Lend Lease’sinfrastructure services business
PNLK-SF-120A – Contractor Control - Lease Boundary Access Request
100 – General Administration /
Guide to completing this works application:
  1. Complete works information below
  2. Attach the Traffic Management Plan (where applicable) / Permits
  3. Attach the authorised Safe Work Method Statements.

Note: Contact Peninsula Link Freeway Control Centre (FCC) on phone 03 5978 4012 before traffic management and work commences - this includes initial pre-warning signs. When traffic management changes during the works and on completion, contact the FCC.

Part 1 – Basic Information

Name of Contractor: / Request made on / Click here to enter a date. /
Contractor Address:
Point of Contact (Name): / Phone: / Mobile:
Position Title: / Email:
Onsite Works Supervisor (Name): / Phone: / Mobile:
Email:
Have you been inducted for the Project: / ☐Yes ☐ No

Part 2 - Access Requirements

Access required from: / Click here to enter a date. / to / Click here to enter a date. / between / AM/PM / and / AM/PM
Scope of works:
Works Location: (provide map where applicable) / Chainage:
Number of personnel on site: / Other contractors on site:
Are keys Required? / ☐Yes ☐ No / If so, which keys:

Part 3 – Permit Requirements

Are works occurring within 12m of live traffic lane? (If yes, then a Traffic Management Plan is to be submitted) / ☐Yes ☐ No / Entry into confined space required? / ☐Yes ☐ No / Dial Before You Dig Required? / ☐Yes ☐ No / Electrical Permit (LV/HV) required for works? / ☐Yes ☐ No

Part 4 – Plant and Equipment

Plant / Equipment to be brought on site / Materials to be brought on site:

Applicants sign-off

I confirm that the information provided to support this request for access is a true and accurate reflection of the proposed works. I confirm that the appropriate authorisations, permits and approvals have been obtained from Lend Lease Infrastructure Services Pty Ltd and Abigroup Contractors Pty Ltd. I confirm that only personnel inducted on the Peninsula Link O&M phase will be in attendance at site.

Name: / Title: / Date: / Signature:

O&M Operations Approval

Approval Authority Level / Email request to / Position Title / Signature / Date/Time
Type 1 – Access to the freeway not requiring traffic management / / Operations Leader
Type 2 – Requiring traffic management during an Off-Peak period / / Operations Leader
Type 3 – Planned damage / disturbance of assets (e.g. trenching) / / Asset Manager
Type 4 – Requiring traffic control during a Peak period / / Operations and Maintenance Manager

Approval Advice Given

Access type granted by authoriser: / ☐Type 1 ☐Type 2 ☐Type 3 ☐Type 4
Name: / Andrew Mason / Title: / Operations Manager / Date: / Signature:
Name: / Chris Zammit / Title: / HSEQ Officer / Date: / Signature:
Name: / Phil Naulls / Title: / O&M Manager / Date: / Signature:

Withdrawal of Authority

Reason for withdrawal:
Date and Time:
By whom (Name and Sign):

GENERAL CONDITIONS FOR WORKING ON PENINSULA LINK

The following general conditions apply to all Contractor Control – Lease Boundary Access Request Forms that are issued by LLIS.

1 GENERAL CONDITIONS

  1. All Access Request Forms (ARF) applications must be submitted a minimum of 3 working days prior to the commencement of any works with all supporting documentation.
  2. ARFs can only be issued to companies who are approved HSE Contractors and have completed the Peninsula Link Induction.
  3. All works on carriageways will require an approved traffic management plan and implementation of the traffic management plan as per the VicRoads Code of Practice – Road Management Act 2004 – Worksite Safety Traffic Management.
  4. The ARF is only valid for the period specified and deemed void at end of ARF finish time.
  5. The Contractor must perform only those works, which are specified on the ARF. If conditions related to the ARF change, then all works are to cease, until new works are approved by the relevant Peninsula Link Works Authoriser.

2 SAFETY AND ENVIRONMENT

  1. All persons working on Peninsula Link are required to wear appropriate Personal Protective Equipment (PPE), safety footwear and safety vests as a minimum.
  2. The ARF holder is responsible for identifying any job specific safety clothing/equipment required by the relevant OH&S legislation.
  3. All onsite personnel must have a full understanding of the scope and safety requirements of the works.
  4. All vehicles and mobile plant are to be fitted with an amber flashing light(s). All mobile plant is required to be fitted with reversing beepers.
  5. All activities conducted under the ARF shall comply with all applicable WHS legislation, regulations, Codes of Practices, relevant Australian Standards and Lend Lease Global Minimum Requirements.
  6. All plant and equipment used for works are required to be tested, tagged and operated in accordance with the current WHS and Environmental regulations and operated by appropriately trained certified operator, competent to carry out the activities.
  7. All emergencies, hazards, unsafe work practices, incidents and injuries must be reported immediately to the Traffic Control Centre (FCC) on 5978 4012. Crossing of Live Lanes is STRICTLY PROHIBITED – this will result in withdrawal of your work authority.
  8. Ensure the worksite is kept in a neat and tidy condition during works and returned to its original state once works are complete.

p1 / Version 4
As at 25th of March 2013 / Uncontrolled when printed / Access Request Number: