Workplace Traffic Hazard Management Form - duplicate

• Document No.

• Workplace Traffic Management Form

• Store Location

  Blacktown

  Crossroads

  Auburn

• Conducted on

  Date

• Personnel

• The following checklist should be used to evaluate workplace traffic hazards in order to assess the potential for injury to occur.
  If any of the questions in the checklist result in a NO answer then:
  1. A Risk Assessment must be conducted
  2. Controls must be devised

1A. Hazard Management Details - General

• Name of Person conducting activity:

• Date Conducted

  Date

• Work area/ task

1B. Hazard Identification - Analysis of Workplace Records

• Records of injuries shall be examined to identify where, and in what jobs, workplace traffic related injuries and incidents have occurred or could occur.
  The following factors require consideration. (Tick as appropriate)

• Any established 'rights of way'

• Any exclusion zones

• The maintenance history of the vehicle involved

• Any vision black spots

• The training and licencing of the vehicle operator

• Any traffic management signage

• Any personal protective equipment worn by vehicle operators

2. Workplace Traffic Hazard Identification (Please tick)

2B. Work Processes

• Are there work processes?

• Developed in consultation with operators and employees?

  Yes

  No

  N/A

• Clearly communicated?

  Yes

  No

  N/A

• Reviewed for workplace hazards?

  Yes

  No

  N/A

• Reviewed after implementation?

  Yes

  No

  N/A

• Incorporated into an overall training program?

  Yes

  No

  N/A

• Are systems in place fro?

• Reporting of equipment damage?

  Yes

  No

  N/A

• Reporting of incidents?

  Yes

  No

  N/A

• Reporting of Stock Damage?

  Yes

  No

  N/A

• Maintenance?

  Yes

  No

  N/A

• Re-fuelling/Recharging?

  Yes

  No

  N/A

• Managing the safety of bystanders?

  Yes

  No

  N/A

• Training operators?<br>

  Yes

  No

  N/A

• Assessment of individual loads?

  Yes

  No

  N/A

• Enforcing of speed limits in the warehouse?

  Yes

  No

  N/A

• Assessing vehicle stablity?

  Yes

  No

  N/A

2C. Operator

• Does the operator?

• Understand the recharging procedure?

  Yes

  No

  N/A

• Have a licence to operate the equipment?

  Yes

  No

  N/A

• Understand the workplace rules and requirements?

  Yes

  No

  N/A

• Understand the workplace layout?

  Yes

  No

  N/A

• Follow the Traffic Management Plan correctly?

  Yes

  No

  N/A

• Control the vehicle appropriately during its operation?

  Yes

  No

  N/A

• Use safety devices appropriately (Seat belts/horn)

  Yes

  No

  N/A

• Have knowledge of the operator manual?

  Yes

  No

  N/A

• Operate at an appropriate speed?

  Yes

  No

  N/A

• Understand the requirement to report:<br>* Equipment damage<br>* Forklift incidents<br>* Stock damage

  Yes

  No

  N/A

2A. Work Environment

• Public Car Park?

  Yes

  No

  N/A

• Efficient workplace layout/plan?

  Yes

  No

  N/A

• Floor and Surfaces in good condition?

  Yes

  No

  N/A

• Travel and pedestrian paths identified and clearly marked?

  Yes

  No

  N/A

• Pedestrian and vehicle exclusion zones?

  Yes

  No

  N/A

• Designated loading and unloading zones?

  Yes

  No

  N/A

• Clearly identified 'right of way' area?

  Yes

  No

  N/A

• Designated maintenance areas?

  Yes

  No

  N/A

• Identified black spots?

  Yes

  No

  N/A

• Clear and adequate signage?

  Yes

  No

  N/A

• Adequate ventilation for the operation of vehicles with internal combustion engines?

  Yes

  No

  N/A

• Barricades protecting plan and pedestrian walkways?

  Yes

  No

  N/A

3. Forklift management

• Is the Forklift Pre-Operational Checklist currently in use? (Should be recorded on Safety Cloud)

  Yes

  No

  N/A

• Are the Picker and Turret Pre-Operational checklists currently in use. (Should be recorded on Safety Cloud)

  Yes

  No

  N/A

Risk Assessment Information

• If there is a requirement to conduct a Risk Assessment as a result of this evaluation, enter the details here.

  Safe

  At Risk

  N/A

• Items requiring attention

• Risk Rating (As per risk matrix assessment)

  Very High

  High

  Medium

  Low

• If controlled immediately list details here:

• If longer term controls required list here:

• Date to be implemented:

  Date

• WHS Officer verifies controls are effective

  Sign

• Date signed

  Date

• Manager verifies controls are effective

  Sign

• Date signed

  Date