Less than one-third of the F6 meets internationally recognised minimum safety standards, according to a report just released.
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The Australian Road Assessment Program (AusRAP) report also gave 13 per cent of the freeway the minimum one-star rating, including a section of the freeway at the foot of Mt Ousley and a stretch that includes the Picton Road intersection.
The report assessed 4738 kilometres of NSW and ACT roads with sections rated on a scale of one to five stars, with one star being the least safe and five stars the safest.
Safe roads include design elements such as dual-lane divided carriageways, good line marking and wide lanes, while lower-rated roads are likely to have single lanes and be undivided with poor line marking and hazards close to the road.
For sections of the F6, factors such as the curvature of the road or steep grades led to the one-star rating.
NRMA Motoring and Services deputy president and Illawarra representative Michael Tynan said more attention to safety was needed on the F6.
"The NRMA acknowledges the Australian and NSW governments' investment in the F6, including the recent announcement of more climbing lanes, however, more is needed to see the road become safer," Mr Tynan said.
He said deaths and injuries on NSW roads cost the community on average, $2.8 billion each year.
NRMA president Wendy Machin said AusRAP's Safer Roads Investment Plans found that a $2 billion spend on roads including the F6 and Federal and Hume highways, targeting six specific safety countermeasures, could deliver $7.1 billion in safety benefits to the community through the avoided cost of crashes.
The six safety measures were roadside barriers, central median barriers, shoulder rumble strips, skid-resistant paved road, protected turning lanes and additional lanes installed at dangerous sections of road.
Last week, University of Wollongong academic Philip Laird warned Mt Ousley Road may soon reach a tipping point when there was too much traffic for the road to handle.
Yesterday, northbound traffic on Mt Ousley was delayed by a three-car accident about 7.40am near Appin Road.
Last week, an accident and a truck fire on separate sides of Mount Ousley Road caused major delays.