APPLICATION KIT AND GUIDELINES FOR ORGANISATIONS SEEKING TO UNDERTAKE WORKS WITHIN ROAD RESERVE LOW COMPLEXITY WORKS.

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Document No: 16-02-12A Issue Date: 09 December 2014 APPLICATION KIT AND GUIDELINES FOR ORGANISATIONS SEEKING TO UNDERTAKE WORKS WITHIN ROAD RESERVE LOW COMPLEXITY WORKS (An approved Traffic Management Plan is not mandatory but may be required) This Policy is owned and controlled by the Executive Director Regional Services. Please submit all comments and requests for changes to the delegated custodian Network Management Officer Authorisation This document is authorised for use. EXECUTIVE DIRECTOR CENTRAL & NORTHERN REGIONS Date: 03/09/2012 ISSUE 2 REVISION 2 The Controlled Copy of this document is contained on the MAIN ROADS WA website. Hard copies are not controlled and might not be the latest revision. MRWA File 05/2083 TRIM File No.: D12#272651

REVISION RECORD ISSUE REVISION DATE CHANGES 1 1 09.12.2002 Original version 2 0 03.09.2012 Cover Page and Other Various 2 1 9.9.2014 Update contact information 2 2 5.11.2015 Update contact information To the extent permitted by law, Main Roads WA, its employees, agents, authors and contributors are not liable for any loss resulting from any action taken or reliance made by users of these documents or the information displayed. If you have any questions or comments regarding this document, please refer to attachment 3. Contact Peter Sewell, Director Regional Operations, on Ph: (08) 9323 4656; or E-mail: peter.sewell@mainroads.wa.gov.au.

TABLE OF CONTENTS 1 PURPOSE OF THE APPLICATION KIT AND GUIDELINES... 4 2 REQUIREMENTS FOR UNDERTAKING WORKS IN ROAD RESERVES MANAGED BY MRWA... 4 3 SUBMITTING AN APPLICATION... 5 4 APPLICANT S RESPONSIBILITIES... 5 5 TIMEFRAME FOR ASSESSMENT OF APPLICATIONS... 5 6 INTEGRATED SERVICE AGREEMENTS... 5 7 TERMINATION OF UNAUTHORISED OR SUB-STANDARD WORKS... 6 8 INSURANCE... 6 9 INDEMNITY... 6 10 PERFORMANCE SECURITY... 6 11 WORKING HOURS AND OTHER RESTRICTIONS... 6 12 TRAFFIC MANAGEMENT PLAN... 7 13 QUALITY PLAN... 7 Attachments Attachment 1 APPLICATION FORM... 8 Attachment 2 FORM OF INDEMNITY... 13 Attachment 3 MAIN ROADS CONTACTS... 14

1. PURPOSE OF APPLICATION KIT AND GUIDELINES This Application Form is to seek Main Roads WA approval for organisations to undertake works of low complexity within the road reserve, such as unsealed rural driveways or other minor works. Low complexity works are described as those works which will require minimal Specifications and which will cause minimal disruption to road users. (The installation of poles, signs, walls, driveways etc. need to have Main Roads approval before commencing.) Duty of Care Anyone carrying out operations on a road open to traffic has a duty of care under common law to take all reasonable measures to prevent accident or injury to construction workers & road users, damage to assets owned by Main Roads & other utility providers and to maintain existing environment. 2. REQUIREMENTS FOR UNDERTAKING WORKS IN ROAD RESERVES MANAGED BY MRWA Applicants are required, as a minimum, to comply with the following current standards, Acts and legislation: Main Roads WA Traffic Management for Works on Roads - Code of Practice (available from the MRWA Website: Road and Traffic Information > Traffic Management > Workzones on Roads > Traffic Management for Works on Roads - Code of Practice). Main Roads Specification 201 Quality Systems. Main Roads Specification 202 Traffic. Main Roads Specification 203 Occupational Safety and Health. Main Roads WA Specification 301- Clearing. Main Roads WA Other Specifications Refer to Tender Document Preparation system (available from the MRWA Website: Tender Document Preparation > Specifications). AS/NZS 1906 AS/NZS 1906.4:2010 : Retro-reflective materials and devices for road traffic control purposes - High-visibility materials for safety garment. AS/NZS 3845:1999 AS/NZS 3845:1999 : Road safety barrier systems. AS/NZS ISO 31000 Risk Management Principles and Guidelines. AS/NZS 4602:1999 AS/NZS 4602.1:2011: High visibility safety garments - Garments for high risk applications. Austroads Guides. Disability Services Act 1993. Main Roads Operational Guideline 08 - Clearing of Roadside Vegetation by External Parties. Australian Standard 1742.2 Manual of Uniform Traffic Control Devices, Part 2 Traffic Control Devices for General Use. Australian Standard 1742.3 Manual of Uniform Traffic Control Devices, Part 3 Traffic Control Devices for Works on Roads. Utility Providers Code of Practice for Western Australia (available from the MRWA Website: Road and Traffic Information > Works on main Roads > Codes, Policies & Guidelines). Operational Guideline 100 Installation of Underground Services within Road Reserves (available from the MRWA Website: Road and Traffic Information > Works on main Roads > Codes, Policies & Guidelines). Road Traffic Act WA 1974. Road Traffic Code WA 2000. Occupational Safety and Health Act 1984.

