Tasman Power Rail Collision Or Impact CCC

• Site conducted

• Date & Time

  Date

• Task

• Work Area

• Prepared by

Fitness for Work and Fatigue Management

• Am I fit for work and able to stay focused on the task? E.g. physical/mental wellbeing, free from the effects of fatigue and/or medication.<br>

  Yes

  No

  N/A

Operator Competency

• Do I have the required authorisation and competency (including current qualifications) for this task?

  Yes

  No

  N/A

Access Control

• Do I have authorisation to occupy this section of the rail network?<br>

  Yes

  No

  N/A

• Have I confirmed my route and my limits of authority? E.g. Occupancy permit issued, flags in place, etc<br>

  Yes

  No

  N/A

• Do the boundaries on the occupancy permit reflect the correct boundaries of the main track work zone?

  Yes

  No

  N/A

Positive Communication System

• Do I understand the required positive communication protocols/procedures for this task?

  Yes

  No

  N/A

• Is my communication device working and appropriate for the task? E.g. adequate coverage and quantity of devices<br>

  Yes

  No

  N/A

• Have I completed a positive communication test before performing the task?<br>

  Yes

  No

  N/A

• Have I discussed and agreed to the shunt plan with all team members?<br>

  Yes

  No

  N/A

Positive Communication System

• Have I confirmed three step protection before approaching, boarding or moving between railway equipment?

  Yes

  No

  N/A

Isolation and Verification of Zero Energy

• Have I followed an approved isolation procedure?<br>

  Yes

  No

  N/A

• Have I placed my personal lock onto the correct isolation point?<br>

  Yes

  No

  N/A

• Have all energy sources been identified, isolated and checked for zero energy? E.g. process flows, mechanical, stored, residual, hydraulic, pneumatic, chemical, electrical.

  Yes

  No

  N/A

Securing Rolling Stock

• When working on or near rolling stock, have I confirmed it is stable and secured to prevent uncontrolled movement? E.g. brake resistance test completed, three step protection, wheel chocks, adequate number of brakes applied.<br>

  Yes

  No

  N/A

Signalling and Signage

• Have I confirmed signalling and signage are in place in the danger zone or when working within a rail corridor ?<br>

  Yes

  No

  N/A

• Is the signalling and signage in the area I am working visible and operational? E.g. audible alarm, flags, lights etc.

  Yes

  No

  N/A