Alternative Work Hours and Rest Periods

Application Form
Transport (Rail Safety) Act 2010

Privacy Statement: The Department of Transport and Main Roads is collecting the information on this form for the purposes of assessing an
application for alternative work hours and rest periods for train drivers. This information is required under the Transport (Rail Safety) Act 2010 and
the Transport (Rail Safety) Regulation 2010. Authorised departmental officers will have access to this information and will not disclose your personal
information to any third party without your consent, unless required to do so by law.

Note: In accordance with the Transport (Rail Safety) Regulation 2010, a train operator (defined, for the purposes of this application, as a rail
transport operator who is a rolling stock operator for a freight train or passenger train) must comply with the standard work hours and rest periods
specified in the Regulation for train drivers, unless the train operator has an approval of alternative work hours and rest periods for train drivers.

Please use this form if your wish to apply for an approval of alternative work hours and rest periods for your train drivers, or for variation of an
existing alternative work and rest hours approval.

The Department of Transport and Main Roads will notify you in writing when an application is approved or refused, or if further information is
required.

Please indicate whether the application is:

A new application for an approval of alternative work hours and rest periods for train drivers.
An application for variation (that is, an amendment) to an existing alternative work and rest hours approval.

Applicant Details

Name of accredited train operator

Trading name (if applicable)

Australian Company Number (ACN) or Australian Business Number (ABN)

Registered office address

Postal address

Email address Phone number

Name of key contact representative for the application

Position/Title

Email address Phone number

Railway Operations

Describe the scope and nature of the railway operations relating to the application for alternative work hours and rest periods. For
example:
The railway tracks, and routes, in relation to which the railway operations are carried out; or
The type of train used to carry out the railway operations; or
The type of service provided by the railway operations.

Alternative work hours and rest periods for which approval/variation of approval is sought

Provide details of the alternative work hours and rest periods the subject of the application for approval or variation of approval. (Note:
Attach relevant documents if required.)

Alternative work hours and rest periods under a corresponding law

Do you have alternative work hours and rest periods approved under a corresponding law? (For example, are you exempt from the
requirement to comply with the special fatigue management program requirements in respect of certain rail safety work carried out
within NSW)?
Yes
No

If yes, provide details.

Have you applied for approval of alternative work hours and rest periods under a corresponding law?
Yes
No

If yes, provide details.

Alternative work hours and rest periods management plan

Insert below the alternative work hours and rest periods management plan (or for a variation - the amended alternative work hours and
rest periods management plan), which includes the following details:
The alternative work hours and rest periods, and the railway operations to which the work hours and rest periods apply.
Identification and assessment of any additional risks to the safety of railway operations likely to result from the alternative work
and rest periods.
Any measures to manage the additional risks identified.
(Note: Attach relevant documents if required.)

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Consultation requirements

Provide details on the consultation undertaken about the proposed alternative work hours and rest periods management plan, to
include:
The person, or groups of persons, consulted (including the rail safety workers likely to be affected, their workplace health and
safety representatives, and/or their union representative/s.)
When and how the consultation was carried out.
Views expressed by the persons consulted about the proposed management plan.
Any changes made to the management plan as a result of the consultation.
(Note: Attach relevant documents if required.)

Declaration about the application

All supporting documentation required in the above sections are submitted with this application.
Yes
No

If no, provide details.

Applicants Declaration

I declare that the information provided in this application and any supporting documentation for an approval of alternative work hours
and rest periods for train drivers under the Transport (Rail Safety) Regulation 2010 is true and correct.

Name of applicant

Signature Date

How to lodge this application

Have you:

Completed all relevant sections of this application form?

Provided clear references to attachments or referenced documents?
Attached your alternative work hours and rest periods management plan?
Signed the application form?

This application should be lodged in hardcopy (or electronically as a pdf file with relevant signatures) to the Rail Safety
Regulator at:

Rail Regulation
Department of Transport and Main Roads
PO Box 673 Fortitude Valley QLD 4006
Email: rsr@tmr.qld.gov.au

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Approvals (Office Use Only)

Assessment of the application

Comments about the application

Recommended for approval?

Yes, with standard conditions

Yes, with additional condition/s
No

Reason/s for the decision

Approval

Details of the approval of alternative work hours and rest periods or variation of the alternative work and rest hours
approval

Any additional condition/s imposed by the Rail Safety Regulator

Name and position title of Rail Safety Officer

Signature of Rail Safety Officer Date

Approved?

Name and position title of approving officer

Signature of approving officer Date

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