Occupational Safety and Health Regulations 1996. WorkSafe Plan, WorkSafe WA. Environmental Protection Act 1986. Noise Abatement (Noise Labelling of Equipment) Regulations (No. 2) 1985. Environmental Protection (Clearing of Native Vegetation) Regulations 2004. The Radiation Safety Act 1975. Dangerous Goods Safety Act 2004. Aboriginal Heritage Act 1972. Main Roads Standard for Geometric Design of Driveways (available from the Main Roads website). Main Roads Standard Drawing 9831-6281 Typical Rural Driveway Details (available from the Main Roads website). 3. SUBMITTING AN APPLICATION Applicants are required to complete and submit the Application Form (see Attachment 1) to the appropriate Main Roads Office (see listing at Attachment 3) prior to undertaking any work within the Road Reserve. Main Roads preference is for application submissions to be in electronic format. Main Roads will issue formal approval to proceed with the proposed works when the assessment of the application is complete. Work cannot commence until formally approved by Main Roads. 4. APPLICANT S RESPONSIBILITIES These Guidelines are not to be regarded as definitive. Ultimately it is the responsibility of the individual or organisation proposing to undertake works within the Road Reserve to ensure they comply with all relevant statutory and other obligations. Applicants are responsible for the safe and timely execution of the proposed works and shall notify Main Roads of any changes in the way the works will be undertaken. Applicants are responsible for all costs associated with the works including the Applicants supervision, inspection, materials testing, road signage and line marking and any other requirements as specified by Main Roads. Applicants are responsible for works undertaken by contractors or sub-contractors working on their behalf. 5. TIMEFRAME FOR ASSESSMENT OF APPLICATIONS Individuals and organisations submitting an application should ensure that sufficient time is allowed for Main Roads to assess the application. Where proposed works are of low complexity, applicants should allow a minimum of 15 business days for the Application to be assessed. 6. INTEGRATED SERVICE AGREEMENTS Road Network Operations, operational asset management, maintenance delivery, capital works delivery and project contract management services for freeways, highways and main roads are being delivered through a number of Integrated Services Arrangements (ISAs) implemented by Main Roads.

The Applicant, including any of its contractors, must cooperate with Main Roads and the related Integrated Services Provider (ISP) during implementation of the work and must provide any document, drawing or other records relating to the proposed works on request. 7. TERMINATION OF UNAUTHORISED OR SUB-STANDARD WORKS Main Roads regularly undertakes surveillance of the road network. Should any unauthorised works be detected, the individual/organisation responsible may be instructed to immediately terminate any work and remove all plant and equipment from the site. Main Roads will not be liable for any costs associated with any work that is terminated prior to completion. Any sub-standard works detected on the network must be immediately rectified to the satisfaction of Main Roads. The Applicant will be responsible for the cost of rectifying any sub-standard works. If the sub-standard works including sub-standard traffic management are not corrected, Main Roads may instruct the individual/organisation or utility provider responsible to immediately terminate any work and remove all plant and equipment from the site. Main Roads may then arrange to complete the work with the Applicant being responsible for these costs. 8. INSURANCE The type of insurances that Applicants will be required to have in place will depend on the impact the proposed works will have on road users and the road network. Insurance requirements will be determined by Main Roads after receipt of the Application Form (Attachment 1). Applicants will be advised of the type of insurances that must be in place prior to works commencing. 9. INDEMNITY The Applicant is required to indemnify Main Roads against any claims that may arise out of the work. The Form of Indemnity to be completed and submitted with the Application is at Attachment 2. The Indemnity is required for all works and must be provided to Main Roads prior to the works commencing. 10. LOCAL GOVERNMENT The Applicant is responsible for obtaining all necessary approvals from the relevant local government authority, i.e. Council or Shire. Main Roads will advise the Applicant whether an additional approval for the proposed works is required from the local government or any other authority. 11. WORKING HOURS AND OTHER RESTRICTIONS Applicants must provide details in the Application Form relating to the proposed commencement date for the works including the daily start and finish times for Main Roads approval.

