Inquiry Search
Rec-ID | Code | Recommendation |
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REC314-3259 | 32 - Doctrine, standards, and reform | Implement previous review recommendations for bushfire management including those relating to the 2009 amendments to the Fire and Emergency Services Act 2005, State Bushfire Coordination Committee operation, State Bushfire Management Plan, as well as urgent completion of Codes of Practice for fuel hazard reduction on all land tenures, and redevelopment of Bushfire Management Area Plans accompanied by effective community engagement to build an understanding of risk. |
REC314-3269 | 32 - Doctrine, standards, and reform | Develop and practice procedures for the CFS, DEW and local governments to access and deploy heavy plant and machinery for fuel reduction operations both before and during bushfires. |
REC314-3267 | 16 - Training and behaviour | Invest in fireground leadership and incident management training for CFS, SES and MFS personnel to improve safety on the fireground. Invest in greater technological interoperability such as AVL, Thermal Imagery, Burnover Protection Systems (BOPS), lightning tracking and appropriate vehicle fleets for bushfire conditions including at the peri-urban interface. |
REC314-3262 | 10 - Infrastructure | Invest in upgrading and integrating ICT platforms to eliminate manual data transfers, and ensure IT and radio communication interoperability across the agencies, together with a dedicated focus on the development of a coordinated risk intelligence capability to provide all stakeholders with a common operating picture and rapid damage assessments. |
REC314-3261 | 24 - Govt responsibility | Consider amending the Fire and Emergency Services Act 2005 to align SAFECOM Board operations with accepted governance standards with the Minister appointing an Independent Chair of the SAFECOM Board. The SAFECOM Chief Executive (CE) should report to the Board and maintain SAFECOM’s role at the direction of the Board. Alternatively, SAFECOM could be abolished, moving to a model of a Department of Fire and Emergency Services where the departmental head reports to the Minister but the value proposition of any such machinery of government change would need to be thoroughly examined. |
REC314-3260 | 32 - Doctrine, standards, and reform | Align risk assessment tools and processes to Risk Management Standard ISO 31000 and the National Emergency Risk Assessment Guidelines (NERAG) and communicate these on public-facing platforms. Make Bushfire Management Area Plans (BMAP) accountable for managing and reporting on region-specific risk and identifying critical infrastructure such as mobile phone towers as key risks. |
REC314-3272 | 10 - Infrastructure | Clarify business continuity and restoration of critical infrastructure in the planning and response phases to facilitate water replenishment, fireground remediation and access to businesses (including farming properties). |
Rec-ID | Code | Recommendation |
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REC302-2399 | 24 - Govt responsibility | Implement a fully integrated civilianised single call and dispatch centre, that includes a redundancy option outside the Sydney CBD, which will adopt an agnostic approach to deploy the quickest most suitable resource to an emergency. Such a centre should be managed by either a non uniformed public servant staffed organisation like the Office for Emergency Management, or the NSW Police Force |
REC302-2395 | 32 - Doctrine, standards, and reform | Remove those policies, guidelines, memoranda of understanding and committees that are made redundant as a result of adopting recommendation #2 while updating any remaining policies that are considered to still be relevant |
Rec-ID | Code | Recommendation |
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REC301-2387 | 32 - Doctrine, standards, and reform | TFS, PWS and STT agree an updated version of the Interagency Fire Management Protocol which maintains the principle that there will be one state-wide point of command for major unwanted fires burning in the State of Tasmania, explicitly recognises the right of each of TFS, PWS and STT to have their objectives prioritised in incident action planning and adequate resources applied to those objectives, and provides a mechanism for executive decision-makers from TFS, PWS and STT to come together and agree objectives and resourcing levels that will then be operationalised by whole-of-State control structures. |
Rec-ID | Code | Recommendation |
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REC296-1359 | 10 - Infrastructure | Renegotiate the maintenance contract at the end of the current contract and have DPTI through AGFMA take on the maintenance contract. |
REC296-1353 | 10 - Infrastructure | Regular annual testing at 100% on a load bank needs to be scheduled into a maintenance schedule. |
REC296-1358 | 10 - Infrastructure | If the existing generator is capable of providing the current essential power requirements then the generator needs a major inspection and overhaul all items that may need to be replaced due to age and condition. This includes checking compression, oil pressure, coolant pumping and all other critical components and may actually require providing a temporary generator while the Hospital generator receives a major inspection and possible re build. A ball park figure to do this would be $50,000.00 plus cranage and transport to Detroit workshop probably another $10,000.00 then a temporary generator would need to be hired and installed which could run into $10’s of thousands of dollars depending on how long the engine was out of service. For the money that would be spent checking and rebuilding the existing engine it would be recommended to replace the generator with a new generator. |
REC296-1363 | 10 - Infrastructure | Due to the age of the generator, reliability and reparability risk due to age and the apparent under capacity of the generator it is recommend to replace the generator with a new generator and associated control system designed for the current load requirements and allowance for some future expansion. |
REC296-1352 | 10 - Infrastructure | A monthly testing regime needs to be developed that will allow the generator to be tested at full essential load capacity and to ensure that 4 hour monthly testing can be done every month. |
REC296-1357 | 10 - Infrastructure | Monthly test results need to be accurately recorded. |
REC296-1362 | 10 - Infrastructure | Carry out a detailed audit of the current Hospital essential loads to determine the current load requirements of the Hospital. |
REC296-1351 | 10 - Infrastructure | From the above assessment determine the existing generator load requirements and provide a new generator to meet those loads. |
REC296-1356 | 10 - Infrastructure | Accurate records need to be provided as to what is done for each service. |
REC296-1361 | 10 - Infrastructure | Prepare and carry out a testing regime and testing strategy and ensure testing of the generator is done every month for 4 hours over that month and under full Hospital load with test result recorded every 15 minutes. |
REC296-1350 | 10 - Infrastructure | Remove any loads that do not need to be on essential power. |
REC296-1355 | 10 - Infrastructure | Replacement of all original pipes and hoses not yet done. |
REC296-1360 | 10 - Infrastructure | Carry out regular load bank testing on the generator with a load bank large enough to fully load the generator to 110% which will clean out the engine and also identify whether the generator is capable of providing full load for a sustained length of time. |
REC296-1349 | 10 - Infrastructure | Conduct an assessment of the current essential loads and determine if there are loads that should not be on essential power. |
REC296-1354 | 10 - Infrastructure | Monthly and annual maintenance servicing needs to be scheduled for the generator to DPTI or CHSA schedule requirements. |
Rec-ID | Code | Recommendation |
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REC295-1291 | 24 - Govt responsibility | That the Flood Reform Task Group, as proposed by the Department |
REC295-1323 | 32 - Doctrine, standards, and reform | Review and update the role, function, workload and focus of the groups/committees that contribute to incident management and emergency management capabilities including the State Emergency Management Training Committee, Interagency Incident Management Sub-Committee and the Central Exercise Writing Team. |
REC295-1308 | 24 - Govt responsibility | That the Department of the Premier and Cabinet revise the ministerial documents relating to emergency management. |
REC295-1333 | 32 - Doctrine, standards, and reform | Develop a State Relief and Recovery Plan as a distinct part of the State Emergency Management Plan which should include: a) potential locations for suitable facilities for relief and recovery centres which: are in locations safe from hazards such as flooding and bushfire; and, have appropriate access and suitable ablutions. b) formalisation of roles and capabilities of non-government organisations such as Red Cross |
REC295-1277 | 32 - Doctrine, standards, and reform | That the Department of Planning, Transport and Infrastructure review their Business Continuity Plan to: |
REC295-1313 | 16 - Training and behaviour | That regular training and exercising is conducted for all State Emergency Centre participants including Liaison Officers. |
REC295-1284 | 16 - Training and behaviour | Deliver consistent and regular training in the use of the SA Government Radio Network to all users to maximise the efficiency and effectiveness of the network in times of emergency e.g. reduce the issues associated with network busy signals. |
REC295-1290 | 32 - Doctrine, standards, and reform | Continue development of the Damage Assessment Support Plan to: |
REC295-1321 | 16 - Training and behaviour | Through the Emergency Management Workforce Project, identify and provide training and development for SA’s emergency management sector personnel (government agencies, and non-government agencies including volunteers). State Emergency Management Committee should consider supporting recommendations from stage two of the project when the project report is tabled. |
