Inquiry Search
Rec-ID | Code | Recommendation |
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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. |
REC314-3261 | 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. |
REC314-3259 | 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. |
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. |
REC301-2385 | 25 - Inquiry, audit, lessons management and after action review | TFS should initiate a policy review (seeking support from government as appropriate) to clearly identify what body or agency is responsible for planning, carrying out and enforcing fuel management on private property at a township level. If current arrangements are unclear or ineffective, TFS should request government to consider making this a statutory responsibility of TFS and provide any additional funding required to support this function. |
Rec-ID | Code | Recommendation |
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REC299-1344 | 25 - Inquiry, audit, lessons management and after action review | That a review of the cross‑tenure approach be undertaken to determine its effectiveness and to address issues that arise in fire prevention on private and public land. |
REC299-1343 | 25 - Inquiry, audit, lessons management and after action review | That the Government conduct a review of fire prevention |
REC299-1338 | 19 - Offences | The Government introduce an amendment to the Country Fire Authority Act 1958 or other instruments which imposes significant penalties and strengthens enforcement, including via infringement notices, for offences against Total Fire Ban requirements before the 2017‑2018 fire season. |
REC299-1337 | 19 - Offences | The Government should: |
Rec-ID | Code | Recommendation |
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REC291-1249 | 25 - Inquiry, audit, lessons management and after action review | The Department of the Premier and Cabinet to conduct an independent review of the current arrangement for the management and distribution of the Emergency Services Levy. The review will have the specific purpose of: · seeking input from key entities including the Departments of Treasury, Finance, Fire and Emergency Services, Lands, and Parks and Wildlife, WA Local Government Association, and the Office of Bushfire Risk Management. · ensuring the arrangement has the flexibility and agility to deal with emerging bushfire risk priorities. · establishing a budget process that enables a shift in investment towards prevention, mitigation and building community resilience and capability. |
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. |
REC291-1233 | 25 - Inquiry, audit, lessons management and after action review | The State Government to explore options for streamlining the functions and the independence of the State Emergency Management Committee Secretariat and the Office of Bushfire Risk Management with a view to including an inspectorate function, and appointing a person who is dedicated to that role. The purpose is to provide assurance and reporting, and to inquire into, monitor and report transparently on emergency management standards, preparedness, capability, service delivery and investment performance outcomes. Within two years of the establishment of this arrangement the State Government to review and assess whether it is meeting the desired outcomes. |
Rec-ID | Code | Recommendation |
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REC287-1188 | 25 - Inquiry, audit, lessons management and after action review | The Tasmanian fire agencies commission a review into the efectiveness of aerial firefghting in the 2016 fires, in order to better understand and to document for future reference the cost-efectiveness of specifc fire suppression strategies and tactics in different vegetation types. The Review should include a comparative analysis of fire suppression options whether aerial or ground-based. |
REC287-1186 | 9 - Community education | The Tasmanian fire agencies review: • their pre-season engagement with groups such as (but not limited to) environmental groups who might beneft from a greater understanding of fire management tactics, in order to inform them of and receive feedback on intended approaches to firefghting and fire management the work of the Public Information Section at incident management, regional and State level, to develop an increased appreciation of what information management might be most appropriate to serve the public interest in understanding the progress of the incident and to identify ways of providing surge capacity to resource effective information management in protracted and signifcant incidents. |
REC287-1185 | 25 - Inquiry, audit, lessons management and after action review | The Tasmanian fire agencies take steps at a national level to share learnings from the 2016 fires about the administration of interstate assistance and support the codifcation of the workings, structure and reporting lines of an Interstate and International Liaison Unit for future complex deployments within Australia and New Zealand. |
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. |
REC287-1182 | 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. |
Rec-ID | Code | Recommendation |
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REC280-1388 | 25 - Inquiry, audit, lessons management and after action review | That the NSW Rural Fire Service: |
REC280-1396 | 25 - Inquiry, audit, lessons management and after action review | That the Minister for Police and Emergency Services review the communications technologies used by the NSW Rural Fire Service, Fire and Rescue NSW, the NSW National Parks and Wildlife Service and Forestry NSW during fire fighting operations, to ensure that systems are standardised and effective. Within this context, the potential value of satellite phone technology should be investigated. |
REC280-1379 | 9 - Community education | That the NSW Rural Fire Service develop and implement a comprehensive community education campaign aimed at increasing community understanding of and support for hazard reduction burns. |
REC280-1395 | 32 - Doctrine, standards, and reform | That the NSW Rural Fire Service reassess the protection of pastoral assets during bush fires to ensure that priority for protection is not simply afforded to the homestead, and that land holders are, within reason, able to request which of their own assets are protected. |
REC280-1391 | 32 - Doctrine, standards, and reform | That the NSW Rural Fire Service review its procedures, systems and infrastructure for notifying community members of bush fires, both when a fire has broken out and as it proceeds, to ensure the provision of timely and adequate information. |
REC280-1390 | 32 - Doctrine, standards, and reform | That the NSW Government consider enabling the default position during catastrophic and extreme fire danger periods to be the same as for section 44 fires, so that fire control centres have the same systems and resources ready to deploy should a fire break out. |
REC280-1403 | 32 - Doctrine, standards, and reform | That the Ministry for Police and Emergency Services urgently review its policies for the provision of disaster welfare services to ensure that in the event of a bush fire emergency and the declaration of a fire under section 44 of the Rural Fires Act 1997, adequate funding and services, especially recovery centres and mental health services, are provided for an adequate length of time, with gradual transition to normal service delivery when those services are no longer required. |
REC280-1389 | 32 - Doctrine, standards, and reform | That the NSW Government, as a matter of urgency, amend the Rural Fires Act 1997 to codify the current interim arrangements for command and notification requirements for class 1 and class 2 fires, which clarify that the NSW Rural Fire Service or Fire and Rescue NSW: |
REC280-1397 | 32 - Doctrine, standards, and reform | That the NSW National Parks and Wildlife Service adopt an interim fencing agreement in the immediate aftermath of a fire. This will enable emergency and interim works to commence, but features such as length, fencing components and site of the fence line are not binding. A final fencing agreement would be negotiated no earlier than six months following a major national park fire. |
Rec-ID | Code | Recommendation |
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REC278-1225 | 32 - Doctrine, standards, and reform | The committee recommends that the Australian and Tasmanian Governments: • develop options to increase co-operation to ensure that the Tasmanian Wilderness World Heritage Area is protected and conserved in line with Australia's obligations under the World Heritage Convention; and • work together to ensure strong provisions to protect the Tasmanian Wilderness World Heritage Area from bushfire risks are included in the Tasmanian Wilderness World Heritage Area Management Plan. |
REC278-1224 | 21 - Role of Commonwealth Government | The committee recommends that the Australian Government recognise the need to enhance protection and conservation efforts in the Tasmanian Wilderness World Heritage Area by allocating increased funding: |
REC278-1223 | 21 - Role of Commonwealth Government | The committee recommends that the Australian Government commit to long-term funding for the the National Aerial Firefighting Centre of an amount that is at least equal to government's current contribution, rising in line with the Consumer Price Index |
REC278-1222 | 21 - Role of Commonwealth Government | The committee recommends that the Australian Government, in conjunction with state and territory governments, investigate a national remote area firefighting capability, to support Australian fire agencies. |