The working hours and working days as agreed by the parties must not be varied without the prior approval of Main Roads except, where in the interests of safety or to protect life or property, the Applicant or the Applicant s Contractor finds it necessary to vary the agreed working days or hours. Should such an event occur Main Roads is to be notified without delay. 12. TRAFFIC MANAGEMENT PLAN Traffic Management Plans (TMPs) provide a means of planning and implementing how all likely road users (public transport and passengers, cyclist, pedestrians, motorists and commercial operations) will be safely and efficiently guided through works activities and ensure the network performance is not unduly impacted, for the duration of the works. TMPs must be prepared in advance of the works being conducted and are generally subject to auditing before and during implementation. Where the proposed works or the proximity of the works will affect the road users including pedestrians, a Traffic Management Plan will need to be prepared, approved and forwarded to Main Roads not less than 10 working days prior to commencement of works. Any traffic management requirements are to be in accordance with Main Roads WA Traffic Management for Works on Roads Code of Practice which is available from the Main Roads Website http://www.mainroads.wa.gov.au. (Road and Traffic Information > Traffic Management > Workzones on Roads >> Traffic Management for Works on Roads - Code of Practice) Guidelines for preparing a Traffic Management Plan are also available from the Main Roads website. (Road & Traffic Information > Traffic Management > Plan Preparation) A copy of the Traffic Management Plan and letter granting Roadway Access Approval must be available at the work site during works and provided to Main Roads or the Main Roads Integrated Services Provider (ISP) upon request. Failure to comply with this requirement may result in the works being suspended. 13. QUALITY PLAN The Quality Plan shall address the responsibilities of the Applicant or the Applicant s Contractor in relation to the proposed work and shall demonstrate how its procedures and instructions shall be applied to the work to demonstrate compliance with all relevant technical specifications. The Quality Plan shall address the requirements of the Main Roads Specification 201 which is available on the Main Roads WA website http://www.mainroads.wa.gov.au (Tender Preparation > Specifications).

APPLICATION FORM ATTACHMENT 1 APPLICATION FORM FOR WORKS OF LOW COMPLEXITY This Application Form is to be completed in accordance with the attached Application Kit and Guidelines for Organisations Seeking to Undertake Works within the Road Reserve. The Kit is available from Main Roads website http://www.mainroads.wa.gov.au. Applicant - Proponent of Works Name of Organisation and Address * Name and Position of Applicant Applicant s Contact Details Email Phone Fax Project Manager s Contact Details Email Phone Fax * For subcontractor information see page 12. Note: If insufficient space on this form please includes attachments.

Location of Proposed Works Exact Location (include road names, distance to nearest cross street and map reference) Local Government Proposed Start Date Duration Suburb/Town Proposed Hours of Work Description of Proposed Works

Method for Proposed Works including trenching, line boring, installation casing, filling with grout, remove/replace, install new, add to service, remove redundant, position/alignment, depth of service, etc. ENVIRONMENTAL AND HERITAGE CONSTRAINTS (Environmental Checklist) Applicants are required to complete the following Projects Works Environmental Checklist (see Table 2 below) in regards to the proposed project works. In order to minimise delays in the application process, applicants are required to submit additional supporting information in relation to the checklist (for example, Clearing Permit Number, licences or other approvals granted). Evidence of this additional documentation should be provided with this application. The applicant is required to obtain all necessary approvals, permits and licences for the proposed project works. If the proposed works require the clearing of native vegetation, a native vegetation clearing permit must be obtained by the applicant prior to the commencement of project works in accordance with the Environmental Protection Act, 1986. The applicant s clearing permit number will need to be provided to MRWA with this application. Clearing permits are issued by the Department of Environment and Conservation (DEC) and these permits are the responsibility of the applicant. Information regarding native vegetation clearing permit applications can be found at: http://www.dec.wa.gov.au/index.php?option=com_content&task=view&id=2919&itemid=1780 (or use http://www.dec.wa.gov.au/) Table 2 Project Works Environmental Aspects Checklist Item No. Environmental Aspect Checklist (Yes/No/ NA) Provide Evidence of Permit/Approval/Licence Do the project works require the clearing of vegetation? (No, proceed to item no. 5) 1 a. What is the quantity of vegetation to be cleared? 2 a. Do the project works require the clearing of native vegetation? b. Have all necessary approvals been