REC295-1303 | 16 - Training and behaviour | That the State Emergency Service be provided with resources to enable them to deliver swiftwater awareness training to all first responders including emergency services, SA Police and council crews. |
REC295-1332 | 32 - Doctrine, standards, and reform | Develop a Disaster Waste Management Plan to form part of the State Emergency Management Plan which describe participating agencies and responsibilities for various aspects of waste management during and after emergencies. |
REC295-1312 | 24 - Govt responsibility | That the Department of Education and Child Development be included as a member of State Emergency Management Council and represented in the State Emergency Centre. |
REC295-1282 | 32 - Doctrine, standards, and reform | That the Office for Digital Government, in close partnership with telecommunications companies (e.g. Telstra, Optus, Vodaphone), develop a Control Agency Plan for Information and Communication Technology including mobile communications. The plan should consider: |
REC295-1289 | 32 - Doctrine, standards, and reform | That SA Police, emergency services, health facilities, utility providers and other key service providers, review their Business Continuity Plans giving consideration to factors such as: a) identification of: business critical needs; essential services power requirements; back-up power requirements for all facilities including State, regional and local facilities such as Police, SES, MFS and CFS stations; the need for any arrangements for back-up power to be included in contracts for design and or lease of Government premises b) contingencies for black system events and extended power outages c) regular back-up generator testing regime protocols, including testing under load and for long durations d) contingencies for communications when mobile, landline and/or radios are not operational e.g. satellite phones; and e) alternative State control centre facilities that are pre-identified, equipped and have procedures for moving to the alternative facility. |
REC295-1319 | 24 - Govt responsibility | That a single emergency service multi-agency control centre be established with sufficient capacity and capability to deal with all types of emergency incidents in SA. Also consider Police and State Emergency Centre. |
REC295-1301 | 32 - Doctrine, standards, and reform | Establish an ‘Interstate Deployment Support Plan’ for incoming interstate resources. The plan should outline responsibilities and arrangements for this function. Consider including this plan into the State emergency management arrangements. |
REC295-1331 | 32 - Doctrine, standards, and reform | Task South Australian Fire and Emergency Services Commission with further developing the Emergency Alerts capability across government agencies including to: a) establish and maintain a centralised training program for emergency alert initial and refresher training. b) establish a pool of endorsed Emergency Alert personnel from across government agencies to enable control agencies to assist each other with the emergency alert function during emergencies. c) develop supporting processes to ensure that the capability supports: emergencies involving any hazard; consistent issuing of alerts and warnings; consistent messages; and effective communication and notification of alerts issued to relevant internal and external stakeholders |
REC295-1311 | 32 - Doctrine, standards, and reform | That the State Emergency Management Plan be reviewed and updated including: a) a better description of the responsibilities of Hazard Leaders Page xx b) establish a mechanism for a hazard leader to identify systemic failures in coordination of their hazard, with a clear process to raise those issues with SEMC and seek a remedy c) establish resilience as a key heading in the plan, with clearly documented strategies and responsibilities; and d) consider the Schar/Mulroney submission and taking a ‘fresh eyes’ approach |
REC295-1281 | 32 - Doctrine, standards, and reform | In order to increase resilience and public safety during emergencies, the State Emergency Management Committee should request the Australia and New Zealand Emergency Management Committee to place on the agenda, and consider establishing a national position, on redundancies for mobile communications (including phone tower back-up power) and the National Broadband Network. |
REC295-1318 | 24 - Govt responsibility | That the recommendation made following the Pinery bushfire, ‘to review control facilities at State, region and incident level’, be expanded to include all emergency services facilities that will be utilised for major incidents other than bushfire e.g. flood and earthquake and to also be extended into metropolitan areas, and implemented. |
REC295-1288 | 24 - Govt responsibility | That Attorney General’s Department explore options to overcome fatigue and welfare issues of SAGRN staff associated with emergency events of extended duration. |
REC295-1295 | 32 - Doctrine, standards, and reform | That resources be provided to support the implementation of recommendations in the South Australian Levee Bank Management Issues Paper (DEWNR, 2015) including: a) development of relevant policy; and b) identification of responsibilities in relation to levee management and flood mitigation |
REC295-1330 | 32 - Doctrine, standards, and reform | Update the Public Information Functional Support Group Plan to include: a) standards, outputs, systems and processes required to be used by control agencies and the Public Information Functional Support Group during emergencies b) guidance on the public information cycle through the prevention, preparedness, response and recovery phases which includes the responsibilities and information requirements during different phases, and effective transition between phases c) establishing a public information intelligence cell within the Public Information Functional Service Group; and d) identifying tools or resources to monitor social media |
REC295-1310 | 32 - Doctrine, standards, and reform | That additional guidance be provided in the State Emergency Management Plan regarding the activation, structure and operation of Zone Emergency Support Teams. This should include: a) the reporting relationship between the Zone Emergency Support Teams, the State Emergency Centre and the State Coordinator b) briefing requirements between the State Coordinator (or their representative) and the Zone Emergency Support Teams when the State Emergency Centre is activated c) responsibilities for provision of local public information; and d) the appointment of public information officers in Zone Emergency Support Teams (where there is no incident management team (established) to provide information to local communities |
REC295-1280 | 32 - Doctrine, standards, and reform | That a State Plan be developed for managing the consequences of a black system event or other major power outage. The plan should include: |
REC295-1316 | 24 - Govt responsibility | That the position of Deputy Director, Office for Digital Government is dedicated to the Office for Digital Government; and that people throughout DPC are identified and trained to perform appropriate roles within the State Crisis Centre |
REC295-1287 | 32 - Doctrine, standards, and reform | That the glossary of terms in the State Emergency Management Plan be reviewed to ensure all relevant language is included. All agencies need to ensure the use of clear communication and accurate use of terminology, including in describing the status of critical services e.g. Triple Zero (000), SA Government Radio Network, electrical and water supplies and infrastructure. |
REC295-1292 | 32 - Doctrine, standards, and reform | That, giving consideration to the previous recommendation, the Flood |
REC295-1324 | 16 - Training and behaviour | Establish a State incident management and emergency management training capability which provides for: a) consistent training across the State b) personal development and endorsement processes for roles c) identification, recruitment and development of personnel from other government agencies; and d) incident management and State emergency centre functional role training and development across all sectors. e) skills maintenance including upskills, refresher training and exercises f)incident and strategic leadership training g) consistent training for inter-agency liaison officers at all levels |
REC295-1309 | 32 - Doctrine, standards, and reform | That members of Emergency Management Council ensure they are prepared to undertake their roles and responsibilities during emergency events, including establishing: a) contingencies for communication e.g. satellite phone b) access to relevant documents such as the State Emergency Management Plan, supporting plans, ministerial guidelines, agency plans and contacts in hard copy and/or portable device c) formalised arrangements for briefings (up and down), and d) arrangements for suitable representation e.g. relevant Chief Executive(s) or their deputy, at all Emergency Management Council meetings . |
REC295-1279 | 10 - Infrastructure | Install UPS on traffic lights on main Central Business District (CBD) and arterial roads to allow an effective movement of traffic during a loss of power. |
REC295-1314 | 32 - Doctrine, standards, and reform | That an Emergency Management Assurance Framework be established as soon as possible to support the emergency management arrangements and the State Emergency Management Plan. Consider establishing an Inspector General Emergency Management department or position. |
REC295-1286 | 10 - Infrastructure | That the Attorney General’s Department consult with local government regarding potential for them to provide logistical support associated with backup power supply to SA Government Radio Network towers in the event of an emergency. |
Rec-ID | Code | Recommendation |
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REC291-1248 | 24 - Govt responsibility | The State Emergency Management Committee to establish a State Bushfire Coordinating Committee as a sub-committee of SEMC. The State Bushfire Coordinating Committee will be chaired by the Director of the Office of Bushfire Risk Management and will have the primary responsibility to: · develop a State Bushfire Management Policy and a set of long term bushfire risk management objectives; · provide a forum for key bushfire risk management stakeholder agencies; · advise the SEMC on matters pertaining to bushfire, in particular, to report against the investment in, and achievement of the bushfire risk management objectives; · provide advice and support to the proposed Chief Officer of the Rural Fire Service on bushfire risk management matters; and · report to SEMC and to the community on bushfire risk management matters on at least an annual basis. |
REC291-1247 | 32 - Doctrine, standards, and reform | The State Government to create a Rural Fire Service to enhance the capability for rural fire management and bushfire risk management at a State, regional and local level. The proposed Rural Fire Service will: · be established as a separate entity from the Department of Fire and Emergency Services or, alternatively, be established as a sub-department of the Department of Fire and Emergency Services; · have an independent budget; · be able to employ staff; · have a leadership structure which, to the greatest degree possible, is regionally based and runs the entity; · be led by a Chief Officer who reports to the responsible Minister on policy and administrative matters; and to the Commissioner for Fire and Emergency Services during operational and emergency response; · have responsibilities and powers relating to bushfire prevention, preparedness and response; and · operate collaboratively with the Department of Fire and Emergency Services, the Department of Parks and Wildlife, Local Government and volunteer Bush Fire Brigades. In creating the Rural Fire Service, the State Government to consider whether back office and corporate support services could be effectively provided by an existing Department, such as the Department of Fire and Emergency Services or the Department of Parks and Wildlife. The State Government to review the creation of the Rural Fire Service two years after its establishment, to assess whether its structure and operations are achieving the intended outcome. |
REC291-1238 | 32 - Doctrine, standards, and reform | The State Emergency Management Committee to adopt, across all hazards, the doctrine of: · the primacy of life; · the ‘Strategic Control Priorities’ (as documented by the Department of Fire and Emergency Services); and · community warnings that are timely, tailored and relevant. Agencies will reinforce amongst emergency management personnel the importance of this doctrine through briefings and intent statements. |
Rec-ID | Code | Recommendation |
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REC287-1189 | 16 - Training and behaviour | That suffcient Tasmanian firefghters are trained in winch operations to sustain a ‘first strike’ capability until they can be reinforced (if necessary) by interstate capability; and that consideration be given to how winch-capable aircraft can be sourced to support this activity at fire incidents. |
REC287-1187 | 16 - Training and behaviour | All Tasmanian fire agency staff who are assigned to aviation-related roles be required to complete the formal nationally recognised training appropriate to that role. Tasmanian fire agencies arrange secondments to larger states for staff who are going to undertake aviation-related roles, to give them practical experience of the role in advance of any major incidents. |
REC287-1184 | 24 - Govt responsibility | The Tasmanian fire agencies think more broadly about how staff who are already employed by Government could support the management of future emergencies. |
REC287-1183 | 16 - Training and behaviour | Further conversations take place between TFS and SES to identify what skills and capabilities may be transferable between the agencies, not just in the event of a future fire, but in case of future hazards for which SES is the primary response agency, including food, earthquake and tsunami. |
REC287-1182 | 32 - Doctrine, standards, and reform | The fire agencies consider how the Regional Fire Operations Centre (RFOC) as a concept adds value once a level 3 IMT is up and running in a region. |
REC287-1190 | 16 - Training and behaviour | That a full review be undertaken of the benefts and costs of training a cadre of Tasmanian volunteer firefghters in remote area firefghting, with reference to the experience of jurisdictions interstate that already do so. |
REC287-1181 | 16 - Training and behaviour | The Tasmanian fire agencies develop a multi-agency position to ensure that training for incident controllers includes training in how the transition from local incident control to Divisional Command is managed. |
Rec-ID | Code | Recommendation |
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REC284-1365 | 10 - Infrastructure | The electrical master plan for the site should be updated to include planning for the scheduled replacement or refurbishment of those parts of the infrastructure that have not been renewed in the last 10 years. This planning to consider other upgrades or plans for the FMC overall. |
REC284-1370 | 10 - Infrastructure | Review control system for the main generator normal/essential changeover system and ensure that it has effective backup/manual or redundant operations, and suitable testing facilities. The Essential board that supplies the main generator power to Blocks A, B, C (except theatres), D, E (except certain critical engineering plant) (MD-1-4P-10E), is a potential single point of failure of a significant portion of the emergency power system and as part of the Master Plan update should be considered as a priority. |
REC284-1369 | 10 - Infrastructure | Review all generator locations for arrangements for temporary generator installation, including design of modifications as required for electrical connections and spatial requirements at installation locations, to be documented in an emergency procedure. |
REC284-1374 | 10 - Infrastructure | Provide walls around critical electrical infrastructure within the main plant area to provide security and protection from catastrophic water system failures. |
REC284-1368 | 10 - Infrastructure | Improvements to installation to be implemented as follows: - Lighting within the generator enclosure and immediately adjacent to be emergency battery-backed type. - Improvements to the spatial layout within the main generator enclosure should be investigated, including allowance for the control panel door to open 180o (only 90o currently); moving the fuel pumps to a more accessible location, and ensuring clear access to the day tank for manual filling if required. - Improvements to communications facilities between critical areas, including fixed phone line connections between the main control room, main generator control panel in the P (energy) Building, and the generator enclosure, and allowing link to offsite specialist advice. - Where generator maintenance requires operations outdoors (not applicable to main generator, but applicable to others), a shelter over the relevant area should be provided to allow safe work during wet or hot weather. - Written emergency procedures to be prepared covering credible failure scenarios with step by step checklists and recommended actions. |
REC284-1373 | 10 - Infrastructure | Review generator installations details as noted in report and implement physical improvements where possible. |
REC284-1367 | 10 - Infrastructure | Add to generator test procedure a checklist at the end of testing which includes checking that all systems are back to normal positions and includes a requirement to leave the day tank full where there is a bulk tank/day tank arrangement. |
REC284-1372 | 10 - Infrastructure | As part of the electrical master plan update recommended above, a complete and consistent set of single line diagrams describing the electrical distribution network be prepared. Relevant diagrams to be laminated and displayed in the main substations. Labelling to all main electrical equipment be reviewed and updated in accordance with the final documents. |
REC284-1366 | 10 - Infrastructure | A detailed review of the fuel control and BMS systems (for all generators) be carried out and actions taken to: 1) Ensure that the fuel alarm system is operational and properly calibrated, and ensure that the alarms are connected to the BMS. 2) Ensure that the BMS transmits these alarms effectively to the maintenance staff. 3) If this review demonstrates risk of fuel control systems not adequately reporting alarms, consider an independent day tank level switch to be installed in each generator fuel tank, directly connected to the BMS. 4) Consider the feasibility of adding a “fuel system not in auto” or “fuel system fault/fail safe watchdog” or “pre-alarm identifying that the generator is about to shut down without intervention” feature to current systems – subject to details of each individual generator system. |
REC284-1371 | 10 - Infrastructure | Generator dual redundant starter systems should be considered. |
Rec-ID | Code | Recommendation |
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REC273-1145 | 32 - Doctrine, standards, and reform | Review relevant Legislation associated Acts and Plans to establish a consistent approach to fire and emergency management to minimise duplication and risk of contradiction. That the Hazard and Functional area plans be amalgamated and establish a SA Bushfire Plan, under the SEMP, which clearly define role of SACFS. |
REC273-1143 | 32 - Doctrine, standards, and reform | That SACFS in consultation with SAMFS consider adopting common terminology and capability requirements for strike teams being ‘4-5 appliances and a group officer’ in line with other jurisdictions. |
REC273-1133 | 32 - Doctrine, standards, and reform | That a complete review of current naming conventions of personnel and centres, in accordance with the outcomes of the Victorian Bushfire Royal Commission is undertaken, to ensure clarity around command, control and coordination within SA. |
