• Follow the Traffic Management Plan & place signage in the correct position, clearly use slow bat, hold required qualifications, wear hi - vis vest

• Risk Rating Scale = 20 HIGH

• Responsible for implementation : ALL TRAFFIC CONTROLLERS

Potential Hazard

• Sunburn and or Fatigue

• Risk Rating Scale = 19 HIGH

Safety Control

• Wear sun hat and use sunscreen, take required breaks and ensure drinking water is available

• Risk Rating Scale = 3 LOW

• Responsible for implementation : ALL STAFF

• 10. Stopping traffic

  Assessed as Safe to proceed

  Action taken to Address Hazard

  Not Applicable for this job
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Potential Hazard

• Vehicle collisions

• Risk Rating Scale = 25 UNACCEPTABLE RISK - preventative action must be taken

Safety Control

• Clearly display the stop bat, hold required qualifications, wear hi - vis vest

• Risk Rating Scale = 20 HIGH

• Responsible for implementation : ALL TRAFFIC CONTROLLERS

Potential Hazard

• Muscular/Skeletal injury from impact with worker / vehicle

• Risk Rating Scale = 25 UNACCEPTABLE RISK - preventative action must be taken

Safety Control

• Hold required qualifications, wear hi - vis vest

• Risk Rating Scale = 20 HIGH

• Responsible for implementation : ALL TRAFFIC CONTROLLERS

Potential Hazard

• Sunburn and or Fatigue

• Risk Rating Scale = 19 HIGH

Safety Control

• Wear sun hat and use sunscreen, take required breaks and ensure drinking water is available

• Risk Rating Scale = 3 LOW

• Responsible for implementation : ALL STAFF

• 11. Weather Conditions

  Assessed as Safe to proceed

  Action taken to Address Hazard

  Not Applicable for this job
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Potential Hazard

• Change in weather conditions. E.G. Extreme heat, Lightning, Hail

• Risk Rating Scale = 24 UNACCEPTABLE RISK - preventative action must be taken

Safety Control

• Site Supervisor is to monitor and discuss with other site employees

• Risk Rating Scale = 12 MED

• Responsible for implementation : SITE SUPERVISOR

ELECTRICAL SPOTTING JOBS

• 12. Spotting and Plant Operation

  Assessed as Safe to proceed

  Action taken to Address Hazard

  Not Applicable for this job
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Potential Hazard

• Death due to contact with overhead wires

• Risk Rating Scale = 25 UNACCEPTABLE RISK - preventative action must be taken

Safety Control

• Hold required qualifications, always maintain 2 forms of contact with operator, remain alert, have whistle around neck, assess clearance,

• Do Not Leave Spotting Position Unless Told To Do So By Plant Operator!

• Risk Rating Scale = 20 HIGH

Potential Hazard

• Sunburn and or Fatigue

• Risk Rating Scale = 25 UNACCEPTABLE RISK - preventative action must be taken

Safety Control

• Wear sun hat and use sunscreen, take required breaks and ensure that drinking water is available.

• Risk Rating Scale = 8 MED

• Responsible for implementation : ALL SPOTTERS

Potential Hazard

• Muscular / Skeletal injury from strain

• Risk Rating Scale = 21 UNACCEPTABLE RISK - preventative action must be taken

Safety Control

• Staff must take regular breaks to ensure they do not suffer any body/muscle fatigue.

• Risk Rating Scale = 8 MED

• Responsible for implementation : ALL SPOTTERS

• As you assess the work site, if you identify any other hazards, please record them below.

• 13. Additional Hazards

Hazard

• What potential hazard did you identify?

• Risk Rating Scale =

• What safety controls are needed to reduce the risk?

