Safe Work Method Statement
XYZ Surveyors Pty Ltd
Traffic Hazards in Road Reserve Surveys
Version 1 Page 1 of 2
Do not commence work if you think it is unsafe, use your common sense and err on the side of caution. Spend a few
minutes each day prior to starting work to ensure all controls are in place.
Warning: If the risk is assessed as high, Traffic Management is to be carried out by a company
specialising in Traffic Management services.
REF NO.
DATE
SITE LOCATION
MANAGER /SUPERVISOR:
1. Select type of road1:
Collector or
Rural C

Local Road
Secondary or
Rural A or B

Arterial or
Rural M


Freeway

2. Select the posted speed limit of the road:
Up to 60 km/h 
70 km/h 
80 km/h 
90 km/h 
100 km/h 
110 km/h 
3. Select the separation between personnel and traffic2:
Less than
1.2 metres
1.2 metres to
3 metres

3 metres to
9 metres

More than
9 metres


4. Select the duration of the survey job3 :
No more than
5 minutes

More than 5 minutes and
not more than a day

More than a day

5. Select weather conditions:
dry 
wet 
low visibility 
windy 
other:
6. Record other hazards present4 :
7. By considering the above answers, assess the risk level5 by using the risk matrix below and
record risk levels in the table on page 2:
RISK MATRIX
LIKELIHOOD
CONSEQUENCE
RARE
COMMON
MINOR
LOW
LOW
MEDIUM
SIGNIFICANT
LOW
MEDIUM
HIGH
MEDIUM
HIGH
HIGH
LIFE THREATENING
1
OCCASIONAL
Melways and VicRoads Country Directory will indicate the type of road by a colour scheme set out in the legend of
these directories.
2
Separation refers to the minimum distance at any point in time any personnel may be from moving traffic during the
work covered by this SWMS.
3
The Code of Practice requires more controls the longer the job is.
4
Such as hilly terrain, service stations, schools, narrow shoulder, pedestrians etc.
5
Please assess the risk level for each task of the job. Example of tasks include: work at the intersection of X and Y
streets, taking measurement on the road at point X, crossing roads, using tripod along north side of X street etc. For
long term works please refer to Risk Rating Table 5 of Code. If the risk level according to that table is high or very
high, the Code has specific requirements.
Safe Work Method Statement
XYZ Surveyors Pty Ltd
Traffic Hazards in Road Reserve Surveys
Version 1 Page 2 of 2
Record of Risk levels
Task
Risk
Task
Risk
Use the principles and diagrams identified in the Surveyor’s Field Guide To Safe Work Practices
Within Road Reserves to assist in determining your control measures for short term works.
Traffic Management Plan