REC273-1129 | 32 - Doctrine, standards, and reform | Incorporating ‘triggers’ within Chief Officers Standing Orders No. 17, which requires the escalation of the State Controller role to the rank of Assistant Chief Officer or greater, depending on the increased risk or activity. |
REC273-1128 | 32 - Doctrine, standards, and reform | Incorporate in operational doctrine the ability for the State Controller to determine the operational readiness levels of the state or regions based on either the predicted and/or actual risk and/or activity to some or all of the regions. |
Rec-ID | Code | Recommendation |
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REC264-1078 | 32 - Doctrine, standards, and reform | The State review and revise the community carbon monoxide response protocol and the firefghter carbon monoxide response protocol, to: |
REC264-1088 | 32 - Doctrine, standards, and reform | GDF Suez adopt and apply the firefghter carbon monoxide response protocol. |
REC264-1077 | 32 - Doctrine, standards, and reform | The State take the lead in advocating for a national compliance standard for PM |
REC264-1085 | 10 - Infrastructure | GDF Suez establish enhanced back-up power supply arrangements that do not depend wholly on mains power, to: • ensure that the Emergency Command Centre can continue to operate if mains power is lost; and • ensure that the reticulated fre services water system can operate with minimal disruption if mains power is lost. |
REC264-1075 | 32 - Doctrine, standards, and reform | The State: • bring forward the commencement date of s.16 of the Mineral Resources (Sustainable Development) Amendment Act 2014 (Vic), to facilitate the requirement that approved work plans specifcally address fre prevention, mitigation and suppression; and • acquire the expertise necessary to monitor and enforce compliance with fre risk measures adopted by the Victorian coal mining industry under both the mine licensing and occupational health and safety regimes. |
REC264-1084 | 32 - Doctrine, standards, and reform | GDF Suez revise its Emergency Response Plan, to: • require an increased state of readiness on days of Total Fire Ban; • require pre-establishment of an Emergency Command Centre; • require pre-positioning of an accredited Incident Controller as Emergency Commander; and • require any persons nominated as Emergency Commander to have incident controller accreditation and profciency in the use of the Australasian Inter-service Incident Management System. |
REC264-1074 | 32 - Doctrine, standards, and reform | The State enact legislation, to: • require Integrated Fire Management Planning; and • authorise the Emergency Management Commissioner to develop and implement regional and municipal fire management plans. |
REC264-1080 | 32 - Doctrine, standards, and reform | The State develop and widely disseminate an integrated State Smoke Guide, to: • incorporate the proposed State Smoke Plan for the management of public health impacts from large scale, extended smoke events; • include updated Bushfre Smoke, carbon monoxide and PM protocols; and 2.5 • provide practical advice and support materials to employers, communities and individuals on how to minimise the harmful effects of smoke. |
REC264-1079 | 32 - Doctrine, standards, and reform | The State review and revise the Bushfre Smoke Protocol and the PM Health Protection Protocol, to: 2.5 • ensure both protocols are consistent with each other; and • ensure both protocols include assessment methods and trigger points for specifc responses. |
Rec-ID | Code | Recommendation |
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REC258-2541 | 16 - Training and behaviour | The Civil Aviation Safety Authority finalises its Capability Framework and overhauls its training program to ensure identified areas of need are addressed, including: |
REC258-2526 | 24 - Govt responsibility | The Australian Government develops the State Safety Program into a strategic plan for Australia’s aviation safety system, under the leadership of the Aviation Policy Group, and uses it as the foundation for rationalising and improving coordination mechanisms. |
REC258-2562 | 32 - Doctrine, standards, and reform | The Civil Aviation Safety Authority amends the current Terms of Reference of the Industry Complaints Commissioner so that: |
REC258-2533 | 32 - Doctrine, standards, and reform | The Civil Aviation Safety Authority: |
REC258-2538 | 32 - Doctrine, standards, and reform | The Department of Infrastructure and Regional Development and Department of Defence (and appropriate agencies) establish an agreed policy position on safety oversight of civil operations into joint user and military airports. |
REC258-2561 | 24 - Govt responsibility | The Australian Government amends regulations so that background checks and the requirement to hold an Aviation Security Identification Card are only required for unescorted access to Security Restricted Areas, not for general airside access. This approach would align with international practice. |
REC258-2531 | 32 - Doctrine, standards, and reform | The Civil Aviation Safety Authority’s Board exercises full governance control. The nonexecutive directors should possess a range of appropriate skills and backgrounds in aviation, safety, management, risk, regulation, governance and government. |
REC258-2537 | 32 - Doctrine, standards, and reform | The Civil Aviation Safety Authority delegates responsibility for the day-to-day operational management of airspace to Airservices Australia, including the designation of air routes, short term designations of temporary Restricted Areas, and temporary changes to the classification of airspace for operational reasons. |
REC258-2555 | 32 - Doctrine, standards, and reform | The Civil Aviation Safety Authority changes the current two-tier regulatory framework (act and regulations) to a three-tier structure (act, regulations and standards), with: |
REC258-2530 | 24 - Govt responsibility | The Australian Government appoints an additional Australian Transport Safety Bureau Commissioner with aviation operational and safety management experience. |
REC258-2536 | 32 - Doctrine, standards, and reform | The Australian Transport Safety Bureau and the Civil Aviation Safety Authority amend the wording of their existing Memorandum of Understanding to make it more definitive about interaction, coordination, and cooperation. |
REC258-2554 | 32 - Doctrine, standards, and reform | Recreational Aviation Administration Organisations, in coordination with the Civil Aviation Safety Authority, develop mechanisms to ensure all aircraft to be regulated under CASR Part 149 are registered. |
REC258-2529 | 32 - Doctrine, standards, and reform | The Australian Transport Safety Bureau and the Civil Aviation Safety Authority utilise the provision in their bilateral Memorandum of Understanding to accredit CASA observers to ATSB investigations. |
REC258-2535 | 32 - Doctrine, standards, and reform | Airservices Australia, in conjunction with the Department of Infrastructure and Regional Development and the Civil Aviation Safety Authority, reconsiders the policy on ‘Assessment of Priorities’ that stipulates that air traffic controllers sequence arriving aircraft based on category of operation, rather than on the accepted international practice of ‘first come, first served’. |
REC258-2542 | 16 - Training and behaviour | The Civil Aviation Safety Authority publishes and demonstrates the philosophy of ‘just culture’ whereby individuals involved in a reportable event are not punished for actions, omissions or decisions taken by them that are commensurate with their experience and training. However, actions of gross negligence, wilful violations and destructive acts should not be tolerated. |
REC258-2527 | 32 - Doctrine, standards, and reform | The Department of Infrastructure and Regional Development plays a stronger policy role in the State Safety Program. |
REC258-2534 | 16 - Training and behaviour | The Civil Aviation Safety Authority develops a staff exchange program with industry. |
Rec-ID | Code | Recommendation |
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REC257-1537 | 32 - Doctrine, standards, and reform | Commanding Officer Defence Explosive Ordnance Training School review and enforce Standard Operating Procedures to ensure that appropriate explosive ordnance accounting and handling practices, in accordance with Defence doctrine, are adhered to during all training activities. |
REC257-1550 | 32 - Doctrine, standards, and reform | Defence engage with both the Bureau of Meteorology and the Rural Fire Service to determine a more suitable index system. In the interim, Range Standing Orders be amended so that live-firing on the ranges on Marrangaroo Training Area not be permitted where the Forest Fire Danger Index for either the Central Ranges District or Greater Sydney Region is 12, it being the threshold for HIGH Fire Danger Rating or above. put another way, and in a practical sense, Range Standing Orders should, as an interim measure, require the Officer in Charge Practice and the Range Control Officer to consider the Forest Fire Danger Index for both Central Ranges District AND Greater Sydney Region on the day of any given serial. If either index is as 12 or above, live-firing should not be permitted. Any indication in Range Standing Orders or elsewhere that live-firing is permitted on Marrangaroo Training Area when the Fire Danger rating is HIGH should be rescinded. |
REC257-1536 | 16 - Training and behaviour | The Australian defence Force Explosive Ordnance Disposal course be reviewed by Manager Joint Training - Air Force, to ensure the assessments meet the learning outcomes specificed in the relevant Training Management Package. |
REC257-1549 | 32 - Doctrine, standards, and reform | Marrangaroo Training Area Range Standing Orders should be reviewed to impose a requirement that the Officer in Charge of any live-firing practice ascertain and consider current weather parameters, temperature, humidity, wind strength and direction, registered at Mt Boyce immediately prior to any demolition serial. The setting of those parameters and their limits should be decided in consulation with the Bureau of Meteorology and Rural Fire Service and inserted into Range Standing Orders. |
REC257-1554 | 32 - Doctrine, standards, and reform | All documents be reviewed to remove ambiguity and perceived inconsistencies. Marrangaroo Training Area Range Standing Orders be subject to further examination, with particular consideration of the bushfire mitigation strategies referred to in the Bushfire Management Plan 2011-2014 before amendments to Chapter 10 are made. the basis upon which Range Standing Orders might fix a cut-off point for live-firing exercises should depend on continued bushfire strategies. Range Standing orders and Marrangaroo Training Area Bushfire Management Plan be reviewed annually. if hazard reduction has not occurred or the fire trails degraded, Range Standing Orders should take into account of heightened risk. |
REC257-1543 | 32 - Doctrine, standards, and reform | Range Standing Orders be amended to include a direction that no Defence vehicle is to leave the administration area of Marrangaroo Training Area during a bushfire, except to leave Marrangaroo Training Area itself through the main gate, unless it is a properly equipped bushfire fighitng vehicle havig at least four wheel drive capabiliy and self-protection equipment. |
REC257-1553 | 32 - Doctrine, standards, and reform | On matters relating directly to safety or risk, or when live-firing may occur, where there is ambiguity or apparent inconsistency, the most conservative or restrctive order should be followed until formal clarification has been provided. |
REC257-1540 | 16 - Training and behaviour | Commanding Officer Defence Explosive Ordnance Training School, assisted by Joint Logistics Command Regional Explosive Ordnance Serices staff, conduct explosive ordnance accounting training for all instructional staff as a matter of priority and that such training be conducted for Defence Explosive Ordnance Training School staff on an annual basis. |
REC257-1552 | 32 - Doctrine, standards, and reform | Authority be given to the regional Environmental Officer to close a range or impose live-firing restriction in addition to any set out in Range Standing Orders if circumstances so warrant. |
REC257-1538 | 32 - Doctrine, standards, and reform | Commanding Officer Defence Explosive Ordnance Training School amend relevant instructions, both generally and specifically, so as to ensure that explosive ordnance used in training serials is logged in real time, in accordance with extant doctrine. |
REC257-1551 | 32 - Doctrine, standards, and reform | The use of Internal and External ranges at MTA for patrolling activities be prohibited. |
Rec-ID | Code | Recommendation |
---|---|---|
REC247-0852 | 32 - Doctrine, standards, and reform | That the role and expected duties of the State Controller be clearly defined in the Emergency Management Act 2006. |
REC247-0908 | 32 - Doctrine, standards, and reform | That the State Emergency Management Committee examine whether there are any legal issues associated with continuing recovery operations where the overarching emergency management arrangements have ceased. |
REC247-0871 | 32 - Doctrine, standards, and reform | That Tasmania Fire Service critically reviews the operation of the Six Operational Priorities to determine whether they are appropriate and effective. |
REC247-0925 | 16 - Training and behaviour | That training and development of personnel to establish a suitable state of readiness, be included in the recommended review by Tasmania Police of its approach to emergency management. |
REC247-0881 | 32 - Doctrine, standards, and reform | That Tasmania Fire Service establishes sufficient resources and expertise to research, develop, implement and review its policies and operations. |
REC247-0940 | 32 - Doctrine, standards, and reform | That the Government actively support the timely development and implementation of an ongoing Strategic Fuel Management Plan. |
REC247-0904 | 10 - Infrastructure | That the Department of Infrastructure Energy and Resources consult Aurora Energy on the use of wooden poles for overhead infrastructure with a view to mitigating the risk in bushfires. |
REC247-0870 | 32 - Doctrine, standards, and reform | That Tasmania Fire Service considers adopting a primary tactic of an aggressive first attack on fires. |
REC247-0924 | 16 - Training and behaviour | That an exercise program — to establish and maintain an acceptable state of readiness for agencies and organisations required to be involved in emergency operations — be developed and implemented. |
REC247-0877 | 32 - Doctrine, standards, and reform | That Tasmania Fire Service reviews its approach to fire management operations at night, and develop and effectively implement unambiguous policy and operating procedures. |
REC247-0936 | 16 - Training and behaviour | That the State Fire Management Committee note the decline in machinery and skilled operators from the forestry industry in the private sector and determines how this reduction in fire management capability can be addressed. |
REC247-0898 | 32 - Doctrine, standards, and reform | That the State Special Emergency Plan–Recovery and the emergency management structure for recovery be reviewed. |
REC247-0869 | 32 - Doctrine, standards, and reform | That Tasmania Fire Service ensures that planning for active fires includes a proactive approach wherever possible. |
REC247-0914 | 32 - Doctrine, standards, and reform | That the Tasmanian Emergency Management Plan includes a comprehensive all hazards communications policy and plan. |
REC247-0876 | 32 - Doctrine, standards, and reform | That Tasmania Fire Service reviews its approach to blacking out and mopping up, including its policies, operating procedures and training. |
REC247-0930 | 32 - Doctrine, standards, and reform | That the State Emergency Management Committee determine suitable risk management tools, such as the Bushfire Risk Assessment Model, and encourages their use in assessing bushfire risk in a consistent manner. |
REC247-0897 | 32 - Doctrine, standards, and reform | That a standing plan is developed to manage the transition from immediate recovery to medium and long-term recovery, and arrangements are made to ensure this plan can be effectively implemented in a timely way. |
REC247-0868 | 16 - Training and behaviour | That Tasmania Fire Service, Forestry Tasmania, and Parks and Wildlife Service have a process for ensuring fire strategy and tactics are appropriate and remain focussed. |
REC247-0913 | 32 - Doctrine, standards, and reform | That the State Fire Commission structures its Tasmania Bushfire Safety Policy so policy outcomes are identifiable and progress in achieving outcomes can be evaluated. |
REC247-0874 | 32 - Doctrine, standards, and reform | That Tasmania Fire Service reviews operational practices to ensure there is continuity of fire operations when fire suppression action is required. |
REC247-0929 | 32 - Doctrine, standards, and reform | That the State Emergency Management Committee considers structuring the Tasmania Emergency Management Plan in a way that provides more specific guidance, commitment to and accountability for action to be taken. |
REC247-0883 | 32 - Doctrine, standards, and reform | That Tasmania Police ensures planning for emergency operations includes a proactive approach wherever possible. |
REC247-0950 | 32 - Doctrine, standards, and reform | That resources are committed to developing and implementing approved reforms to the emergency management arrangements. |
REC247-0864 | 32 - Doctrine, standards, and reform | That Tasmania Fire Service reviews its position on fire ground management to determine whether a unified command model at the fire ground should be adopted. |
REC247-0912 | 32 - Doctrine, standards, and reform | That the State Fire Commission finalise its position on the Tasmania Bushfire Safety Policy without further delay. |
REC247-0872 | 32 - Doctrine, standards, and reform | That Tasmania Fire Service considers what adjustments may be necessary to the promotion and use of the Six Operational Priorities to ensure plans are suitable for the circumstances of each fire. |
REC247-0928 | 24 - Govt responsibility | That the Government take into account demographic change in its assessment of the consequences of climate change on emergency events. |
REC247-0882 | 32 - Doctrine, standards, and reform | That Tasmania Fire Service documents and publishes its operational policies and procedures so they are accessible to and suitable for operational personnel. |
REC247-0949 | 32 - Doctrine, standards, and reform | That following any review, the Emergency Management Act 2006 be amended. |
Rec-ID | Code | Recommendation |
---|---|---|
REC223-0518 | 16 - Training and behaviour | The Department of Environment and Conservation explore human resourcing models that: · make succession planning a priority; · look at options for the attraction and retention of staff; and · review how the salary levels of staff matches the decision making required in major activities such as prescribed burns. |
Rec-ID | Code | Recommendation |
---|---|---|
REC201-0256 | 22 - Role of local Gvt | Noting existing legislative and policy arrangements, there is merit in considering options for the future management of Level 3 fires in Local Government areas. |
Rec-ID | Code | Recommendation |
---|---|---|
REC200-1699 | 24 - Govt responsibility | The State Government ensure that the continued development of the Fire and Emergency Service Authority's Integrated Bushfire Risk Management System is dependent on an independent comparative assessment of its functionality and cost-effectiveness against the Spatial Support System used by the Department of Environment and Conservation. |
REC200-0382 | 32 - Doctrine, standards, and reform | Emergency Management Western Australia and the State Emergency Management Committee amend WESTPLAN-BUSHFIRE to require State Emergency Coordination Group meetings to be held at the State Coordination Centre in West Leederville. |
