ARTC Safeworking Observations

• Conducted on

  Date

• Prepared by

SITE INFORMATION

• Location
  Address

• KM from:

• KM to:

• Select date

  Date

• Type of work:

• Company:

• Observation by:

• Site Supervisor:

• Site Supervisor RIW number?

• Compliant?

  Yes

  No

• Protection Officer?

• RIW Number:

• Compliant?

  Yes

  No

• PO level?

  Select PO 1 PO 2 PO 3 PO 4 HS 1 HS 2

  • PO 1
  • PO 2
  • PO 3
  • PO 4
  • HS 1
  • HS 2

PO OFFICER WORKSITE PROTECTION PLAN

• Has Work Site Protection Plan been completed correctly as per Worksite Protection Plan RLS-FM-006 as detailed below. The following 7 items are mandatory safety critical items:

• Reference to capital city in top left hand corner

  Yes

  No

• An easily reached safe place?

  Yes

  No

• The identification name of the track / tracks

  Yes

  No

• Worksite location defined whether or not in danger zone by km, Crossover Numbers, Points Number, or Signal Number

  Yes

  No

• The name of locations or stations either side of the worksite

  Yes

  No

• All fields completed at top of worksite protection plan

  Yes

  No

• Emergency assembly point

  Yes

  No

Non-mandatory items

• Does the PO have access to Network Rules and Procedures and Network Information Books (NIBs)?

  Yes

  No

• Where applicable, have additional safety critical items been identified on the Worksite Protection Plan?

• Locations of adjacent worksites

  Yes

  No

  N/A

• Locations and identification of Handsignallers/Lookouts

  Yes

  No

  N/A

• Locations of worksite protection (e.g. flags, detonators, point clips, stop signs)

  Yes

  No

  N/A

• Identification and location of protecting signals

  Yes

  No

  N/A

• Identification of affected signals

  Yes

  No

  N/A

• Identification and location of trackside structures and equipment (e.g. active and passive level crossings, bridges, platforms, culverts, signal gantries)

  Yes

  No

  N/A

• Protection of adjacent line(s)

  Yes

  No

  N/A

• Any exclusion zones/demarcation fencing (e.g. around working plant, overhead power, etc)

  Yes

  No

  N/A

• Locations where there is no safe place

  Yes

  No

  N/A

• Can workers demonstrate knowledge of the Worksite Protection Plan? (e.g. worksite protection limits, Network Control Emergency Phone Number, etc.)

  Yes

  No

PRE START / PRE WORK BRIEF / PO BRIEF

• Has Safety critical information been Communicated and Documented as per Pre work Brief RLS-FM-005? (following 10 questions)

• Scope, date and location of works

  Yes

  No

• Weather conditions

  Yes

  No

• Name and signature of responsible person for conduction the briefing

  Yes

  No

• Location and time of briefing

  Yes

  No

• Whether the Qualified Safe Worker has provided a briefing or not

  Yes

  No

• First aider’s name and location of the First Aid kit

  Yes

  No

• Emergency assembly point

  Yes

  No

• What form the warning alarm will be

  Yes

  No

• Network Controllers emergency contact number

  Yes

  No

• Free from the effects of Drugs and Alcohol

  Yes

  No

• Has the Pre Work Brief been Communicated clearly to the worksite and understood?

  Yes

  No

• Has the PO Brief identified relevant Hazards and Controls?

  Yes

  No

• Has the PO Diary been completed with safety critical information?<br>(e.g. times, names, communications)<br>

  Yes

  No

• Type of Protection?

  Select LPA TWA TOA CSB LOW WIC

  • LPA
  • TWA
  • TOA
  • CSB
  • LOW
  • WIC

• Is Protection deemed appropriate for task being performed?

  Yes

  No

• Are Detonators stored correctly and in-date (5-years from manufacturers stamp)?

  Yes

  No

  N/A

• Has the Detonator Register been filled out?

  Yes

  No

  N/A

• If multiple work groups are present has Delineation been placed between Work Groups?

  Yes

  No

  N/A

• Have All relevant personnel signed the PO Brief?

  Yes

  No

• Number of personnel:

• Do the workers know who the First Aid Officer is?

  Yes

  No

• Any other comments:

• Signature:

  Sign