• Risk Rating Scale after safety measures are applied =

• Who is responsible for implementation:

ENVIRONMENTAL MANAGEMENT PLAN

• 1. Vehicle Noise

  Assessed as Safe to proceed

  Action taken to Address Hazard

  Not Applicable for this job
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Potential Impact

• Disturbance to residents and Fauna

• Risk Rating Scale: 3 Low

Safety Control

• Worksites are predominately roads

• Position traffic stops in most appropriate position

• Risk Rating Scale: 1 Low

• Responsible for Implementation: All Staff

• 2. Vehicle Exhaust spark causes fire

  Assessed as Safe to proceed

  Action taken to Address Hazard

  Not Applicable for this job
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Potential Impact

• Property damage, air contamination

• Risk Rating Scale: 3 Low

Safety Control

• All company vehicles to be turned off when parked

• No vehicles are to be parked in tall grassed areas. SPECIAL PRECAUTION TO BE TAKEN IN THE FIRE DANGER PERIOD.

• Risk Rating Scale: 1 Low

• Responsible for Implementation: All Staff

• 3. Oil / Fuel Spills

  Assessed as Safe to proceed

  Action taken to Address Hazard

  Not Applicable for this job
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Potential Impact

• Water or Land contamination

• Risk Rating Scale: 3 Low

Safety Control

• All company vehicles are inspected before leaving the depot

• All vehicles are regularly serviced to minimise air pollution

• Risk Rating Scale: 1 Low

• Responsible for Implementation: All Staff

• 4. Export of Contaminates / Weeds offsite

  Assessed as Safe to proceed

  Action taken to Address Hazard

  Not Applicable for this job
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Potential Impact

• Water or Land contamination

• Risk Rating Scale: 1 Low

Safety Control

• Vehicles are inspected before leaving the worksite

• Vehicles are cleaned regularly

• Risk Rating Scale: 1 Low

• Responsible for Implementation: All Staff

• 5. Rubbish

  Assessed as Safe to proceed

  Action taken to Address Hazard

  Not Applicable for this job
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Potential Impact

• Water or Land Contamination

• Risk Rating Scale: 3 Low

Safety Control

• All waste produced from food breaks etc. is removed daily

• Risk Rating Scale: 1 Low

• Responsible for Implementation: All Staff

• As you assess the work site, if you identify any other environmental issues, please record them below.

• 6. Additional Environmental Issues

Issues

• What potential issue did you identify?

• Risk Rating Scale =

• What safety controls are needed to reduce the risk?

• Risk Rating Scale after safety measures are applied =

• Who is responsible for implementation:

*Staff On Site

• Listed personnel below have been made aware of and understand the procedure, hazards and control measures outlined in this SAFE WORK METHOD STATEMENT ABOVE. All staff will abide by the measures outlined with the Safe Work Method Statement to ensure the safety of all employees.

• ALL EMPLOYEE'S ON SITE MUST SIGN AND RECORD THEIR TRAINING DETAILS:

Employee

• Employee Name/Signature:

  Sign

• Training, Qualification, Permits, Licences, or Certificates held:

  Select VIC: VBQU506 or RIIOHS205a VIC: VBQU507 or RIIOHS302a CI White Card NSW: Blue Card NSW: Yellow Card NSW: Red Card Spotters Registration Certificate Other

  • VIC: VBQU506 or RIIOHS205a
  • VIC: VBQU507 or RIIOHS302a
  • CI White Card
  • NSW: Blue Card
  • NSW: Yellow Card
  • NSW: Red Card
  • Spotters Registration Certificate
  • Other
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• Other, please specify:

Amendments Required

• ANY CHANGES, ADDITIONS OR DELETIONS TO THE SAFE WORK METHOD STATEMENT ARE TO BE DISCUSSED WITH THE ABOVE PERSONNEL AND THE SITE SUPERVISOR. CHANGES SHOULD ONLY BE MADE BY AUTHORISED PERSONNEL.

• Are there any amendments required to the original SWMS completed?

  Yes

  No
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• Amendments discussed with all personnel on

  Date

Declaration

• Name/Signature of staff member that completed this record:

  Sign

• Are there any Special Comments required for this job?

  Yes

  No
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• Special Comments:

• Once the job has been completed, the form must be filed as per the I.20.04.01 How to complete I Auditor forms.