REC200-1730 | 16 - Training and behaviour | The Fire and Emergency Services Authority and local governments examine the current competencies of Chief Bushfire Control Officers and Community Emergency Services Managers (or Community Fire Managers) and consider what further development is needed to ensure these staff are capable of: |
REC200-0341 | 32 - Doctrine, standards, and reform | The State Government give legislative effect to the Planning for Bush Fire Protection Guidelines. |
REC200-1712 | 10 - Infrastructure | FESA and local governments jointly review radio communications capability prior to the 2011/12 bushfire season with a view to improving the current delivery of service to firefighters. |
REC200-1681 | 24 - Govt responsibility | The State Government transfer responsibility for declaring bushfire prone areas from local government to the Western Australian Planning Commission. The Western Australian Planning Commission should urgently assess those areas that should be declared bushfire prone. |
REC200-0362 | 32 - Doctrine, standards, and reform | The Fire and Emergency Services Authority immediately comply with the provisions of WESTPLAN BUSHFIRE and formally declare incidents at their appropriate level and document and communicate those decisions in a similar way to the systems used by the Department of Environment and Conservation and the Western Australian Police. |
REC200-1720 | 32 - Doctrine, standards, and reform | The State Emergency Management Committee amend State Emergency Management Policy 4.1 (Operational Management) to: |
REC200-1696 | 32 - Doctrine, standards, and reform | The State Government reaffirm its 2009 decision to approve DEC exercising greater flexibility in managing smoke within national guidelines, in order to achieve its prescribed burn program. |
REC200-0380 | 32 - Doctrine, standards, and reform | The State Emergency Management Committee amend State Emergency Management Policy 4.1 (Operational Management) to: give clear and explicit direction about when and how an incident should be declared clearly articulate the actions to be taken clearly define accountabilities provide detailed criteria for elevating issues and engaging other agencies. |
REC200-1729 | 22 - Role of local Gvt | The Fire and Emergency Services Authority and local governments ensure that Community Emergency Service Managers are physically based in local government. |
REC200-0339 | 32 - Doctrine, standards, and reform | Emergency Management Western Australia establish an inter-agency working group to continue the development of the new single emergency services Act. |
REC200-1709 | 32 - Doctrine, standards, and reform | The Western Australian Police and the Fire and Emergency Services Authority jointly examine the Traffic Management System developed in response to the 2009 Victorian bushfires and seek its adaptation to use in WA with additional attention to the access and egress by bona fide residents to areas that are evacuated. |
REC200-0354 | 22 - Role of local Gvt | Local governments consider increasing the number of green waste collections carried out each year to encourage a more proactive approach to property (and vegetation) maintenance by residents. |
REC200-1719 | 24 - Govt responsibility | The State Government recognise the projected changes in climate and potential impact on future fire events. |
REC200-1695 | 22 - Role of local Gvt | The Western Australian Local Government Association explore the feasibility of local governments utilising aerial and satellite imagery to monitor firebreaks and fuel loads on private property. |
REC200-0379 | 24 - Govt responsibility | The State Government recognise the projected changes in climate and potential impact on future fire events. |
REC200-1728 | 24 - Govt responsibility | The Water Corporation immediately review the outstanding orders for hydrant repairs and develop strategies to reduce the backlog. |
REC200-1704 | 32 - Doctrine, standards, and reform | The Fire and Emergency Services Authority review its use of the Australian Interagency Incident Management System to ensure that the most appropriate resources (including aerial resources) are used to respond to an incident. If resources are rejected during an incident either through the decision making process or other grounds, the reason for the decision should be documented. |
REC200-0353 | 22 - Role of local Gvt | The State Government give its full support to the Western Australian Local Government Association’s Send to Solve initiative. |
REC200-1717 | 24 - Govt responsibility | The State Government mandate that the title deeds for relevant properties be amended to indicate if the property is in a declared bushfire prone area. |
REC200-1694 | 24 - Govt responsibility | The State Government give its full support to the Western Australian Local Government Association's Send to Solve initiative. |
REC200-0375 | 22 - Role of local Gvt | Local governments institute a comprehensive program to assess fuel loads and bushfire preparedness on private properties. The program should give reference to the creation and maintenance of a Building Protection Zone, in line with FESA guidelines. This program should be implemented and managed under the Bush Fires Act 1954 in a manner similar to the fire break inspection program. |
REC200-1727 | 24 - Govt responsibility | The State Government transfer responsibility for the installation, removal, maintenance of fire hydrants to the Water Corporation, in accordance with the recommendations of the 2006 CDJSC Inquiry into Fire and Emergency Services Legislation. |
REC200-1703 | 32 - Doctrine, standards, and reform | The Fire and Emergency Services Authority develop formal procedures for mandating the completion of Incident Action Plans, ensuring the documents are detailed and that they record critical decision making. |
REC200-0345 | 22 - Role of local Gvt | Local governments continue to include information on bushfire risk and preparedness with rates notices. |
REC200-1716 | 24 - Govt responsibility | State and locals governments: |
REC200-1683 | 22 - Role of local Gvt | Local Government recognise the work of the Gas Technical Regulatory Council and ensure any amendments to the Australian Standard are enforced. |
REC200-0367 | 22 - Role of local Gvt | Main Roads Western Australia undertake more frequent examinations of its bridges located in areas prone to bushfire and ensure that the risk posed to loss of infrastructure in a fire is understood by local authorities. |
REC200-1723 | 24 - Govt responsibility | The State Government restructure the Fire and Emergency Services Authority as a Department. As part of this restructure, Emergency Management Western Australia should either |
REC200-1702 | 32 - Doctrine, standards, and reform | The Fire and Emergency Services Authority immediately comply with the provisions of WESTPLAN BUSHFIRE and formally declare incidents at their appropriate level and document and communicate those decisions in a similar way to the systems used by the Department of Environment and Conservation and the Western Australian Police. |
REC200-0390 | 16 - Training and behaviour | The Fire and Emergency Services Authority and local governments examine the current competencies of Chief Bushfire Control Officers and Community Emergency Services Managers (or Community Fire Managers) and consider what further development is needed to ensure these staff are capable of: measuring and mapping fuel loads maintaining fuel load databases drawing up prescriptions for, and overseeing controlled burns building effective working relationships with all relevant stakeholders. |
REC200-1731 | 16 - Training and behaviour | The Interagency Bushfire Management Committee develop a consistent program of education, training (including media), testing and review of Level 3 Incident Controllers. |
REC200-0342 | 22 - Role of local Gvt | Local Government recognise the work of the Gas Technical Regulatory Council and ensure any amendments to the Australian Standard are enforced. Local Government provide information to residents on any changes to the Australian Standard relating to tethering gas tanks and encourage property owners to take action to comply with the Standard. |
REC200-1715 | 22 - Role of local Gvt | Local governments institute a comprehensive program to assess fuel loads and bushfire preparedness on private properties. The program should give reference to the creation and maintenance of a Building Protection Zone, in line with FESA guidelines. |
REC200-1682 | 24 - Govt responsibility | The State Government give legislative effect to the Planning for Bush Fire Protection Guidelines. |
REC200-0363 | 32 - Doctrine, standards, and reform | The Fire and Emergency Services Authority develop formal procedures for mandating the completion of Incident Action Plans, ensuring the documents are detailed and that they record critical decision making. |
REC200-1721 | 32 - Doctrine, standards, and reform | The State Government amend section 50 of the Emergency Management Act 2005 to allow the Chair of the State Emergency Coordination Group to declare an emergency situation. |
Rec-ID | Code | Recommendation |
---|---|---|
REC189-2914 | 32 - Doctrine, standards, and reform | The review team recommend that: |
REC189-2909 | 32 - Doctrine, standards, and reform | Equipping the regulator with a wider range of compliance tools under the legislation should continue to be a policy priority. The aim should be to enhance the regulator’s capacity to secure compliance in an appropriately graduated way. The opportunity should be taken to ensure that the regulator and inspectors can, in appropriate cases, bring proceedings that do not require referral to the Commonwealth Director of Public Prosecutions, such as actions for civil penalties or injunctions. |
Rec-ID | Code | Recommendation |
---|---|---|
REC183-0107 | 32 - Doctrine, standards, and reform | The DEC Fire Management Policy should be reviewed and updated. |
REC183-0115 | 32 - Doctrine, standards, and reform | The Hazard Management Agency for bushfire has not been defined. Defining the HMA for bushfire should be addressed. |
