A LIFE LOST BEHIND THE WHEEL
An investigation report prepared by the NSW Mine Safety Investigation Unit into a fatal collision between a haul dump truck and a light vehicle at Ravensworth open cut mine in November, 2013.
At 11.50 pm on Saturday, 30 November, 2013, 38-year-old Ingrid Forshaw, a trainee plant operator employed by TESA Mining (NSW) Pty Ltd, was fatally injured while working at the Ravensworth open cut mine, near Singleton NSW. Ms Forshaw suffered fatal injuries when the Toyota Landcruiser she was driving collided with and was run over by the front right-hand side wheel of a haul dump truck.
About 11.46pm on Saturday, 30 November, 2013, Ms Ingrid Forshaw parked the haul truck she was operating at the ULM stockpile and collected the Landcruiser which had been parked at the ULM stockpile by another operator at the start of the shift. Ms Forshaw was operating the Landcruiser to collect other workers and go to crib (meal) break.
About 11.49pm, the haul truck operator was hauling coal in a northerly direction along the 9th haul road, he saw the Landcruiser travelling down the 8th ramp (in a westerly direction). As the truck operator approached the intersection he saw the Landcruiser enter the 9th haul road then he lost sight of the Landcruiser.
About 11.50pm, the Landcruiser travelled across the 9th haul road onto the left-hand side of the road into the path of the truck on its right-hand side (the blind side). The truck and Landcruiser collided and Ms Forshaw was crushed inside the Landcruiser and died immediately from multiple injuries.There were no eyewitnesses to the incident other than the truck operator.
CCTV footage that captured the incident was provided to investigators by Ravensworth mine via statutory notice. The footage came from a camera a considerable distance from the incident site.
At 11.50:04 pm (time on the footage) the truck came into view travelling north on the 9th haul road. At 11.50:31pm the Landcruiser came into view travelling west down the 8th ramp. The Landcruiser appeared to slow around the end of the 8th ramp before continuing through the intersection onto the 9th haul road and into the path of the truck at 11.50:45pm.
MINE RISK MANAGEMENT
Glencore Xstrata implemented a SafeCoal initiative in 2009. As part of this, a suite of 12 fatal hazard protocols were developed and issued to the business in May, 2010. The fatal hazard protocols provided the minimum systems and conditions for the management of fatal hazards at every coal assets – Australia, Glencore operation.
The mine’s Sustainable Development Management Operating System (SDMOS) provided an overview of how the fatal hazards were managed.
According to the system, the mine was committed to performing risk assessments to evaluate the controls for the fatal hazard protocols, the legislated major hazards and any risk that had the potential to cause multiple fatalities.
Surface transport management plan
The interaction between haul trucks and light vehicles at open cut mines is a well-known hazard. Section 35 of the Coal Mine Health and Safety Act 2002 (CMHSA) required that the operator of a coal operation establish and maintain major hazard management plans (MHMP).
Clause 30 of the Coal Mine Health and Safety Regulation 2006 set out the required content of MHMPs in relation to hazards arising from the use and operating environment of plant used for the transport of people or materials on the surface part of the operation (transport).
It required that provisions be made for the conditions under which transport may be used, transport being used within design parameters, design of roadways, maximum speeds, steps to ensure transport was safe, and interaction of heavy and light transport.
At the time of the incident the mine had a surface transport management plan (STMP) in place to address the requirements of the legislation and the requirements of fatal hazard protocol number 3 – mobile equipment. The STMP stated that it provided direction to mine personnel and contractors so that hazards associated with surface transport were identified, evaluated and eliminated or controlled to an acceptable level.
The STMP referred to the mine broad brush risk assessment and the mobile equipment risk assessment, which identified operational surface transport hazards that have the potential to result in injury or fatality.
The assessment, dated 6 October, 2010, was attached to the STMP. For the activity of driving light vehicles on haul roads it identified the hazard of collision with heavy vehicle and control measures as “exhibit reflective flag or red light/flashing orange beacon.
The mobile plant risk assessment report, dated 11 July, 2012, described the potential for collision between light and heavy equipment due to vision and communication issues. Associated preventative controls were authorisation of personnel, STMP (road rules), pre-start inspections, competency-based training, equipment introduction to site, road design standards, vehicle standards, speed limits, road maintenance and signage, operations management and communication.