REC278-1220 | 21 - Role of Commonwealth Government | The committee recommends that the Australian Government: • recognise that climate change has increased fire conditions in south-eastern Australia and the risk to natural and cultural values in the Tasmanian Wilderness World Heritage Area; and • report annually to the World Heritage Committee on the state of conservation in the Tasmanian Wilderness World Heritage Area. |
Rec-ID | Code | Recommendation |
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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. |
REC273-1141 | 21 - Role of Commonwealth Government | SACFS and the BoM review current weather, fuel loads and curing rates to determine the most appropriate and accurate forecast is prepared, issued and validated against current conditions. |
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. |
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. |
Rec-ID | Code | Recommendation |
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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. |
REC264-1088 | 32 - Doctrine, standards, and reform | GDF Suez adopt and apply the firefghter carbon monoxide response protocol. |
REC264-1072 | 25 - Inquiry, audit, lessons management and after action review | The State empower and require the Auditor-General or another appropriate agency, to: • oversee the implementation of these recommendations and the commitments made by the State and GDF Suez during this Inquiry; and • report publicly every year for the next three years on the progress made in implementing recommendations and commitments. |
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. |
REC264-1087 | 25 - Inquiry, audit, lessons management and after action review | GDF Suez: • practice and ensures that, by taking a risk management approach, it is suitable for fire prevention, mitigation and suppression in all parts of the Hazelwood mine; and review its ‘Mine Fire Service Policy and Code of Practice’ so that it refects industry best • work plan for the Hazelwood mine. incorporate the revised ‘Mine Fire Service Policy and Code of Practice’ into the approved |
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: |
REC264-1086 | 25 - Inquiry, audit, lessons management and after action review | GDF Suez: • consequences of fire in the worked out areas of the Hazelwood mine, and an assessment of the most effective fre protection for the exposed coal surfaces; conduct, assisted by an independent consultant, a risk assessment of the likelihood and • controls are in place to eliminate or reduce the risk of fre; and prepare an implementation plan that ensures the most effective and reasonably practicable • implement the plan |
REC264-1077 | 32 - Doctrine, standards, and reform | The State take the lead in advocating for a national compliance standard for PM |
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. |
REC264-1075 | 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. |
REC264-1083 | 9 - Community education | The State, led by Emergency Management Victoria, develop a community engagement model for emergency management to ensure all State agencies and local governments engage with communities and already identifed trusted networks as an integral component of emergency management planning. |
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. |
Rec-ID | Code | Recommendation |
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REC261-1506 | 32 - Doctrine, standards, and reform | That the NSW Government, as a matter of urgency, amend the Rural Fires Act 1997 to codify the current interim arrangements for command and notification requirements for class 1 and class 2 fires, which clarify that the NSW Rural Fire Service or Fire and Rescue NSW: |
REC261-1520 | 33 - Relief and recovery | That the Ministry for Police and Emergency Services urgently review its policies for the provision of disaster welfare services to ensure that in the event of a bush fire emergency and the declaration of a fire under section 44 of the Rural Fires Act 1997, adequate funding and services, especially recovery centres and mental health services, are provided for an adequate length of time, with gradual transition to normal service delivery when those services are no longer required. |
REC261-1505 | 25 - Inquiry, audit, lessons management and after action review | That the NSW Rural Fire Service: |
REC261-1516 | 32 - Doctrine, standards, and reform | That the NSW National Parks and Wildlife Service remove from its boundary fencing policy and standard contract the condition that requires adjoining land owners to maintain a fence that has been damaged by trees falling from national park land. |
REC261-1496 | 9 - Community education | That the NSW Rural Fire Service develop and implement a comprehensive community education campaign aimed at increasing community understanding of and support for hazard reduction burns. |
REC261-1512 | 32 - Doctrine, standards, and reform | That the NSW Rural Fire Service reassess the protection of pastoral assets during bush fires to ensure that priority for protection is not simply afforded to the homestead, and that land holders are, within reason, able to request which of their own assets are protected. |
REC261-1508 | 25 - Inquiry, audit, lessons management and after action review | That the NSW Rural Fire Service review its procedures, systems and infrastructure for notifying community members of bush fires, both when a fire has broken out and as it proceeds, to ensure the provision of timely and adequate information. |
REC261-1507 | 24 - Govt responsibility | That the NSW Government consider enabling the default position during catastrophic and extreme fire danger periods to be the same as for section 44 fires, so that fire control centres have the same systems and resources ready to deploy should a fire break out. |
Rec-ID | Code | Recommendation |
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REC258-2527 | 32 - Doctrine, standards, and reform | The Department of Infrastructure and Regional Development plays a stronger policy role in the State Safety Program. |
REC258-2556 | 25 - Inquiry, audit, lessons management and after action review | The Civil Aviation Safety Authority structures all regulations not yet made with the three-tier approach, and subsequently reviews all other Civil Aviation Safety Regulation Parts (in consultation with industry) to determine if they should be remade using the three-tier structure. |
REC258-2533 | 32 - Doctrine, standards, and reform | The Civil Aviation Safety Authority: |
REC258-2539 | 35 - Business and Industry in relation to industry | The Civil Aviation Safety Authority changes its regulatory philosophy and, together with industry, builds an effective collaborative relationship on a foundation of mutual understanding and respect. |
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. |
REC258-2555 | 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: |
REC258-2531 | 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. |
REC258-2538 | 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. |
REC258-2554 | 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. |
REC258-2530 | 24 - Govt responsibility | The Australian Government appoints an additional Australian Transport Safety Bureau Commissioner with aviation operational and safety management experience. |
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. |
REC258-2552 | 25 - Inquiry, audit, lessons management and after action review | The Civil Aviation Safety Authority implements a system of using third-party commercial audits as a supplementary tool to its surveillance system. |
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. |
REC258-2562 | 32 - Doctrine, standards, and reform | The Civil Aviation Safety Authority amends the current Terms of Reference of the Industry Complaints Commissioner so that: |
REC258-2536 | 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. |
REC258-2551 | 25 - Inquiry, audit, lessons management and after action review | The Civil Aviation Safety Authority assures consistency of audits across all regions, and delivers audit reports within an agreed timeframe. |
REC258-2528 | 25 - Inquiry, audit, lessons management and after action review | The Australian Transport Safety Bureau investigates as many fatal accidents in the sport and recreational aviation sector as its resources will allow. |
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. |
REC258-2535 | 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’. |
REC258-2549 | 25 - Inquiry, audit, lessons management and after action review | The Civil Aviation Safety Authority provides full disclosure of audit findings at audit exit briefings in accordance with international best practice. |
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. |
REC257-1548 | 25 - Inquiry, audit, lessons management and after action review | The Regional Director-Defence Support-Northern NSW, make contact with Deputy Commissioner ~~~~~ Director of Operational Services Rural Fire Service, to arrange a headquarters driven bipartite review of the events of 16 October 2013 with a review to mitigation of future fire events generally, and with specific reference to: |
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. |
REC257-1546 | 25 - Inquiry, audit, lessons management and after action review | Defence undertake a review of its ability to respond to a fire within Marrangaroo Training Area, whether bushfire or structural. The underlying assumption should be that the only response available to fight a fire within Marrangaroo Training Area will be provided by Defence. Further, such response must occur while a fire is in its initial stages. A review must either acknowledge the risk of fire occurring in th future, or upgrade Defence's firefighting capability at Marrangaroo Training Area. |