REC183-0110 | 16 - Training and behaviour | DEC should emphasise the principle of foresight by adopting an appreciation and decision making process and training staff in that process. |
REC183-0122 | 16 - Training and behaviour | A staff recognition and reward framework for service to fire management should be considered for DEC fire staff. |
REC183-0108 | 32 - Doctrine, standards, and reform | DEC should consider publishing a new reference document that describes policy, doctrine and key systems of work of the fire management system. This document would be a “brief case” or “back pack” reference and would be reviewed annually and issued to all senior staff and fire management personnel. |
Rec-ID | Code | Recommendation |
---|---|---|
REC182-0123 | 32 - Doctrine, standards, and reform | FESA implements measures that will ensure unity and clarity of command. |
Rec-ID | Code | Recommendation |
---|---|---|
REC149-3134 | 32 - Doctrine, standards, and reform | Improved and agreed guidelines for Safety Case application and assessment, including suggested structure and content, would alleviate many current problems related to Safety Case processes. |
REC149-3141 | 32 - Doctrine, standards, and reform | NOPSA should complete the next revision of Safety Case guidelines in consultation and agreement with stakeholders and continue its program to achieve consistency with a firmer hand from the CEO and management. |
REC149-3130 | 32 - Doctrine, standards, and reform | The regulations pertaining to vessels of opportunity or their interpretation should be changed to facilitate a risk based approach to regulation. This approach will be consistent with the approach taken in other jurisdictions. |
REC149-3140 | 32 - Doctrine, standards, and reform | The industry should provide advice to NOPSA on where the regulations do not provide sufficient clarity and consider developing broad policy/process guidelines in consultation with the regulator to provide clarity and consistency. Regulators should not take personal views or preferences. |
REC149-3129 | 32 - Doctrine, standards, and reform | The consequences of the disapplication of the Navigation Act 1912 should be analysed, the actual consequences identified and unintended consequences addressed. |
REC149-3138 | 38 - Agency/Department Reporting | The current KPI measures used by the Regulator and industry need to be reassessed and the performance indicators need to be related to the risk profiles of the industry. The industry needs to develop the indicators, which need to be agreed and measured by the industry in discussion with other stakeholders. The KPI's selected should be published in comparison with the worldwide offshore industry and with other industries. NOPSA should continue discussions with Australian Safety and Compensation Council (ASCC) with a view to adopting their goals. |
REC149-3137 | 16 - Training and behaviour | As professional competency is one of the key pillars of any Safety Case, commitment to training for current and future needs remains a fundamental requirement for achieving best practice outcomes in safety. Industry should be encouraged to build on its training commitment now being made to achieve a competent and fully accredited workforce over the next five years. |
REC149-3136 | 16 - Training and behaviour | There is a need for industry in consultation with NOPSA to establish a priority programme of accredited education modules in the Safety Case regime targeting stakeholders in the regime at their respective levels to improve the understanding of the Safety Case and correspondent responsibilities. |
Rec-ID | Code | Recommendation |
---|---|---|
REC132-3595 | 32 - Doctrine, standards, and reform | Development of framework document investigating future direction of VBIL including its role during incidents and its role in the transition from bushfire preparation to incident to bushfire recovery phases |
REC132-3592 | 32 - Doctrine, standards, and reform | Clarifying protocols for activating VBIL beyond normal working hours and for 24 hour activations |
REC132-3591 | 32 - Doctrine, standards, and reform | Joint development of templates for provision of core incident information by regional Incident Management Teams to CFA and DSE emergency coordination centres as basis for updates to the VBIL and other authorised information recipients |
Rec-ID | Code | Recommendation |
---|---|---|
REC121-3679 | 32 - Doctrine, standards, and reform | The rail safety regulator should set standards for the design, manufacture, testing and commissioning of rolling stock to ensure that the rolling stock is fit for its purpose. |
REC121-3714 | 16 - Training and behaviour | RailCorp should use its simulators in an interactive manner. |
REC121-3746 | 16 - Training and behaviour | All emergency services personnel should be trained in the location and operation of emergency door release mechanisms on all rail cars. |
REC121-3776 | 38 - Agency/Department Reporting | The Minister for Transport Services should retain, independently of ITSRR, safety auditors to provide a report to the Minister confirming or qualifying the contents of each such ITSRR quarterly report. |
REC121-3655 | 32 - Doctrine, standards, and reform | Procedures should be put in place by RailCorp to ensure that electrical power supply to the area of an accident can be immediately isolated, if necessary, in the event of a rail accident, so as to reduce any risk of exposure of emergency response personnel to injury or harm. |
REC121-3690 | 32 - Doctrine, standards, and reform | All communications protocols must be strictly enforced by all accredited rail organisations. |
REC121-3719 | 16 - Training and behaviour | The position of team leader should be created by RailCorp to be responsible for a group of approximately 30 train drivers, with responsibility to ensure that each train driver’s training needs are being met and that any safety concerns of train drivers are being properly addressed. The team leaders are to have direct access to the Chief Executive of RailCorp if any safety concerns they have are not addressed. |
REC121-3761 | 32 - Doctrine, standards, and reform | Legislative changes should be enacted to ensure the complete independence of ITSRR from the Minister for Transport Services. |
REC121-3661 | 32 - Doctrine, standards, and reform | The rail displan should include provision for the appointment of a rail emergency management co-ordinator at the RMC, and an on-site rail commander with the sole function of assisting and supporting the emergency services during the rescue phase of the emergency response. |
REC121-3698 | 32 - Doctrine, standards, and reform | No RailCorp train should enter into revenue service or remain in service if, in the opinion of the driver in charge of that train, any defect in it creates a risk of injury. |
REC121-3727 | 32 - Doctrine, standards, and reform | The relevant legislation should be amended to provide expressly that OTSI and the Chief Investigator have the power to initiate a rail accident or incident investigation. |
REC121-3770 | 32 - Doctrine, standards, and reform | A safety management system regulation should be promulgated, specifying the requirements of safety management systems in all accredited organisations, using Annexure I to this report as a guide |
REC121-3670 | 16 - Training and behaviour | The RailCorp emergency response plan should be provided to all emergency response agencies. The officers of each emergency service should be trained in any rail specific features of the plan, so as to better ensure inter-agency co-ordination in the circumstances of an emergency. |
REC121-3677 | 16 - Training and behaviour | A training centre for emergency services personnel should be established by RailCorp. The emergency services personnel should be required to undertake training at such a centre, which should be equipped with features replicating railway infrastructure and rolling stock. |
REC121-3712 | 38 - Agency/Department Reporting | RailCorp and ITSRR should co-operate with national programs for the collection, collation, trend analysis and dissemination of safety critical information. |
REC121-3744 | 16 - Training and behaviour | All RailCorp operational personnel should be trained in the location and operation of external emergency door release mechanisms. |
REC121-3775 | 38 - Agency/Department Reporting | The Minister for Transport Services must table in Parliament, each such quarterly report by ITSRR. |
REC121-3654 | 16 - Training and behaviour | All train guards should be trained by RailCorp in the use of the Metronet radio and instructed to use it in any emergency. |
REC121-3688 | 32 - Doctrine, standards, and reform | Communications procedures must be standardised throughout the rail network, so that all railway employees describe the same subject matter in an identical way. |
REC121-3718 | 16 - Training and behaviour | Training should be based upon a needs analysis, to determine what skills a particular person will require to carry out the tasks of any position safely and efficiently, and instruction and practice, to acquire and demonstrate those skills. |
REC121-3760 | 32 - Doctrine, standards, and reform | The Advisory Board established under the Transport Legislation Amendment (Safety and Reliability) Act 2003 must be abolished. |
REC121-3660 | 32 - Doctrine, standards, and reform | The rail displan should include the use by all emergency response personnel of a uniform incident command system, involving procedures for such matters as the establishment of inner and outer perimeters, control of access to the site, orderly evacuation of injured passengers and the establishment of a staging area remote from the accident site, in a unified command structure with the site controller co-ordinating the various emergency services through representatives of each service. |
REC121-3697 | 38 - Agency/Department Reporting | All train drivers’ defects reports should be entered by RailCorp into a computerised record and tracked to finalisation. |
REC121-3723 | 38 - Agency/Department Reporting | All ATSB accident investigation reports should be made public. |