EXAMINATION OF THE CIRCUMSTANCES OF THE INCIDENT
Investigators conducted a range of incident simulation activities at the incident site. These simulations involved positioning light vehicles along the 8th ramp at 10m increments approaching the intersection to simulate Ms Forshaw’s path of travel. The truck was positioned at 50m increments along the 9th haul road to simulate its path of travel.
Simulations were conducted during day and night time conditions. These simulations provided valuable insight into the incident.
Investigators made the following observations during the simulations:
- The Landcruiser could not be seen when it was positioned in the truck’s blind-spots.
- The lack of clearance/side lighting and reflective material on the truck made it difficult to detect at night.
- Lines of sight from the Landcruiser were obscured by the 8th ramp windrow in numerous places, making it difficult to see the truck on the haul road.
- The absence of direct artificial lighting and the impact of secondary (incidental) lighting from the mine infrastructure area (MIA) at the intersection caused background glare.
Observation of the Landcruiser tyre marks indicated that Ms Forshaw travelled about 30m from the intersection across the 9th haul road. There was no indication of skidding, braking, or swerving prior to collision. However, at the point of collision, skidding of the Landcruiser tyres was evident for a distance of 19m to the point where the truck stopped with the Landcruiser trapped under its front right-hand side tyre.
WORK ENVIRONMENT FACTORS
ARRB Group Ltd was engaged by the department to provide an independent report on road environment factors relating to the incident. ARRB conducted a desktop study of the
intersection against Ravensworth mine standards and ‘ARRB best practice’ based on Safe System principles, in lieu of a recognised national standard.
ARRB observations with regard to the intersection type, geometry, control and transient characteristics at the time of the incident are summarised below
The haul roads had been constructed using locally available natural materials (ie, they were not sealed with a bituminous or concrete running surface) and were moderately wet and “tacky” due to rainfall on the preceding day.
The selection of a T-intersection was considered appropriate for the location and operational requirements. The geometry of the intersection was in accordance with Ravensworth mine standards and best practice.
ARRB suggested a maximum speed limit of 50km an hour for haul roads and 30km an hour for ramps.
The width of the 9th haul road (27-28m) was narrower than the Ravensworth mine
standards for a CAT 797F truck (30m) and best practice (29.3m). The width of the 8th ramp (28-30m) was slightly narrower in places than the Ravensworth mine standards for a CAT 797F truck (30m) and generally met best practice (29.3m).
Road gradients and crossfall
The transverse profile of the 9th haul road was provided by a constant crossfall (2.2-3.0 per cent), which was consistent with Ravensworth mine standards and best practice. The transverse profile of the 8th ramp was provided by a constant crossfall (2.5-3.0 per cent) which was substantially consistent with Ravensworth mine standards and consistent with best practice.
The 9th haul road windrow heights were below the minimum height of 2.01m (half the wheel height) based on a CAT 797F required by both Ravensworth mine standards and best practice. The tapered windrow heights (within 10m of intersection) were 2.0m, which were
higher than the Ravensworth mine standard of 1.0m and best practice of 1.2m.
Median windrow heights were below the minimum heights within both the Ravensworth mine standards and best practice. The 8th ramp windrow heights varied considerably, being approximately 0.7m 2.01m requirement in places, and 0.3m too low up to 10m from the intersection.
The windrows for the final 10m to the intersection (1.7m) were higher than both the
Ravensworth mine standard (1.0m) and best practice (1.2m). Median windrow heights generally met the Ravensworth mine standard of 1.5m, but exceeded the best
practice of 1.2m.
The absence of termination/sight boards was not consistent with Ravensworth mine standards or best practice. Existing signs and location were consistent with Ravensworth mine standards and best practice. The size of signs did not comply with best practice.
The provision of guideposts and whirlybirds substantially complied with both Ravensworth mine standards and best practice.
The intersection was controlled by a ‘GIVE WAY’ sign on the 8th ramp. According to best practice, for a haul road with a speed limit of 60km an hour, a sight distance of 115m or better from a distance of seven metres from the intersection was required for the intersection to have a ‘GIVE WAY’ control. The sight distance from a light vehicle at 10m from the intersection was 150m, therefore it exceeded the best practice minimum requirement.
However, the windrow heights and the three per cent downhill gradient at the intersection on the 8th ramp had the potential to reduce the actual line of sight from the light vehicle, such that only the top half of the haul truck could be seen. This part of the truck did not have lights and had only minimal retro-reflective taping applied.
Also, the location and size of the ‘GIVE WAY’ signage on the 8th ramp did not provide optimum warning to drivers approaching the intersection.
The incident occurred in the hours of darkness and as mentioned above no direct artificial
lighting was provided at the intersection. There was secondary (background) lighting from the mine infrastructure area (MIA) in the vicinity of the intersection.
Information from operators indicated that the background lighting of the intersection had the
potential to disorientate or confuse drivers approaching the intersection on the 8th ramp, which may in turn adversely affect a driver’s ability to detect a moving vehicle on the 9th haul road with accuracy and certainty. Reference was made to taking additional care at the intersection to detect whether the lights in vision were stationary or moving, as per a vehicle.
Rainfall data provided by the mine recorded 22.8 millimetres of rain between 8.10am and 10.25am on 29 November, 2013, and 6.2mm of rain between 4.10pm and 9.30pm on
29 November, 2013. No rain was recorded on 30 November, 2013.
Water at intersectio
Water ponding was clearly present at the south-eastern ‘corner’ of the intersection (described as being ‘laying water’ and ‘at the bottom of the ramp’) by an operator.
ARRB considered that the potential for any surface water to pond at this location was
foreseeable given the combination of gradients and crossfalls at the location. Management of the mine indicated that water across the intersection was an anticipated occurrence, such as during and after rain events and the road had a spoon drain across the intersection, requiring all vehicles to slow down on their approach.
The water ponding remained unresolved at the time of the incident. This appears to be inconsistent with the local standard for haul road maintenance which stated ‘Repairs to any defective section of roadway shall take place as soon as practical [sic]’ (ref. Section 6.1 of RDCG).
Level of interaction between light vehicles and heavy vehicle
Up to the time of the incident there had been 361 loads of waste and 38 loads of coal hauled on the night shift on 30 November, 2013.
There were around 66 operators from Crew 3 (Narama and Ravensworth North) operating
various types of equipment including excavators, dozers, graders, and haul dump trucks.
Simulations were conducted during day and night time conditions. These simulations provided valuable insight into the incident
The truck operator’s accoun
The truck operator recognised the intersection and the presence of the Landcruiser on the 8th ramp. The operator saw the Landcruiser get to the bottom of the ramp and saw the Landcruiser entering the intersection. The truck operator assumed the Landcruiser would pull up and once the truck went past, pull in behind the truck. The truck operator then lost sight of the Landcruiser. The field of vision of the truck operator was restricted due to the truck blind spots.
Hours of work
In the seven day period before the shift on which the incident occurred, Ms Forshaw worked a total of 45 hours.
In the seven day period before the shift on which the incident occurred the truck operator worked a total of 24.45 hours.
The truck operator reported that he had between six and eight hours sleep on the night before the night shift of the incident. He also reported that he had two-and-a-half hours sleep in the afternoon before the start of the night shift. The truck operator stated that he felt “quite good” physically around the time just before the incident.
Drug and alcohol result
No alcohol was detected in Ms Forshaw’s body from samples taken during the post mortem examination. The samples taken were unsuitable for testing for drugs.
Ms Forshaw was subjected to random drug and alcohol urine screens at the mine on 19
February, 2013, and 22 February, 2013. No drugs or alcohol were detected in the screens.
No drugs were detected in blood and urine samples taken from the truck operator following the incident. The truck operator was subjected to a random drug and alcohol urine screen at the mine on 8 April, 2013 and no drugs or alcohol were detected.
Mobile phone record
NSW Police obtained the mobile telephone records for Ms Forshaw’s mobile telephone number and the truck operator’s mobile telephone number for 30 November 2013. No phone calls were initiated or received by either of the mobile telephone numbers at or around the time of the incident.
Further, no text messages were received or sent to or from either of the mobile
telephone numbers at or around the time of the incident. It should be noted that the relevant mine policy allowed the use of mobile telephones on hands-free devices. However, the phone records identify they were not being used by either operator when the incident occurred.
SAFETY MANAGEMENT SYSTEM FACTORS
Hierarchy of controls
The WHSA requires a duty holder to eliminate risks to health and safety, so far as is reasonably practicable and if it is not reasonably practicable to eliminate such risks, to minimise them.
A duty holder, in minimising risks to health and safety, must implement risk control measures in accordance with clause 36 of the Work Health and Safety Regulation 2011. Clause 36 requires that the duty holder must minimise risks, so far as is reasonably practicable, by doing one or more of the following:
- Substituting (wholly or partly) the hazard giving rise to the risk with something that gives rise to a lesser risk.
- Isolating the hazard from any person exposed to it.
- Implementing engineering controls.
- If a risk then remains, the duty holder must minimise the remaining risk, so far as is reasonably practicable, by implementing administrative controls.
- If a risk then remains, the duty holder must minimise the remaining risk, so far as is reasonably practicable, by ensuring the provision and use of suitable personal protective equipment.
Under the headings below, the mine control measures are considered against the WHSA hierarchy of controls with regard to the circumstances of the incident and available controls. Personal protective equipment was not considered due to the nature of the incident.
Elimination and substitution
Light vehicles and heavy vehicles at the mine were operated by operators on multi-purpose haul roads and ramps. Segregation (separation) of light and heavy vehicles was not provided on haul roads and ramps in the operating environment.
Both the truck and Landcruiser had a reverse camera (although the reverse camera on the truck was not working at the time of the incident or for some time before the incident). Neither the truck nor the Landcruiser had any other proximity detection device or collision avoidance system installed.
The STMP and RDCG are outlined in Section 7 above and discussed with regard to “work
environment factors” above.
The following points are noted:
- Positive communication between vehicles was not required at intersections.
- A pre-operational inspection of the Landcruiser was not conducted.
Ms Forshaw was passed as competent and authorised to operate light vehicles on 25 February, 2013 (7 days after starting at Ravensworth). The trainer commented that Ms Forshaw completed all the requirements of the course both theory and practical and had a detailed mine site tour, as well as understanding all the safe work procedures.
Competency records for Ms Forshaw indicated she was competent to operate CAT 789C haul dump trucks.
The truck operator was competent to operate the following vehicles as at 30 November 2013:
- Light vehicles (trained 6/12/12)
- CAT 789C haul dump truck (trained 26/1/13)
- CAT 789D haul dump truck (trained 18/2/13)
- CAT 793D haul dump truck (trained 7/11/13)
The night shift on 30 November, 2013, was the first time the truck operator had been assigned to operate a CAT 793D following his training on that model on 7 November 2013. According to the truck operator, the CAT 793D were a similar truck to the CAT 789C models that he had operated numerous times, but they were wider and carried more tonnage.
The truck operator’s training on the CAT 793D consisted of a theory assessment and operating the truck for ‘a few’ haul loads with a trainer.
The transfer of information at the mine occurred via quarterly training days, monthly communication sessions, fortnightly letters, pre-shift meetings, noticeboard announcements, and kiosks.
A presentation at the November 2013 quarterly training days (November QTD) noted that from 289 hazards/improvements raised up to that point in 2013, roads were the top hazard which accounted for 12 per cent of hazards raised (35 reports). Windrows were the equal second top hazard accounting for 8 per cent of hazards raised (23 reports).
A presentation on light vehicle interactions, and heavy vehicles interactions, was given at the November QTD. It is noted that Ms Forshaw attended the November QTD on 27 November 2013. The truck operator did not attend the November QTD.
The Landcruiser operated by Ms Forshaw entered the path of the truck. It is possible that Ms Forshaw:
- recognised the presence of the intersection, but was not able to detect the truck
- observed the truck, but misinterpreted the road environment presented and what was required.
The combination of a range of factors is likely to have contributed to the incident.
- the interaction of light and heavy vehicles on haul roads at ROC created opportunity for vehicle collisions
- some aspects of the intersection design and signage did not meet ROC guidelines and/or ARRB best practice
- the height of the windrows may have restricted Ms Forshaw’s line of sight from the Landcruiser while travelling in a westerly direction down the 8th ramp making it difficult to see the truck on the 9th haul road approaching the intersection
- the background lighting near the intersection had the potential to disorientate or confuse drivers approaching the intersection on the 8th ramp. The background lighting may have adversely affected Ms Forshaw’s ability to detect a moving vehicle on the 9th haul road with accuracy and certainty
- the presence of the water ponding may have been a contributory factor in the incident if it had distracted Ms Forshaw and/or led to reflection of the secondary lighting and vehicle headlights off the water’s surface causing glare and confusion
- the poor visibility of the truck due to the obscured front bumper lights and the recessed RHS low beam light may have contributed to the incident by limiting the visibility of the truck that night. Due to the height of the truck and its close proximity to the intersection, the lack of light coming from the bumper lights would have made it difficult for Ms Forshaw to see the truck
- the absence of other illumination devices on the truck to enhance the visibility of the front, top and side of the truck would have made it difficult to detect the truck whilst travelling down the 8th ramp and at the intersection
- the limited field of vision of the truck operator meant that the operator could not see the Landcruiser when it was positioned in the truck blind spot in order to take evasive action.
- there were no proximity or collision avoidance systems installed on the truck or Landcruiser to warn the operators of the presence of the other vehicle
- there was an over-reliance on administrative controls to manage heavy and light vehicle interactions at Ravensworth mine.
Safe system principle
The Safe system principles adopted by ARRB in considering the road environment at
Ravensworth mine was explained by the concept ‘Safe Road Users driving at Safe Speeds in Safe Vehicles on Safe Roads and Roadsides’, i.e. the components are complementary and considered as inputs to a system which can determine the ultimate outcome, rather than being seen in isolation.
It is recognised within the safe system that:
- humans (road users) make mistakes on road networks and should not ‘pay’ with their life for doing so
- the human body has only limited tolerance to impact forces.
ARRB has had great success in applying both the long-standing and emerging safe system principles of road network safety and road safety engineering to a range of private sector road networks. This has included assisting many mine owners / operators to rationalise and reduce risk on their haul road networks within open cut mining operations.
Road design and construction standards and guideline
Open cut mine sites are unique operating environments with many different functions and uses taking place, with a diverse range of vehicles (in terms of size, performance, fields of view, etc) and vulnerable road users. Their interactions and the risks associated with such interactions need to be understood, and knowledge, skills and experience applied.
ARRB noted that definitive industry standards and guidelines do not currently exist in this
technical area, either internationally or within Australia. Many documents have been developed, either by individual mines or mining companies which all tend to vary in terms of coverage and the level of road safety, traffic engineering and traffic management knowledge and experience displayed.
Reliance on human behaviou
Due to the lack of engineering controls that were in place regarding the circumstances of the incident, a high reliance was placed on administrative controls which in turn place a high reliance on human behaviour. The causes identified for a number of heavy vehicle interactions at Ravensworth mine in 2012 and 2013 all relate to human behaviour.
Also, all of the critical controls identified were administrative controls which rely on human behaviour. Human error is a well-known characteristic of human behaviour that cannot be completely eliminated but systems of work can be made more robust. Technologies are available which offer another layer in the process of minimising risks.
Proximity detection and collision avoidance system
The role of proximity detection systems and collision avoidance systems has been highlighted in recent years. MDG 2007 (February 2014) the Guideline for the selection and implementation of collision management systems in mining has been developed for use by coal mines, metalliferous mines and quarries. It provides guidance for an operator to select and implement a suitable system for their operation as well as providing consistency across the mining industry.
MDG 2007 states that a collision management system needs to provide additional layers of protection to reduce the risk of collision interaction where other types of controls are not effective or impractical to apply. It is not intended that the system replaces existing administrative controls (eg, induction, training, etc) but will be elevated within the hierarchy of controls to ensure that the risks associated with interactions are minimised.
Many mining operations are exploring the potential of introducing proximity detection. The
benefits of avoiding predictable human errors in respect to positioning around machinery by warning personnel or slowing/stopping machinery movements can provide an engineering solution to a hazard (or unwanted event).
Guidelines for heavy vehicle lighting and reflective materia
The Guideline for Mobile and Transportable Equipment for Use in Mines (MDG 15) (March 2002) was compiled to assist manufacturers, purchasers, owners, operators, site contractors and the department’s mining inspectorate when assessing safety aspects of mobile and transportable equipment used at mines, including surface coal mines.
Section 3.11.3 Reflectors/lights, requires that adequate reflectors, reflective tape and/or lights shall be provided on all equipment to make it readily visible from any direction and hence reduce the likelihood of a collision.
This includes but is not limited to:-
- a) lights or reflectors visible from the side arranged in strips to assist in identifying the length of the equipment (this applies in particular to dump trucks)
- b) the front head board or highest extremity of all trackless equipment to provide visibility inundulating terrain.
It is noted this guideline does not provide specific detail about the type and location of lights and reflectors on heavy vehicles.
Additional observations regarding the mine’s risk management proces
The following observations were made during the investigation:
- There was no distinction drawn in risk assessments and control measures concerning the interaction of heavy and light vehicles between night and day time operations.
- No risk assessments regarding the suitability of the visibility devices on light vehicles and haul trucks were conducted between 1 January, 2013 and 30 November, 2013.
- No formal analysis had been undertaken to determine the need to separate light and heavy vehicles on the mine haul or access roads.
- The mobile equipment risk assessment conducted in July, 2012, had only four team members involved and only two of them were operators. The risk assessment review team did not represent all of the stakeholders that could be affected by the outcomes.
- Design specifications for the intersection were unable to be located.
- There were no risk assessments specific to the intersection identified.
- The reverse camera not working on the truck was not classified as a safety critical defect under the mine’s defect management system. As such the truck could continue to be used.
- There was no procedure regarding the transportation of operators to crib huts for crib breaks.
A safety climate survey was completed by 305 Ravensworth mine workers (100 per cent of the workforce) in November, 2012. The survey report noted that overall the worksite safety climate was fair and moderately strong.
The report noted that the frequency of near-misses and minor safety events were fairly prevalent across the site and respondents indicated they were not always compliant with safety procedures.
Priorities identified in the report were as follows:
- The extent to which workers are encouraged to contribute to and get involved in safety initiatives onsite.
- Perceptions of supervisor production pressure.
- Between-team safety communication quality.
- Willingness to report errors and mistakes to the organisation.
- Work-safety tension, in particular, the perception that tasks and duties performed as part of standard work practice can interfere with staying safe.
- Fatigue management, in particular, more effective strategies to improve the sleep quality of workers during nightshifts and intervene in the relationship between sleep quality and incidents.
With regard to fatigue management recommendations, the report identified that the mine may consider revising their roster to reduce night work.
Ravensworth mine introduced an external contractor to ensure pre-operational safety inspections were being completed on a 24-hour basis.
Draft guideline for intersection
Glencore developed a draft guideline for intersections and site standards were reviewed against this guideline. A draft intersection approval assessment checklist was developed for future intersection construction.
In accordance with a statutory improvement notice issued by the inspector of coal mines dated 1 December, 2013, all ‘GIVE WAY’ signs were changed to ‘STOP’ signs.
An intersection signage review was completed on 7 May, 2013.
The review considered the incident intersection and as a result the signage remained a ‘STOP’ sign due to there being less than 30m of flat ground prior to the intersection and because water pools on the ramp. Some other mine intersections reverted to “GIVE WAY” signs.
An intersection review was conducted which covered the intersection. It noted “most corne bunds lowered” and “consider a process to ensure that water does not capture at the bas of… [8th] ramp…”
The truck recessed ligh
The right hand side low beam light of the truck was relocated forward at the request of the site check inspector. The work order for this noted that it was done to allow for unrestricted vision.
Light vehicle competenc
Trainees now receive a 12-hour shift of instruction on driving a light vehicle in the hours of darkness. Trainees are now required to complete a series of skidpan exercises, includin descending a wet ramp and controlled braking in wet conditions.
Dump truck visibility tria
There was a trial of green clearance lights, luminescent paint, and reflective tape on certain haul trucks to attempt to improve truck visibility.
The incident highlights the importance of having an effective risk management program in relation to the interaction of light vehicles and heavy vehicles at open cut mines.
The following recommendations are advanced to improve industry safety and reduce the likelihood of similar incidents occurring in the future. When considering the recommendations below, mine operators are reminded of their obligation to take a combination of measures to minimise the risk, if no single measure is sufficient for that purpose.
Recommended practice for industry
- Consider separation of light vehicles and heavy vehicles on haul roads.
- Consider alternatives to the use of light vehicles for personnel transport while heavy vehicles are being operated on haul roads.
- Consider the use of traffic management systems which manage vehicle interactions at intersections, ie, traffic signals, warning lights and hard barriers.
- Ensure appropriate road grades, lines of sight, windrow heights, speed limits and signage at intersections.
- Consider the location and impact of background lighting and its potential to disorientate or confuse operators while driving on haul roads and at intersections.
- Consider dedicated haul road and intersection lighting and ensure lighting is adequate.
- Ensure haul roads and intersections are adequately maintained on a regular basis.
- Consider the visibility of heavy vehicles and in particular haul trucks during night operations. Consideration should be given to the location, cleanliness and operation of vehicle lighting and the use and positioning of reflective materials, to enhance visibility of the vehicle.
- Consider the use of proximity detection and collision avoidance systems on light vehicles and heavy vehicles.
- Ensure daily inspections of haul roads and intersections are carried out by a competent person.
- Undertake regular documented surface transport management audits and risks assessments on all mine roads and intersections, which consider both day and night operation. With regard to fatigue management recommendations, the report identified that the mine may consider revising their roster to reduce night work