MSA004 - Road Journey Management Plan & Risk Assessment

• Prepared by

  Select

• Add name:

• Travelling to:

  Select

• Date of Journey:

  Date

• Journey Manager / Scheduled Contact:

  Select

• Have you discussed the journey with them?

  YES

  NO

Risk Assessment

• Is this the driver's first time journey on this route?

  YES

  NO

• Discuss with Road Journey Manager/Contact

• Is the anticipated driving time for the journey greater than eight hours?

  YES

  NO

• Discuss with Road Journey Manager/Contact. Ensure Breaks from driving every 3 hours.

• Will the journey require driving in darkness?

  YES

  NO

• Discuss with Road Journey Manager/Contact

Route

• Route description / Summary:

• Screenshot of route in Google Maps/QGis or Mudmap

  Media

• Is there a need for towing on the journey?

  YES

  NO

• Discuss with Road Journey Manager/Contact & refer to Towing Guideline + Towing checklist

• Estimated Arrival:

  Date

• Will this be a return journey?

  YES

  NO

• Estimated return date & time:

  Date

Contact

• It is the drivers responsibility to notify their scheduled contact before departure and maintain scheduled contact

  Agree

  Disagree

• Contact frequency: - Departing for Journey, 11h00 and arrival at destination as per standard Moho scheduled check-ins

Vehicle details

• Driver Name:

  Select

• Add name:

• Passenger(s)

  YES

  NO

• Add name:

• Vehicle Type

  Select Small Vehicle / Light Truck (Class C) Medium Vehicle Heavy Vehicle Other

  • Small Vehicle / Light Truck (Class C)
  • Medium Vehicle
  • Heavy Vehicle
  • Other

• Relevant licenses and/or competencies to operate this vehicle

  YES

  NO

• All necessary vehicle pre-starts will be completed prior to travel

  YES

  NO

Approvals

• Driver confirms an InReach device will be kept on for the entire trip and scheduled check-ins will be abided to:

  YES

  NO

• Drivers name & signature

  Sign