REC121-3769 | 32 - Doctrine, standards, and reform | The ITSRR should continue to participate in the development of a national system for rail safety regulation, provided that any ultimate agreement between the States and Territories and the Australian Government does not produce a safety outcome for New South Wales that is less than would be achieved by the implementation of all the recommendations contained in this report. |
REC121-3669 | 16 - Training and behaviour | All operational rail staff should be trained by RailCorp in the action check list relevant to each. |
REC121-3675 | 16 - Training and behaviour | All rail employees should be trained by their employer to commence any emergency communication with the words “Emergency, emergency, emergency”, thereafter to identify themselves, the train, its location, what has occurred, the approximate passenger load and whether death or injuries have occurred. |
REC121-3736 | 32 - Doctrine, standards, and reform | The RailCorp passenger containment policy must be abandoned. |
REC121-3774 | 38 - Agency/Department Reporting | The ITSRR must provide a quarterly report to the Minister for Transport Services on the progress made by RailCorp in implementing these recommendations, including: |
REC121-3653 | 10 - Infrastructure | The RMC should be equipped by RailCorp with a transcriber system, or mimic board, or such other system as is necessary to enable identification of the precise location at any time of any train on the RailCorp network. |
REC121-3687 | 10 - Infrastructure | There must be compatibility of communications systems throughout the rail network. It is essential that all train drivers, train controllers, signallers, train guards and supervisors of trackside work gangs in New South Wales be able to communicate using the same technology. |
REC121-3717 | 16 - Training and behaviour | RailCorp must establish a task analysis for particular categories of employees, to identify the specific skills and responsibility of those employees or groups of employees, and thereafter undertake a training needs analysis, to develop the skills required in particular areas. |
REC121-3756 | 16 - Training and behaviour | RailCorp should ensure that where the safety competency of any manager is deficient such manager is required to undertake professional development courses to raise his or her safety competency level to an adequate standard. |
REC121-3696 | 32 - Doctrine, standards, and reform | Defects reporting, recording and rectification should be integrated with the RailCorp regimes for train maintenance. |
REC121-3722 | 38 - Agency/Department Reporting | The ATSB should deliver any report of any such rail accident which it investigates to the Board of any rail organisation involved in the accident, ITSRR and the Minister for Transport Services. |
REC121-3767 | 24 - Govt responsibility | All accredited rail organisations should be required to re-apply every three years to ITSRR for accreditation. |
REC121-3668 | 32 - Doctrine, standards, and reform | The RailCorp emergency response plan should include action checklists of the steps that each employee is required to take, and the order for specific employees to follow in case of emergency. |
REC121-3674 | 32 - Doctrine, standards, and reform | Uniform verbal descriptions identifying that power has been isolated should be developed by RailCorp and utilised by all railway personnel, electrical service providers and all emergency response personnel. |
REC121-3705 | 32 - Doctrine, standards, and reform | The ITSRR should develop standards for periodic medical examinations which include the following: |
REC121-3730 | 32 - Doctrine, standards, and reform | Legislation should be enacted and any necessary arrangements made, to enable the ATSB to review any reports of any investigation by a rail organisation or the OTSI into any serious incident or accident in New South Wales. |
REC121-3773 | 32 - Doctrine, standards, and reform | The ITSRR should ensure that RailCorp establishes a safety management system containing the 29 elements identified in the SMSEP report, and ensure the ongoing monitoring and improvement of the safety management system established. |
REC121-3651 | 10 - Infrastructure | A dedicated telephone line should be established by RailCorp between the RMC and any Emergency Services Control Centre for use during any emergency. |
REC121-3686 | 32 - Doctrine, standards, and reform | The standard in relation to the collection and use of data from data loggers should provide that such information must be accessed in the circumstances of any accident or incident and can be accessed to monitor driver performance generally. |
REC121-3716 | 16 - Training and behaviour | Train driver and guard training should encourage teamwork and discourage authority gradients. |
REC121-3751 | 16 - Training and behaviour | RailCorp should make it a condition of employment that all level 2 managers have or obtain a formal qualification in system safety management. |
REC121-3659 | 32 - Doctrine, standards, and reform | A railway disaster plan, or rail displan, should be developed by RailCorp and the emergency services to ensure co-ordinated inter-agency response to rail accidents and incidents on the RailCorp network. |
REC121-3695 | 10 - Infrastructure | There should be interoperability of communications equipment between all trains operating on the New South Wales rail network. |
REC121-3721 | 24 - Govt responsibility | The ITSRR should ensure that OTSI, as a division of ITSRR, co-operates and assists the ATSB in the conduct of any independent investigation by the ATSB of any rail accident or incident in New South Wales. |
REC121-3763 | 32 - Doctrine, standards, and reform | The ITSRR should publish guidelines to be followed by accredited organisations. |
REC121-3667 | 32 - Doctrine, standards, and reform | RailCorp should develop and implement an emergency response plan for management of all rail accidents. Such a plan should be subsumed by the rail displan in the case of serious accidents or incidents. |
REC121-3672 | 16 - Training and behaviour | All emergency response personnel should be specifically trained in the features of railways which are relevant to their work, such as the location and means of operation of all emergency door releases on trains, the location and use of signal telephones, the methods by which electrical power can be isolated and the means by which they can readily identify and obtain information from the on-site rail commander. |
REC121-3701 | 32 - Doctrine, standards, and reform | Train inspections should be carried out at the time of stabling RailCorp trains, as well as a part of train preparation prior to entering service. |
REC121-3729 | 38 - Agency/Department Reporting | All reports of the Chief Investigator of OTSI should be delivered, upon completion and without being reviewed, to ITSRR and the Minister for Transport Services. |
REC121-3772 | 32 - Doctrine, standards, and reform | RailCorp should establish a safety management system containing the 29 elements identified in the SMSEP report which is in volume 2 of this report. |
REC121-3650 | 16 - Training and behaviour | Staff at the Rail Management Centre (RMC) should receive training from RailCorp to enable them to quickly and accurately assess that an emergency has occurred and to provide precise and reliable information to emergency response personnel about the location of the emergency, the available access to the site and the resources necessary. |
REC121-3685 | 32 - Doctrine, standards, and reform | The ITSRR should impose a standard in relation to the collection and use of data from data loggers. |
REC121-3715 | 16 - Training and behaviour | RailCorp should use its simulators to train drivers and guards in methods of dealing with degraded operations on the rail network. |
REC121-3750 | 32 - Doctrine, standards, and reform | ITSRR should initiate and/or participate in the development of a national standard for crashworthiness of all passenger trains. |
REC121-3657 | 10 - Infrastructure | All signal telephones must be maintained by RailCorp in proper working order. |
REC121-3692 | 32 - Doctrine, standards, and reform | Communications protocols and procedures should be standardised and mandated by regulations making them a condition of accreditation. |
REC121-3720 | 24 - Govt responsibility | The New South Wales Government should make the necessary arrangements with the Australian Government, including any necessary legislation, for the Australian Transport Safety Bureau (ATSB) to have the power to investigate all rail accidents occurring on the New South Wales rail network the investigation of which may advance the knowledge of the causes of rail accidents in Australia. |
REC121-3762 | 32 - Doctrine, standards, and reform | The Chief Executive of ITSRR should have sole accountability and responsibility for the regulation of rail safety in New South Wales. |
REC121-3662 | 32 - Doctrine, standards, and reform | The rail displan should provide for the site controller to have complete control of the site, with other agencies co-ordinating with and supporting him or her, until the rescue phase of the emergency response has been completed. |
REC121-3699 | 32 - Doctrine, standards, and reform | All reported train defects should be certified by a person in a supervisory position in RailCorp as having been rectified. |
REC121-3728 | 32 - Doctrine, standards, and reform | Any barriers to communication between OTSI and ITSRR should be removed, so as to ensure that any findings made by OTSI in relation to any investigation it conducts are reported immediately to ITSRR. |
REC121-3771 | 32 - Doctrine, standards, and reform | RailCorp should establish an integrated safety management system which includes the following: |
REC121-3671 | 32 - Doctrine, standards, and reform | The RailCorp emergency response plan should include a requirement for the debriefing of all senior rail and emergency response personnel involved in any rail accident, so as to determine the way or ways in which emergency response arrangements for rail accidents can be continually improved, and thereafter implement such improvements. |