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. |
REC257-1543 | 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. |
REC257-1551 | 32 - Doctrine, standards, and reform | The use of Internal and External ranges at MTA for patrolling activities be prohibited. |
REC257-1539 | 25 - Inquiry, audit, lessons management and after action review | Defence Security Authority conduct an investigation into the whereabouts of items of anaccounted explosive ordnance issued to Defence Explosive Ordnance Training School Exercise Marrangaroo. |
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. |
REC257-1538 | 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. |
REC257-1549 | 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. |
Rec-ID | Code | Recommendation |
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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. |
REC247-0898 | 32 - Doctrine, standards, and reform | That the State Special Emergency Plan–Recovery and the emergency management structure for recovery be reviewed. |
REC247-0940 | 32 - Doctrine, standards, and reform | That the Government actively support the timely development and implementation of an ongoing Strategic Fuel Management Plan. |
REC247-0872 | 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. |
REC247-0910 | 33 - Relief and recovery | That suitable facilities are established from which to effectively control and coordinate immediate recovery operations. |
REC247-0946 | 20 - Role of police | That Tasmania Police establishes a section within its structure with responsibility for developing and maintaining contemporary expertise in emergency management, progressing innovation, assisting organisational change initiatives and supporting its responsibilities in state emergency management arrangements. |
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. |
REC247-0926 | 25 - Inquiry, audit, lessons management and after action review | That membership of the State Emergency Management Committee, and other processes to link in appropriate agencies and organisations to emergency management, be included in the recommended review of the emergency management arrangements. |
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. |
REC247-0937 | 19 - Offences | That the legislation and enforcement arrangements are reviewed to ensure there are suitable offences and penalties, investigation and enforcement capabilities, and a rigorous approach is taken to breaches of the law. |
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. |
REC247-0909 | 25 - Inquiry, audit, lessons management and after action review | That the plans for social recovery be reviewed, and plans and procedures are established ready for implementation. |
REC247-0945 | 20 - Role of police | That Tasmania Police conducts a review to ensure emergency management is treated as a priority and a core function throughout the organisation, including the development of contemporary capabilities, and is supported by an appropriate culture. |
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. |
REC247-0923 | 25 - Inquiry, audit, lessons management and after action review | That a process be established for the timely implementation of approved recommendations from the 2009 Victorian Bushfires Royal Commission. |
REC247-0951 | 25 - Inquiry, audit, lessons management and after action review | That an independent means of monitoring and reporting on the implementation of approved recommendations is established. |
REC247-0896 | 33 - Relief and recovery | That the state level structural arrangements for managing recovery operations are reviewed. |
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. |
REC247-0870 | 32 - Doctrine, standards, and reform | That Tasmania Fire Service considers adopting a primary tactic of an aggressive first attack on fires. |
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. |
REC247-0944 | 9 - Community education | That the State Emergency Management Committee develops and coordinates a whole-of-government community resilience strategy for emergencies in a form that can be practically implemented, as a priority. |
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. |
REC247-0914 | 32 - Doctrine, standards, and reform | That the Tasmanian Emergency Management Plan includes a comprehensive all hazards communications policy and plan. |
REC247-0950 | 32 - Doctrine, standards, and reform | That resources are committed to developing and implementing approved reforms to the emergency management arrangements. |
REC247-0891 | 9 - Community education | That emergency management plans specifically include processes for effectively engaging with local communities and using community resources, including volunteers. |
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. |
REC247-0869 | 32 - Doctrine, standards, and reform | That Tasmania Fire Service ensures that planning for active fires includes a proactive approach wherever possible. |
REC247-0907 | 33 - Relief and recovery | That the State Emergency Management Committee ensures that a program of debriefing on recovery issues is completed by all relevant agencies and organisations, and detailed plans and operating procedures are established ready for implementation. |
REC247-0943 | 9 - Community education | That a bushfire community education and information strategy be professionally developed and coordinated across the fire authorities by Tasmania Fire Service. |
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. |
REC247-0913 | 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. |
REC247-0949 | 32 - Doctrine, standards, and reform | That following any review, the Emergency Management Act 2006 be amended. |
REC247-0883 | 32 - Doctrine, standards, and reform | That Tasmania Police ensures planning for emergency operations includes a proactive approach wherever possible. |
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. |
REC247-0864 | 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. |
REC247-0903 | 25 - Inquiry, audit, lessons management and after action review | That the role of Red Cross in emergency management plans and procedures for the activation of Red Cross be reviewed. |
REC247-0941 | 25 - Inquiry, audit, lessons management and after action review | That the Strategic Fuel Management Plan includes measurable targets and they are actively monitored and reported on to the community. |
REC247-0873 | 25 - Inquiry, audit, lessons management and after action review | If it is considered more information is required on action to suppress the fires in Dunalley and why fire operations did not continue, the Department of Justice should conduct an independent examination of this matter. |
REC247-0912 | 32 - Doctrine, standards, and reform | That the State Fire Commission finalise its position on the Tasmania Bushfire Safety Policy without further delay. |
REC247-0947 | 20 - Role of police | That Tasmania Police develops and implements a program for examining emergency management arrangements and facilities in Australia. |
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. |
REC247-0927 | 25 - Inquiry, audit, lessons management and after action review | That an accountability process be established for managing improvement in the emergency management arrangements, including annual State of Readiness Reports by relevant departments and agencies and on the overall emergency management arrangements. |
Rec-ID | Code | Recommendation |
---|---|---|
REC236-2802 | 32 - Doctrine, standards, and reform | The committee recommends that where the consideration and implementation of an ATSB recommendation may be protracted, the requirement for regular updates (for example 6 monthly) should be included in the TSI Act. |
REC236-2786 | 32 - Doctrine, standards, and reform | The committee recommends that the ATSB be required to document investigative avenues that were explored and then discarded, providing detailed explanations as to why. |
REC236-2807 | 32 - Doctrine, standards, and reform | The committee recommends that the Aeronautical Information Package (AIP) En Route Supplement Australia (ERSA) is updated to reflect the need for caution with regard to Norfolk Island forecasts where the actual conditions can change rapidly and vary from forecasts. |
REC236-2795 | 25 - Inquiry, audit, lessons management and after action review | The committee recommends that a short inquiry be conducted by the Senate Standing Committee on Rural and Regional Affairs and Transport into the current status of aviation regulatory reform to assess the direction, progress and resources expended to date to ensure greater visibility of the processes. |
REC236-2801 | 25 - Inquiry, audit, lessons management and after action review | The committee recommends that the ATSB review its process to track the implementation of recommendations or safety actions to ensure it is an effective closed loop system. This should be made public, and provided to the Senate Regional and Rural Affairs and Transport Committee prior to each Budget Estimates. |
REC236-2785 | 32 - Doctrine, standards, and reform | The committee recommends that the ATSB move away from its current approach of forecasting the probability of future events and focus on the analysis of factors which allowed the accident under investigation to occur. This would enable the industry to identify, assess and implement lessons relevant to their own operations. |
REC236-2806 | 25 - Inquiry, audit, lessons management and after action review | The committee recommends that the relevant agencies investigate appropriate methods to ensure that information about the incidence of, and variable weather conditions at, Norfolk Island is available to assist flight crews and operators managing risk that may result from unforseen weather events. |
