Traffic Management Risk Assessment Form
Use this form to assess traffic-related hazards, control measures, and required mitigations for a site or planned activity.
Site and Activity Details
Project/Site Name
*
Site/Location Address or Description
*
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessor Name
*
Team/Department or Contractor Name
Activity / Work Type Requiring Traffic Management
*
Please Select
Roadworks
Lane closure
Utility works
Construction works
Surveying
Deliveries/collections
Event setup
Plant/machine operation
Maintenance/repairs
Other
Date and Time of Planned Works
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Traffic Conditions and Exposure
Road Type or Environment
*
Public Road
Site Access Road
Car Park
Loading Area
Pedestrian Area
Mixed-Use Area
Other
Expected Traffic Volume or Intensity
*
Please Select
Low
Moderate
High
Very High
Pedestrian Presence Level
*
None
Low
Moderate
High
Vehicle Types Involved
*
Cars
Light Commercial Vehicles
Heavy Goods Vehicles
Forklifts
Buses
Motorcycles
Bicycles
Pedestrians
Other
Visibility Conditions
*
Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Poor, 10 is Excellent
Time of Day of Activity
Hour Minutes
AM
PM
AM/PM Option
Hazard Identification
Identify Applicable Traffic Hazards
*
Vehicle-pedestrian conflict
Reversing vehicles
Limited visibility
Speed of traffic
Poor signage
Narrow access
Congestion
Site entry/exit conflicts
Weather impact
Night work
Temporary lane/route changes
Other
Hazard Details Table
Other Traffic Hazards
Existing Controls and Risk Rating
Existing Traffic Control Measures
*
Cones
Barriers
Signage
Banksman / Traffic Marshal
Speed Limits
Segregated Walkways
Flagging
Lighting
Pedestrian Diversion
Access Restrictions
Other
Control Effectiveness Rating
*
Very Ineffective
1
2
3
4
Very Effective
5
1 is Very Ineffective, 5 is Very Effective
Likelihood Rating
*
1
2
3
4
5
Severity / Consequence Rating
*
1
2
3
4
5
Initial Risk Level
*
Please Select
Low
Medium
High
Very High
Additional Mitigation Measures
Proposed Additional Controls
*
Additional signage
Cones/barriers
Traffic controller/marshal
Temporary speed reduction
Lane closure/traffic diversion
Pedestrian segregation
Lighting/enhanced visibility
Communication briefing
Other
Responsible Person
*
Target Completion Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Residual Risk Rating After Controls
*
1
2
3
4
5
Attachment Included
Traffic management plan attached
Site sketch attached
Review, Approval, and Declaration
Overall Assessment Decision
*
Acceptable
Acceptable with actions
Not acceptable
Reviewer/Approver Name
*
Review Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Acknowledgment of Assessment Outcome
*
I acknowledge the assessment outcome
I do not acknowledge the assessment outcome
Submit Assessment
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