Risk Assessment
Form – Level Crossing
PART A – Assessment Summary
Risk Assessment Number:
Assessment Date & Time:
Assessment Location:
Initial Assessment
Revised Assessment
Department:
RISK ASSESSMENT TEAM
NAME
POSITION
SIGNED
RLX Number (Crossing number):
Crossing type (e.g. Passive – Give Way):
Line section (Railway reference)
INSERT PHOTO / DIAGRAM
DEPARTMENT / WORKS MANAGER (sign-off once completed):
Name:
Signed:
Date:
REW REPRESENTATIVE (sign-off once completed):
Name:
Signed:
Date:
Railway Interface Risk Assessment Form
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Review date: : February 2016
DATE
Risk Assessment Process

Prior to completing the on-site assessment, ensure you are appropriately attired – PPE

Identify all interface hazards that concern the Road Corridor and risk assess them using the matrices included in this tool.

Whilst on site, observe traffic and motorist behaviour, where possible. For example, drivers consistently/regularly failing to check both ways prior to crossing where only
passive controls (e.g. Give Way signs) are in place will increase the likelihood of an incident occuring.

All identified risks should be recorded on a Rail Interface Risk Register.

Please also identify and record where another party (other than Rail or Road operator) may be implicated, and who will notify them.
Example layout of the Danger Zone and Safe Places in a rail corridor
Railway Interface Risk Assessment Form
Document Number: XXX
Version: 1 Dated: Aug 2014
PART B – Hazard Identification
No.
Potential hazards to check
1.
1.1
Risk rating
(refer Matrix)
Proposed actions / treatment
Responsible
party
Road Pavement – in road corridor
Surface conditions
1.2
Risks identified

Worn/smooth?

Corrugations?

Potholes, loose
materials, vegetation?
e.g. braking issues for vehicles due to
smooth surface
Pedestrian trip hazards
Additional comments
2.
Yellow Box Marking
2.1
3 metres before level crossing?
2.2
5 metres after level crossing?
2.3
Visible/good condition?
(scrubbing, faded?)
e.g. train-vehicle collision caused by
short stacking on northerly
approach.
Additional comments
Railway Interface Risk Assessment Form
Document Number: XXX
Version: 1 Dated: Aug 2014
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No.
Potential hazards to check
3.
Risks identified
Risk rating
(refer Matrix)
Proposed actions / treatment
Responsible
party
Pavement marking – in road corridor
3.1
‘Rail X’ (scrubbing?)
3.2
‘Stop’ line
3.3
‘Give Way’ line
3.4
Barrier (condition)
Additional comments
4.
Traffic control
4.1
Advance warning signage –
visible on approach by motorists
(e.g. line of sight issues with
vegetation or design/placement)
4.2
Active advanced warning signs visible on approach by motorists
(e.g. line of sight issues with
vegetation or design/placement)
Additional comments
Railway Interface Risk Assessment Form
Document Number: XXX
Version: 1 Dated: Aug 2014
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No.
Hazards identified
5.
5.1
5.2
Risks identified
Risk rating
(refer Matrix)
Proposed actions / treatment
Responsible
party
Line of sight
From road (both approaches):

Left?

Right?
At road corridor interface
(assess in situ at driver height for
standard sedan vehicle)

At passive?

At active?
e.g. vehicle-train collision caused by
vegetation obscuring view to
left/east on northerly approach
e.g. vehicle-train collision caused by
poor visibility when looking to the
east in static position at level
crossing whilst travelling/facing
south.
Additional comments
Railway Interface Risk Assessment Form
Document Number: XXX
Version: 1 Dated: Aug 2014
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Risk Rating
LIKELIHOOD
Label
A
Descriptor
Almost Certain
B
Likely
C
Possible
D
Unlikely
E
Rare
Description
This event will occur at least on an annual basis
The event has occurred several times or more in
your career
The event might occur once in your career
The event does occur somewhere in the industry
from time to time
Heard of something
Indicative frequency
More than one occurrence per year
Recorded occurrences within a 5 year period
Recorded occurrences within 10 year period
Recorded occurrences within a 20 year period
Once in 30 years
CONSEQUENCE
Label
5
4
3
Descriptor
Catastrophic
Major
Moderate
2
Minor
1
Insignificant
Reputation/Brand
High impact long-term issue
with major reputation or
community consequences
requiring Board
intervention
Long-term issue with major
reputation or community
impact requiring Board
Committee intervention
Financial / Legal
Infrastructure
Financial Loss over $5M
Major third party litigation
Long term loss of
or inability to use
critical
infrastructure
Financial Loss between $1 5M
Serious third party
litigation/dispute
Long term loss of
or inability to use
support
infrastructure
Long-term issue with major
reputation or community
impact requiring CEO
intervention
Financial Loss between
$500k – 1M
Limited impact third party
litigation / dispute
Significant
degradation of
infrastructure
Medium term issue with
significant or community
impact with requiring CEO
intervention
Community incident
requiring management
incident
Financial Loss between
$100k – 500k
Threat of third party
litigation
Financial loss under $100k
Minor threat of third party
litigation
Railway Interface Risk Assessment Form
Document Number: XXX
Version: 1 Dated: Aug 2014
Safety
Permanent disabling
injury of fatality
Multiple serious
injuries. Extended
inpatient treatment
and or rehabilitation
Outpatient treatment
at a hospital or
inpatient treatment
for non permanent
injury
Environment
Serious environmental issue with long
term wide scale irreversible impacts
Long-term issue with major
environmental impact, some possible
irreversible impacts
Regulatory intervention, local
community angst longer term but
reversible impacts
Degradation of
infrastructure
Minor lost timer and
or medical treatment
at a hospital
Possible intervention by regulator,
some community interest, short term
reversible impact
Short term minor
issues with use of
infrastructure
No treatment required
or minor first aid
treatment
Minor incident no intervention by
regulator minor community interest
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RISK RATING MATRIX
Insignificant
1
Minor
2
CONSEQUENCES
Moderate
3
Major
4
Catastrophic
5
Medium (M)
High (H)
High
Extreme (E)
Extreme
Medium
Medium
High
High
Extreme
C – Possible
Low (L)
Medium
High
High
High
D – Unlikely
Low
Low
Medium
Medium
High
E – Rare
Low
Low
Medium
Medium
High
LIKELIHOOD
A – Almost Certain
B – Likely
RISK RATING
Extreme
High
Medium
Low
Immediate senior management attention required. No recommencement of activity until formal management guidance is received
Senior management attention needed. Action plans and management responsibility specified.
Managed at line management level. Manage by specific monitoring or response procedures, with management responsibility specified
Managed at team level. Managed by routine procedures, unlikely to need specific application of resources.
HIERARCHY OF CONTROL
1. Eliminate
2. Substitute/ Isolate/
Engineering
3. Admin/ PPE
Eliminate the hazards
Substitute the hazard with something safer. Isolate the hazard from people. Reduce the risks through engineering controls
Reduce exposure to the hazard using administrative actions. Use personal protective equipment (PPE)
Railway Interface Risk Assessment Form
Document Number: XXX
Version: 1 Dated: Aug 2014
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