obtained to clear native vegetation? c. Has a native vegetation clearing permit been obtained to clear native vegetation? d. What is the clearing permit number for the proposed project works? 3 a. Does the project area contain Aboriginal Heritage Sites? b. Have all necessary approvals been obtained to disturb Aboriginal Heritage? 4 a. Does the project area contain Cultural Heritage Sites? b. Have all necessary approvals been obtained to disturb Cultural Heritage? (end of checklist for Clearing Permit holders) If no native vegetation clearing is required, do the project works: 5 Impact dieback or other pathogens located within the project area? 6 Impact contaminated sites located within the project area? 7 a. Impact wetlands/watercourses located within the project area? b. Have all necessary approvals been obtained to disturb wetland/watercourses? 8 a. Impact surface/groundwater located within the project area? b. Have all necessary approvals been obtained to disturb surface water/groundwater? 9 Impact acid sulfate soils located within the project area? 10 Generate soil erosion, flooding or salinity within the project area? 11 Generate dust? 12 Generate noise/vibration? 13 a. Impact Aboriginal Heritage sites located within the project area? b. Have all necessary approvals been obtained to disturb Aboriginal Heritage? 14 Impact European Heritage sites located within the project area? b. Have all necessary approvals been obtained to disturb Cultural Heritage? e.g. Clearing permit no. 23/658 e.g. Section 18 Application No.

Details of the Applicant s Contractor Fill in this section if the works are to be undertaken by someone other than the Applicant (a contractor or sub-contractor). Contractors Name and Address (Company undertaking actual work) Phone Fax Mobile Project Manager Phone/E-mail Field Representative Phone Fax After Hours Contact Phone 1 Phone 2 Endorsement Please endorse below and forward to appropriate Main Roads Office (see list at Attachment 3). I hereby certify that this application contains a true and accurate description of the proposed works. All works will be carried out in accordance with the information contained in this application, legislative & statutory requirements and to any other conditions or specifications imposed by Main Roads. Signed:.. (Applicant) Date. Name of Applicant:... (PRINT) Position/Title:.... Please note that incomplete applications may cause delays. Main Roads will advise you in writing of any requirements to be met. (Please refer all enquiries to Main Roads Office.)

FORM OF INDEMNITY ATTACHMENT 2 INDEMNITY In consideration for the Commissioner of Main Roads ( Main Roads ) permitting the Applicant to undertake works in the road reserve, the Applicant agrees to indemnify and keep indemnified Main Roads from and against, and must pay Main Roads on demand as a debt, the amount of any claim, damage, cost, expense, loss (whether direct, indirect, consequential or otherwise) or liability which Main Roads may suffer or incur as a result of, in respect of, in connection with or in relation to the works the Applicant undertakes under this application (the Indemnity). The Indemnity does not apply to the extent that any damage, expense, loss, liability or claim is caused by a negligent act of Main Roads, its employees or agents. The Indemnity does not lessen or otherwise affect the Applicant s other obligations arising out of its application to undertake works within the road reserve. Signed: Duly authorised officer of the Applicant Signed: For the Commissioner of Main Roads Name of Signatory: Name of Officer: Name of Applicant: Date: Date:

MAIN ROADS CONTACTS ATTACHMENT 3 Please direct all enquiries to the Main Roads Customer Information Center on 138 138 or email to enquiries@mainroads.wa.gov.au for Metro Region (ask for the Customer Services Manager) For regional office, please visit the Main Roads website contact page: https://www.mainroads.wa.gov.au/aboutmainroads/contactus/pages/contactus.as px (also ask for the Customer Services Manager)