REC236-2794 | 32 - Doctrine, standards, and reform | The committee recommends that CASA, in consultation with an Emergency Medical Services industry representative group (eg. Royal Flying Doctor Service, air ambulance operators, rotary wing rescue providers) consider the merit, form and standards of a new category of operations for Emergency Medical Services. The minister should require CASA to approve the industry plan unless there is a clear safety case not to. Scope for industry to assist as part of an audit team should also be investigated where standardisation is an issue. This should be completed within 12 months and the outcome reported publicly. |
REC236-2800 | 38 - Agency/Department Reporting | The committee recommends that where a safety action has not been completed before a report being issued that a recommendation should be made. If it has been completed the report should include details of the action, who was involved and how it was resolved. |
REC236-2784 | 32 - Doctrine, standards, and reform | The committee recommends that the minister, in issuing a new Statement of Expectations to the ATSB, valid from 1 July 2013, make it clear that safety in aviation operations involving passengers (fare paying or those with no control over the flight they are on, e.g. air ambulance) is to be accorded equal priority irrespective of flight classification. |
REC236-2805 | 25 - Inquiry, audit, lessons management and after action review | The committee recommends that the relevant agencies review whether any equipment or other changes can be made to improve the weather forecasting at Norfolk Island. The review would include whether the Unicom operator should be an approved meteorological observer. |
REC236-2793 | 25 - Inquiry, audit, lessons management and after action review | The committee recommends that CASA processes in relation to matters highlighted by this investigation be reviewed. This could involve an evaluation benchmarked against a credible peer (such as FAA or CAA) of regulation and audits with respect to: non-RPT passenger carrying operations; approach to audits; and training and standardisation of FOI across regional offices. |
REC236-2799 | 38 - Agency/Department Reporting | The committee recommends that the ATSB prepare and release publicly a list of all its identified safety issues and the actions which are being taken or have been taken to address them. The ATSB should indicate its progress in monitoring the actions every 6 months and report every 12 months to Parliament. |
REC236-2804 | 32 - Doctrine, standards, and reform | The committee recommends that Airservices Australia discuss the safety case for providing a hazard alert service with Fijian and New Zealand ATC (and any other relevant jurisdictions) and encourage them to adopt this practice. |
REC236-2792 | 25 - Inquiry, audit, lessons management and after action review | The committee recommends that the investigation be re-opened by the ATSB with a focus on organisational, oversight and broader systemic issues. |
REC236-2798 | 32 - Doctrine, standards, and reform | The committee recommends that, where relevant, the ATSB include thorough human factors analysis and discussion in future investigation reports. Where human factors are not considered relevant, the ATSB should include a statement explaining why. |
REC236-2803 | 32 - Doctrine, standards, and reform | The committee recommends that the government consider setting a time limit for agencies to implement or reject recommendations, beyond which ministerial oversight is required where the agencies concerned must report to the minister why the recommendation has not been implemented or that, with ministerial approval, it has been formally rejected. |
REC236-2789 | 32 - Doctrine, standards, and reform | The committee recommends that the Transport Safety Investigation Act 2003 be amended to require that the Chief Commissioner of the ATSB be able to demonstrate extensive aviation safety expertise and experience as a prerequisite for the selection process. |
REC236-2808 | 38 - Agency/Department Reporting | The committee recommends that in relation to mandatory and confidential reporting, the default position should be that no identifying details should be provided or disclosed. However, if there is a clear risk to safety then the ATSB, CASA and industry representatives should develop a process that contains appropriate checks and balances. |
REC236-2796 | 32 - Doctrine, standards, and reform | The committee recommends that the ATSB-CASA Memorandum of Understanding be re-drafted to remove any ambiguity in relation to information that should be shared between the agencies in relation to aviation accident investigations, to require CASA to: |
Rec-ID | Code | Recommendation |
---|---|---|
REC224-1631 | 24 - Govt responsibility | The State Government prepare a strategy before the 2013-14 bushfire season on how the main firefighting agencies should deal with a drier South West region where fewer prescribed burns can be completed each year. |
REC224-1629 | 24 - Govt responsibility | The Minister for Emergency Services must ensure that future post-incident analyses are completed and made public within eight weeks of a natural disaster. |
Rec-ID | Code | Recommendation |
---|---|---|
REC223-0521 | 9 - Community education | The Department of Environment and Conservation develop and implement a strategy to better inform the community about the complexities and decisions surrounding prescribed burns when they are undertaken in the rural urban area. |
REC223-0516 | 25 - Inquiry, audit, lessons management and after action review | The Department of Environment and Conservation review its implementation of the findings of the Ferguson Review conducted in 2010. |
REC223-0523 | 25 - Inquiry, audit, lessons management and after action review | The Government consider enacting legislation to facilitate the review of all future major incidents, including but not limited to fire, earthquake, storm and marine inundation, and the emergency response to them. |
REC223-0522 | 25 - Inquiry, audit, lessons management and after action review | The response operation to the Margaret River bushfire in November 2011 be the subject of a review with independent oversight. |
Rec-ID | Code | Recommendation |
---|---|---|
REC208-0528 | 32 - Doctrine, standards, and reform | That, as part of the Pollution Incident Management Response Plan to be developed for Orica’s Kooragang Island site, or by another appropriate mechanism, the Office of Environment and Heritage ensure that Orica’s incident-response procedures address the need to consider all relevant factors when assessing potential impacts, including the height and force of emissions as well as the location of any onsite fallout and whether there are off-site impacts following all serious incidents. |
REC208-0527 | 35 - Business and Industry in relation to industry | That the Office of Environment and Heritage require Orica to engage and fund appropriate independent experts to oversee any modifications to the plant in the next major maintenance overhaul of the plant in 2016 and in any upgrades to the plant prior to that date. |
REC208-0526 | 25 - Inquiry, audit, lessons management and after action review | That OEH’s testing procedures for determining the impact of pollution incidents incorporate additional requirements for the checking and verification of results before those results are released. |
REC208-0530 | 32 - Doctrine, standards, and reform | That, if necessary, regulation be amended to require Health to approve any script used by any party concerned, for door knocking or other information dissemination, if Health is not the first source of information to affected residents. |
REC208-0529 | 32 - Doctrine, standards, and reform | That, when developing requirements concerning pollution incident response management plans pursuant to the recent legislative amendments, the Office of Environment and Hertiage include appropriate definitions as to the meaning of ‘immediately’, and when ‘material harm to the environment is caused or threatened’. |
Rec-ID | Code | Recommendation |
---|---|---|
REC202-0495 | 25 - Inquiry, audit, lessons management and after action review | At the conclusion to the 2011-12 bushfire season, the Minister for Emergency Services institute a thorough review of the operations of FESA, the Police and DEC in protecting the State from bushfires and other natural disasters, with a primary focus on: · staffing levels; · equipment levels and coordination; and · training needs. The Minister report to Parliament by June 2012 on any changes that need to be made to the current departmental structures to optimise the State’s preparedness for the 2012-13 bushfire season. |
REC202-0502 | 32 - Doctrine, standards, and reform | The Minister for Environment bring to Parliament by June 2012 amendments to the Conservation and Land Management Act 1984 that reflect the use by the Department of Environment and Conservation of prescribed burns for both biodiversity conservation and community protection purposes. |
REC202-0493 | 25 - Inquiry, audit, lessons management and after action review | The Minister for Emergency Services report to Parliament every six months on the progress made in completing all of the outstanding Recommendations of the Keelty Report. |
REC202-0500 | 24 - Govt responsibility | In implementing the Keelty Report’s Recommendation 42, the Ministers for Emergency Services and Environment jointly report to Parliament by May 2012 on the likely impacts on, and implications for, the future bushfire operations of the State Government of the drying climate in the State’s South West region. |
REC202-0512 | 9 - Community education | The Minister for Emergency Services commission an independent report to Parliament by June 2012 on an assessment of the success of FESA’s Total Fire Ban community education campaign in improving the community’s knowledge on this issue. |
REC202-0499 | 32 - Doctrine, standards, and reform | The Minister for Emergency Services institute a thorough review by December 2012, including a comparison to other jurisdictions, of the risk analysis processes used by FESA, the Police and DEC to prepare them to protect the State from bushfires and other natural disasters. |
REC202-0511 | 9 - Community education | The Minister for Emergency Services commission an independent report to Parliament by June 2012 on the best practices in other jurisdictions to increase the rate of residents likely to be effected by a bushfire who properly prepare their properties before the bushfire season. |
REC202-0498 | 24 - Govt responsibility | The Minister for Planning report to Parliament by May 2012 on the urgent actions undertaken by the Department of Planning and the Western Australian Planning Commission (WAPC) to transfer responsibility for declaring bushfire prone areas to the WAPC. |
REC202-0510 | 9 - Community education | The Minister for Emergency Services and the Minister for Local Government provide additional resources to FESA, DEC and WALGA in the 2012-13 Budget to improve the Western Australian community’s knowledge of bushfire safety and to allow these agencies to involve the public in their exercises. |
REC202-0497 | 25 - Inquiry, audit, lessons management and after action review | The Minister for Local Government have urgent discussions with the Western Australian Local Government Association (WALGA) as to why they are not supporting the full Recommendations addressed to local government in the Keelty Report. The Minister ensure that by May 2012 WALGA and its member councils have the resources to fully implement theimplementation of the Recommendations. |
REC202-0503 | 24 - Govt responsibility | The Minister for Police and Emergency Services and the Minister for the Environment report to Parliament by December each year as to the state of readiness of the main State Government agencies tasked with fighting bushfires. |
Rec-ID | Code | Recommendation |
---|---|---|
REC201-0247 | 28 - Personal responsibility | Local residents must take a degree of shared responsibility to prepare their properties by reducing the risk of bushfire around their properties and planning for a bushfire emergency. |
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 |
---|---|---|
REC200-1716 | 24 - Govt responsibility | State and locals governments: |
REC200-0343 | 9 - Community education | The Fire and Emergency Services Authority, in partnership with local governments, conduct more focused pre-season bushfire education, which emphasises: Water supply is not guaranteed during a bushfire Power supply is not guaranteed during a bushfire Saving life will be a priority over saving property so expect to be evacuated Once evacuated, access to affected areas may not be possible for several days Water ‘bombing’ by aircraft cannot be guaranteed in bushfire SMS warnings are advice only and may not be timely. |
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. |
REC200-1683 | 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. |
REC200-1721 | 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. |
REC200-0349 | 9 - Community education | The Fire and Emergency Services Authority work in partnership with Main Roads Western Australia and local governments to develop and implement a comprehensive strategy for the use of mobile variable message boards to alert the community to the declaration of a total fire ban and what it means. |
REC200-1688 | 9 - Community education | The Department of Education oversee the provision of bushfire education in schools that are located in bushfire prone areas, ensuring that all schools in these areas incorporate key bushfire messages in their curriculum. |
REC200-1701 | 25 - Inquiry, audit, lessons management and after action review | The Fire and Emergency Services Authority convene a facilitated debriefing session between the families who remained behind to protect their properties, and the incident controllers. |
REC200-1732 | 25 - Inquiry, audit, lessons management and after action review | The State Government review implementation of the Special Inquiry's recommendations in two years. |
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. |
REC200-1715 | 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. |
REC200-0342 | 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. |
REC200-0379 | 24 - Govt responsibility | The State Government recognise the projected changes in climate and potential impact on future fire events. |
REC200-1682 | 24 - Govt responsibility | The State Government give legislative effect to the Planning for Bush Fire Protection Guidelines. |
REC200-1720 | 32 - Doctrine, standards, and reform | The State Emergency Management Committee amend State Emergency Management Policy 4.1 (Operational Management) to: |
REC200-0348 | 9 - Community education | The Fire and Emergency Services Authority consider alternative wording to Total Fire Ban that ensures people gain a more complete understanding of what actions are prohibited. |
REC200-1687 | 9 - Community education | The Fire and Emergency Services Authority work in partnership with the Real Estate Institute of Western Australia to develop a package of information for new residents moving into bushfire prone areas, and a process to ensure this information is provided through real estate agents. |
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. |
REC200-0362 | 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. |
REC200-1699 | 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. |
REC200-1709 | 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. |
REC200-0341 | 32 - Doctrine, standards, and reform | The State Government give legislative effect to the Planning for Bush Fire Protection Guidelines. |
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. |
REC200-1681 | 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. |
REC200-1719 | 24 - Govt responsibility | The State Government recognise the projected changes in climate and potential impact on future fire events. |
REC200-0347 | 9 - Community education | The Department of Education oversee the provision of bushfire education in schools that are located in bushfire prone areas, ensuring that all schools in these areas incorporate key bushfire messages in their curriculum. |
REC200-0392 | 25 - Inquiry, audit, lessons management and after action review | The State Government review implementation of the Special Inquiry’s Recommendations in two years. |
REC200-1686 | 9 - Community education | Local governments continue to include information on bushfire risk and preparedness with rates notices. |
REC200-1728 | 24 - Govt responsibility | The Water Corporation immediately review the outstanding orders for hydrant repairs and develop strategies to reduce the backlog. |
REC200-0361 | 25 - Inquiry, audit, lessons management and after action review | The Fire and Emergency Services Authority convene a facilitated debriefing session between the families who remained behind to protect their properties, and the incident controllers. This session should include open discussion and explain the decisions of all parties – including how the incident controllers determined priorities, and why residents chose not follow their advice to evacuate. The learning outcomes should be promulgated across all agencies and incorporated in future level 3 incident controller training programs. |
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. |
REC200-1704 | 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. |
REC200-0339 | 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. |
REC200-0373 | 33 - Relief and recovery | The Department for Child Protection, the Western Australian Police and the Fire and Emergency Services Authority develop improved arrangements for communicating the loss of home and possessions to persons gathered at evacuation centres with a view to increasing privacy. |
REC200-1718 | 35 - Business and Industry in relation to industry | Western Power and the Water Corporation continue to work collaboratively to assess options to better protect the power supply to water pumping stations in bushfire prone areas. |
REC200-0345 | 22 - Role of local Gvt | Local governments continue to include information on bushfire risk and preparedness with rates notices. |
REC200-0384 | 25 - Inquiry, audit, lessons management and after action review | Emergency Management Western Australia develop mechanisms to calculate the estimated total cost of a fire to the community. |
REC200-1685 | 9 - Community education | The Fire and Emergency Services Authority (FESA) review its distribution of information material, including Prepare. Act. Survive. FESA should also consider including the community in pre-season exercising, in consultation with the Department for Child Protection and local governments. |
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. |
REC200-0354 | 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. |
REC200-1695 | 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. |
REC200-1703 | 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. |
REC200-0368 | 20 - Role of police | The Fire and Emergency Services Authority and the Western Australian Police ensure they receive all necessary legal clarification in relation to Bushfire Responsibilities of Police Officers – Powers Used in Assisting Fire Authorities in Responding to Bushfires, to be promulgated across FESA and WAPOL. |
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. |
REC200-0344 | 9 - Community education | The Fire and Emergency Services Authority (FESA) review its distribution of information material, including Prepare. Act. Survive. FESA should also consider including the community in pre-season exercising, in consultation with the Department for Child Protection and local governments. |
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. |
REC200-1684 | 9 - Community education | The Fire and Emergency Services Authority, in partnership with local governments, conduct more focused pre-season bushfire education, which emphasises: |
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 |
REC200-0353 | 22 - Role of local Gvt | The State Government give its full support to the Western Australian Local Government Association’s Send to Solve initiative. |
REC200-1694 | 24 - Govt responsibility | The State Government give its full support to the Western Australian Local Government Association's Send to Solve initiative. |
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. |
REC200-0367 | 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. |
Rec-ID | Code | Recommendation |
---|---|---|
REC192-1923 | 21 - Role of Commonwealth Government | The Committee recommends that Parliament establish a standing committee for natural disasters. The purpose of this committee would be to ensure that Government agencies and emergency services are fully prepared to deal with natural disasters and to provide an opportunity for Members of Parliament, as opposed to Cabinet, to have input into disaster management. |
Rec-ID | Code | Recommendation |
---|---|---|
REC191-0267 | 9 - Community education | that the Deputy Premier, Attorney-General, Minister for Local Government and Special Minister of State establish with local government a communication strategy to inform all residents about their fire prevention responsibilities. |
Rec-ID | Code | Recommendation |
---|---|---|
REC189-2910 | 21 - Role of Commonwealth Government | NOPSA should: |
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. |
REC189-2908 | 21 - Role of Commonwealth Government | To ensure that NOPSEMA is in a strong position to perform its functions effectively: |
REC189-2906 | 21 - Role of Commonwealth Government | In order to improve the effectiveness of National Offshore Petroleum Safety and Environmental Management Authority (NOPSEMA), with similar benefits for State or Territory regulators, attention should be given to the following actions. |
REC189-2914 | 32 - Doctrine, standards, and reform | The review team recommend that: |
REC189-2913 | 21 - Role of Commonwealth Government | In developing and improving its policies and practices for stakeholder engagement, NOPSA should ensure that: |
Rec-ID | Code | Recommendation |
---|---|---|
REC188-2917 | 33 - Relief and recovery | The committee recommends that relevant Commonwealth agencies continue to monitor the wellbeing of their personnel and that counselling and support services should be provided for as long as necessary. |
REC188-2916 | 33 - Relief and recovery | The committee recommends that the Department of Regional Australia and DIAC liaise with the Christmas Island community to explore options for a permanent memorial to be erected on the island, at a site of the residents' choosing, for the victims of the tragedy. |
REC188-2915 | 33 - Relief and recovery | The committee recommends that Department of Immigration and Citizenship (DIAC) and its relevant contractors continue to monitor the wellbeing of the survivors and that counselling and support services should be provided for as long as is necessary. |
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. |
REC183-0108 | 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 |
---|---|---|
REC182-0135 | 33 - Relief and recovery | FESA revises its standard operating procedures to provide guidance on the format and timing of post-incident community meetings. |
REC182-0123 | 32 - Doctrine, standards, and reform | FESA implements measures that will ensure unity and clarity of command. |
REC182-0132 | 9 - Community education | FESA implements an education and awareness campaign to promote the purpose and utility of community information systems. |
REC182-0127 | 9 - Community education | FESA strengthens its planning process to ensure learnings are incorporated and communicated, levels of preparedness are linked to threat analyses and public awareness and education activities are sustained. |
REC182-0126 | 9 - Community education | FESA promotes a whole-of-community approach, involving FESA, Local Governments and the community, in fire prevention functions, activities and planning. |
Rec-ID | Code | Recommendation |
---|---|---|
REC176-0136 | 21 - Role of Commonwealth Government | The Commonwealth Government examine potential new arrangements for Commonwealth involvement in the development and implementation of a national policy for bushfire management. |
REC176-0141 | 21 - Role of Commonwealth Government | The Commonwealth publish all fuel reduction plans and related audit findings on a national database. |
REC176-0137 | 21 - Role of Commonwealth Government | The Commonwealth co-ordinate a standing national arson forum between fire and law enforcement agencies to be held every two years. |
Rec-ID | Code | Recommendation |
---|---|---|
REC155-3474 | 24 - Govt responsibility | That the Victorian Government consider all available means, consistent with conservation values, for substantially increasing the access of apiarists to the public land estate. |
REC155-3479 | 32 - Doctrine, standards, and reform | That a process of year round community engagement in the preparation of Fire Operations Plans be established. In addition a record of year round community engagement, as contained in the Gippsland Fire Operations Plan, should be a requirement of all Fire Operations Plans. |
REC155-3473 | 24 - Govt responsibility | That the Victorian Government expedite the implementation of its 2006 election commitment to provide four wheel drive clubs with access to management vehicle only tracks. |
REC155-3478 | 38 - Agency/Department Reporting | That all information pertaining to current and planned prescribed burns be published more prominently on the Department of Sustainability and Environment’s website, with a single prominent link to this material on the website homepage. |
REC155-3468 | 38 - Agency/Department Reporting | That the Department of Sustainability and Environment, Department of Primary Industries, Parks Victoria & VicForests separately cost, and report, annual expenditure on fuel reduction burning, ecological burning and regeneration burning in their Annual Reports. |
REC155-3477 | 38 - Agency/Department Reporting | That the details of any variation or amendment of a Fire Operations Plan, including: the carrying forward or postponement of burns within the three-year period covered by a Fire Operations Plan; the carry over, removal or rescheduling of burns between past, present and future Fire Operations Plans; and the alteration of burn boundaries (including alterations of less than 25 per cent); should appear on the Department of Sustainability and Environment’s website at the time of the change and be included in the Fire Operations Plan for the following year. |
REC155-3467 | 38 - Agency/Department Reporting | The Department of Sustainability and Environment should report its performance against the increased prescribed burning target in its annual report, which should also include the following details: |
REC155-3476 | 38 - Agency/Department Reporting | That finalised Fire Operations Plans be made publicly available in their entirety (with the exception of any private information) on the Department of Sustainability and Environment’s website and in hard-copy, and that this requirement be clearly stated in future Codes of Practice. This should include the “district burns list”, or its future equivalents, and a map which shows the corresponding burns for each Fire District. Each map should be provided in a format which can be downloaded directly from the Department’s website without the need for further data manipulation by the user. An identical hardcopy version of the map for each Fire District should be also be available to members of the public on request and free of charge. |
REC155-3483 | 9 - Community education | That the Department of Sustainability and Environment and its partner agencies continue to develop a proactive approach to engagement with the local and wider media to achieve continuous improvement in the standard of community information and education. |
REC155-3466 | 25 - Inquiry, audit, lessons management and after action review | A comprehensive review of the effectiveness of the increased prescribed burning target in meeting ecological and bushfire suppression needs should be conducted every three years. |
REC155-3475 | 9 - Community education | That in relation to Fire Operations Plans, the Department Sustainability and Environment extends the number of community meetings during the public consultation period to a minimum of one meeting for each Fire District, with the possibility of repeat visits to particular areas. |
REC155-3482 | 32 - Doctrine, standards, and reform | That the Victorian Government, and responsible agencies, expedite the implementation of the Integrated Fire Management Planning framework. |
Rec-ID | Code | Recommendation |
---|---|---|
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. |
REC149-3134 | 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. |
REC149-3143 | 21 - Role of Commonwealth Government | The role of the advisory Board, namely to give advice to Ministers and NOPSA when asked, should be made clear to Board members and all stakeholders. The Board and NOPSA should consider the need for a clear description of who does what based on the legislated responsibilities of the NOPSA CEO. |
REC149-3133 | 35 - Business and Industry in relation to industry | Because some issues related to emergency response are beyond any single operator and usually occur outside the title area, there is a need for the representatives of the offshore industry to work together with other governments, interested and involved parties to develop the strategies to be utilised and the emergency planning model that will satisfy the requirements of all parties. |
REC149-3142 | 19 - Offences | NOPSA should use encouragement as the primary tool of enforcing compliance provided willingness to improve is exhibited by the players. |
REC149-3132 | 35 - Business and Industry in relation to industry | Coverage of the regime should be increased to cover the complete hydrocarbons production system from wells through to custody transfer point or reasonable physical/technical system boundary. If NOPSA is also to be responsible for Carbon Capture and Storage it needs to be resourced to ensure that this does not detract from NOPSA's current responsibilities. |
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. |
REC149-3131 | 35 - Business and Industry in relation to industry | The exploration/production operator making all major decisions related to petroleum activities (i.e. selection of rig, well design and selection of service companies) should be made responsible for demonstrating to the regulator that drilling operations can be conducted safely. Where the drilling contractor owns the rig and conducts the day-to-day management of safety on the rig, this duty can be described in a rig specific Safety Case that is owned by the drilling contractor. This rig specific Safety Case does not have to be submitted for every well/well operation. |
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. |
REC149-3146 | 35 - Business and Industry in relation to industry | NOPSA should consider establishing a small forum for consultation consisting of representatives of relevant stakeholders. The representatives should have standing, with authority to participate in decision making and take on commitment on behalf of their stakeholder group. |
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. |
REC149-3138 | 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. |
REC149-3145 | 25 - Inquiry, audit, lessons management and after action review | NOPSA should consider an audit regime that targets Greenfields operations at commencement of operations. |
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 |
---|---|---|
REC122-3779 | 24 - Govt responsibility | The Committee recommends that relevant government departments implement an ongoing management program for the eradication of feral pests and weeds. |
REC122-3790 | 32 - Doctrine, standards, and reform | The Committee recommends that prescribed burning should only be undertaken by professionally trained personnel. |
REC122-3796 | 9 - Community education | The Committee recommends that the government undertake public education programs to increase the awareness of the community to bushfires, the role fire plays in ecosystems and what steps they should take to minimise the impact of a fire. |
REC122-3795 | 3 - Biodiversity | The Committee recommends that the government assess the impact on fauna movement prior to managing native vegetation. |
REC122-3789 | 32 - Doctrine, standards, and reform | The Committee recommends that the native vegetation planning and approval process for prescribed burning be amended to allow flexibility for burning on optimum days. |
REC122-3794 | 3 - Biodiversity | The Committee recommends that when preparing the plan for fire management (including identifying where and when to undertake prescribed burning, firebreaks and fire access tracks) consideration must be given to the impact on local fauna. |
REC122-3788 | 32 - Doctrine, standards, and reform | The Committee recommends that the Native Vegetation Council have a consistent approach to prescribed burning on both public and private lands. |
REC122-3793 | 3 - Biodiversity | The committee recommends that the government actively manage native vegetation for fuel loads, weeds and pests. |
REC122-3786 | 32 - Doctrine, standards, and reform | The Committee recommends that the Native Vegetation Act be amended to allow for prescribed burning. |
REC122-3792 | 3 - Biodiversity | The Committee recommends that, after a fire, as much vegetation as feasible be retained to minimise soil erosion from wind and first rains. |
REC122-3797 | 9 - Community education | The Committee recommends that the Native Vegetation Council continue to seek mechanisms to interact with, and educate the individual farmer and landholder with respect to the Native Vegetation Act, its regulations and exemptions. |
Rec-ID | Code | Recommendation |
---|---|---|
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. |
REC121-3758 | 25 - Inquiry, audit, lessons management and after action review | Following completion of any external audit, a corrective action plan to remedy any identified safety deficiencies should be developed by RailCorp, implemented and followed up within the business groups affected, to ensure appropriate and timely completion of the action plan, by a formal examination of the effectiveness of the controls put in place. Senior management personnel should certify that the corrective action plan has been implemented and is effective. Senior management personnel should be accountable for any such certification. |
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. |
REC121-3723 | 38 - Agency/Department Reporting | All ATSB accident investigation reports should be made public. |
REC121-3765 | 25 - Inquiry, audit, lessons management and after action review | The ITSRR should conduct field audits to satisfy itself that all accredited rail organisations conduct their activities in accordance with the safety management system on the basis of which each was accredited. |
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. |
REC121-3694 | 25 - Inquiry, audit, lessons management and after action review | The ITSRR should conduct random audits of accredited rail organisations for compliance with communications protocols. |
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. |
REC121-3730 | 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. |
REC121-3771 | 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. |
REC121-3713 | 25 - Inquiry, audit, lessons management and after action review | Recommendations one to seven of the final report of the Special Commission of Inquiry into the Glenbrook Rail Accident should be fully implemented, save that the random auditing referred to in recommendations five and seven should be carried out by ITSRR. |
REC121-3757 | 25 - Inquiry, audit, lessons management and after action review | RailCorp should conduct internal and external safety audits to evaluate the adequacy of its safety management system and to ensure that any risk control measures are effective. |
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. |
REC121-3686 | 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. |
REC121-3722 | 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. |
REC121-3763 | 32 - Doctrine, standards, and reform | The ITSRR should publish guidelines to be followed by accredited organisations. |
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. |
REC121-3693 | 25 - Inquiry, audit, lessons management and after action review | ITSRR should ensure that, as a condition of accreditation, each of these recommendations is carried into effect and should audit against them to enforce compliance. |
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. |
REC121-3729 | 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. |
REC121-3770 | 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 |
REC121-3668 | 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. |
REC121-3712 | 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. |
REC121-3753 | 25 - Inquiry, audit, lessons management and after action review | The RailCorp Board should establish independent external safety auditing processes to regularly audit and report to the Board on the implementation of an integrated safety management system by RailCorp and on safety performance generally. |
REC121-3775 | 38 - Agency/Department Reporting | The Minister for Transport Services must table in Parliament, each such quarterly report by ITSRR. |
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. |
REC121-3762 | 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. |
REC121-3659 | 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. |
REC121-3692 | 32 - Doctrine, standards, and reform | Communications protocols and procedures should be standardised and mandated by regulations making them a condition of accreditation. |
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. |
REC121-3728 | 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. |
REC121-3769 | 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. |
REC121-3667 | 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. |
REC121-3750 | 32 - Doctrine, standards, and reform | ITSRR should initiate and/or participate in the development of a national standard for crashworthiness of all passenger trains. |
REC121-3774 | 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: |
REC121-3679 | 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. |
REC121-3761 | 32 - Doctrine, standards, and reform | Legislative changes should be enacted to ensure the complete independence of ITSRR from the Minister for Transport Services. |
REC121-3655 | 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. |
REC121-3691 | 25 - Inquiry, audit, lessons management and after action review | The ITSRR should audit the RMC to ensure communications protocols are being followed. The sanction for non-compliance with communications protocols should be identical to that in the aviation industry and involve immediate removal from duty. Any RailCorp employee not following communications protocols should be required to undertake further training. If, following return to duties after such training, the officer continues to fail to comply with communications protocols, that officer is not to be employed in communications related work. |
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. |
REC121-3768 | 25 - Inquiry, audit, lessons management and after action review | The ITSRR, when considering a re-application for accreditation, should conduct a field audit of the organisation to ensure that it is carrying on its activities in accordance with the basis upon which it seeks accreditation. |
REC121-3664 | 20 - Role of police | The location of the command post for site control at the scene of any rail accident should be identified by NSW Police by a distinctive flashing light. |
REC121-3697 | 38 - Agency/Department Reporting | All train drivers’ defects reports should be entered by RailCorp into a computerised record and tracked to finalisation. |
REC121-3705 | 32 - Doctrine, standards, and reform | The ITSRR should develop standards for periodic medical examinations which include the following: |
REC121-3742 | 19 - Offences | The risk of abuse of internal passenger emergency door releases should be further reduced by introducing significant penalties for any improper use of such an emergency facility. It should be a criminal offence for anyone to use or tamper improperly with an emergency escape facility in a train. |
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. |
REC121-3678 | 35 - Business and Industry in relation to industry | All railway owners and operators should have a quality assurance program for the design and construction of rolling stock and regular review of construction to ensure that the rolling stock satisfies the original functional performance specifications. |
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. |
REC121-3760 | 32 - Doctrine, standards, and reform | The Advisory Board established under the Transport Legislation Amendment (Safety and Reliability) Act 2003 must be abolished. |
REC121-3690 | 32 - Doctrine, standards, and reform | All communications protocols must be strictly enforced by all accredited rail organisations. |
REC121-3726 | 25 - Inquiry, audit, lessons management and after action review | The OTSI should continue to conduct rail accident investigations on behalf of ITSRR and report directly to the Chief Executive of ITSRR. |
REC121-3767 | 24 - Govt responsibility | All accredited rail organisations should be required to re-apply every three years to ITSRR for accreditation. |
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. |
REC121-3696 | 32 - Doctrine, standards, and reform | Defects reporting, recording and rectification should be integrated with the RailCorp regimes for train maintenance. |
REC121-3704 | 28 - Personal responsibility | RailCorp should continue its system of voluntary self-identification and rehabilitation of employees with alcohol or drug related problems. |
REC121-3736 | 32 - Doctrine, standards, and reform | The RailCorp passenger containment policy must be abandoned. |
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. |
REC121-3674 | 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. |
Rec-ID | Code | Recommendation |
---|---|---|
REC098-2152 | 32 - Doctrine, standards, and reform | The Committee recommends that the Commonwealth, through the Council of Australian Governments and the Australasian Fire Authorities Council, initiate an overhaul of the incident management systems used |
REC098-2170 | 32 - Doctrine, standards, and reform | The Committee recommends that Emergency Management Australia request the Australasian Fire Authorities Council to: |
REC098-2187 | 32 - Doctrine, standards, and reform | The Committee recommends that the Commonwealth require state and territory governments to have in place comprehensive bush fire management plans as a pre-requisite for accessing funding from the National Heritage Trust and like programs. |
REC098-2149 | 32 - Doctrine, standards, and reform | The Committee recommends that the Commonwealth work with the states and territories through the proposed Council of Australian Governments to review the response to bushfires to ensure that principles of fire prevention and rapid and effective initial attack are adopted and implemented by all rural fire authorities and public land managers |
REC098-2166 | 32 - Doctrine, standards, and reform | The Committee recommends that Emergency Management Australia work through the Australasian Fire Authorities Council to ensure that: |
REC098-2186 | 38 - Agency/Department Reporting | The Committee recommends that the Department of Transport and Regional Services review its record keeping practices to show the type of emergency for which assistance is provided through the Natural Disaster |
REC098-2141 | 32 - Doctrine, standards, and reform | The Committee recommends that the Commonwealth through the National Heritage Trust, offer assistance to the states and the Australian Capital Territory to develop specific prescribed burning guides, at least |
REC098-2159 | 32 - Doctrine, standards, and reform | The Committee recommends that in changing the incident management systems as proposed in recommendation 23 above all bushfire agencies review concerns about difficulties in communicating operational information from the fire front to air operations. |
REC098-2185 | 21 - Role of Commonwealth Government | The Committee recommends in acknowledgement of the expertise that the Commonwealth can bring to the Australasian Fire Authorities Council and of funding already supplied to the Council for the development of a National Aerial Firefighting Strategy, that the current status of Emergency Management Australia on AFAC as an associate member be upgraded to full membership and that full membership also be extended to the Department of Defence. |
REC098-2135 | 32 - Doctrine, standards, and reform | The Committee recommends that the Commonwealth seeks to ensure that the Council of Australian Governments implements to a minimum national standard adequate access to all public lands including wilderness areas of national parks. |
REC098-2155 | 25 - Inquiry, audit, lessons management and after action review | The Committee recommends that Emergency Management Australia initiate a process involving Australasian Fire Authorities Council and the Australian Assembly of Volunteer Fire Brigades Association to review |
REC098-2184 | 21 - Role of Commonwealth Government | The Committee recommends that the functions and administration of Emergency Management Australia be reviewed to develop an organisation that is proactive and involved in the development and implementation of national policy on emergency response. |
REC098-2131 | 24 - Govt responsibility | The Committee recommends that the Commonwealth through the Council of Australian Governments ensure that states and territories have adequate controls to ensure that local governments implement required fuel management standards on private property and land under their control. |
REC098-2154 | 32 - Doctrine, standards, and reform | The Committee recommends that the Commonwealth seek to ensure that the Council of Australian Governments seek the adoption by all states and territories of multi-agency protocols and agreements for fire |
REC098-2174 | 9 - Community education | The Committee recommends that the Insurance Council of Australia coordinates a public education campaign aimed at illustrating the importance of asset protection and how this can be achieved (that is, insurance products). |
Rec-ID | Code | Recommendation |
---|---|---|
REC037-4164 | 22 - Role of local Gvt | The role of local government in counter—disaster affairs be clearly defined and formalised by legislation. Local government authorities would then be fully aware of their responsibilities and of their entitlement to financial and other counter—disaster resources from State Government level. [Reference paragraphs: 232 to 233] |
REC037-4161 | 32 - Doctrine, standards, and reform | That separate counter—disaster systems be avoided by retaining counter—bushfire arrangements as part of the State’s total counter— disaster system. [Reference paragraph: 228] |
REC037-4168 | 32 - Doctrine, standards, and reform | The provisions of the State Disasters Act, 1983, be extended to cover the proposed policy and organisational amendments. (Reference paragraph: 286] |
REC037-4160 | 32 - Doctrine, standards, and reform | The current counter—bushfire concept be retained, with the proviso that it be kept under continuous review to ensure that all relevant future developments and techniques are effectively utilised. (Reference paragraphs: 88 to 90 and 257 to 259] |
REC037-4167 | 32 - Doctrine, standards, and reform | The definitions of command, control and co—ordination, as stated in the Australian Counter Disaster Handbook, be standardised throughout Victoria’s counter—disaster system. [Reference paragraphs: 106 to 111] |
REC037-4166 | 32 - Doctrine, standards, and reform | In the future development of Victoria’s counter—disaster capability, effective utilisation and management of resources be regarded as a major objective. |
REC037-4165 | 32 - Doctrine, standards, and reform | • Proposed amendments to the State Disaster Plan be formalised |