Inquiry Search
Rec-ID | Code | Recommendation |
---|---|---|
REC326-4344 | 24 - Govt responsibility | To promote integrity and transparency, the Department of Regional NSW should ensure that for all future grant programs it: establishes and follows guidelines that align with relevant good practice guidance including accountabilities, key assessment steps and clear assessment criteria. |
REC326-4340 | 24 - Govt responsibility | To promote integrity and transparency, the Department of Regional NSW should ensure that for all future grant programs it: documents all key decisions and approvals in line with record keeping obligations. |
REC326-4341 | 24 - Govt responsibility | To promote integrity and transparency, the Department of Regional NSW should ensure that for all future grant programs it: ensures regular monitoring is in place as part of funding deeds. |
REC326-4342 | 24 - Govt responsibility | To promote integrity and transparency, the Department of Regional NSW should ensure that for all future grant programs it: ensures staff declare conflicts of interest prior to the commencement of a grants stream, and that these conflicts of interest are recorded and managed. |
REC326-4343 | 24 - Govt responsibility | To promote integrity and transparency, the Department of Regional NSW should ensure that for all future grant programs it: ensures a communications plan is in place, including the communication of guidelines to potential applicants. |
Rec-ID | Code | Recommendation |
---|---|---|
REC324-4316 | 12 - EM agency and authority | Resilience NSW and recovery: That, in order to enhance NSW disaster preparedness, response and recovery, and meet the needs of the people of NSW prior to, during and after a disaster, and provide clarity on agency roles and responsibilities, Resilience NSW be reshaped to ‘Recovery NSW’. The new agency will be more streamlined and agile to drive recovery in the first 100 days post disaster. To achieve this, Resilience NSW’s functions should be reallocated as follows: |
REC324-4305 | 39 - Disaster Risk Management | Cost benefit framework:That, to enable a more systematic prioritisation of investment options in risk mitigation before, during and immediately following a natural disaster event, Government adopt and utilise a Disaster Cost Benefit Framework. This Framework will enable Government to estimate the investment required for any given disaster, starting with flood events, and will enable the fast allocation of funding based on detailed and rapid analysis of flood and property modification, mitigation, preparation, response and finance related options including: |
REC324-4296 | 1 - Land-use and building regs | Caravan parks and manufactured home estates: That, to ensure that permanent residents of caravan parks and mobile housing estates are protected from flood, Government: • prohibit permanent residency in caravan parks and mobile housing estates situated below the risk-based flood planning level. Caravan parks for holiday makers could still be on the floodplain with the provision that, if a flood is imminent, they need to be evacuated • address the issues raised in the 2015 Discussion Paper (Improving the regulation of manufactured homes, caravan parks, manufactured home estates and camping grounds). |
REC324-4318 | 12 - EM agency and authority | Permanent SEOCON: That, to improve NSW’s ability to prepare and respond to floods and other disasters, Government establish a new Deputy Commissioner of NSW Police Force to take on permanently the SEOCON role. This role, in addition to current SEOCON functions, would be responsible for: |
REC324-4307 | 9 - Community education | Flood education: That, to build disaster resilience in future generations as floods and other natural disasters are a fact of Australian life, the Department of Education should design, implement and deliver an evidence-based, targeted education campaign (like sun exposure) in schools (new disaster curriculum). |
REC324-4299 | 1 - Land-use and building regs | Relocating communities most at risk with good homes and amenities: That, to empower vulnerable people and communities to relocate, Government through the NSWRA: |
REC324-4319 | 26 - Research | Climate and weather research: That, to enable effective mitigation and adaptation measures in response to changing climate risks, Government establish NSW as a world centre of disaster research and technology development. This should include: |
REC324-4308 | 26 - Research | Compound mental helath studies: That, to inform Government policies and programs for mental health and disasters, Government commission a longitudinal study on the effect of consecutive disasters on community mental health. |
REC324-4300 | 1 - Land-use and building regs | Simplify the planning system disaster provisions: That, to simplify and improve the state planning processes especially when anticipating and recovering from a disaster, Government: |
REC324-4320 | 12 - EM agency and authority | Knowledge resources to support flood management: That, to provide more accurate and complete data for flood threat identification, warning and modelling systems, Government through the proposed new NSW Reconstruction Authority (NSWRA) work with the Australian Government to: |
REC324-4309 | 12 - EM agency and authority | SES and RFS back-office merger: That, to help protect life and property across NSW in storm and flood events, and to improve resourcing and NSW State Emergency Service (SES) frontline capability, Government implement, before the next storm season, a merger of the SES and NSW Rural Fire Services (RFS) back-office and corporate service functions, while maintaining their separate legislative identity, brand, uniform and volunteer membership. This ‘joined-up’ RFS/SES corporate support structure would be under the command of the RFS given its corporate and operational maturity and would be responsible for: |
REC324-4303 | 39 - Disaster Risk Management | Risk-based approach to calculating flood planning: That, to take account of greater knowledge of climate change, Government reinforce its adoption of a risk-based approach to calculating the flood planning level for planning purposes and, through the NSWRA, immediately start a process of revising all flood planning level calculations in the state’s high-risk catchments. Flood planning level re-determinations for all high-risk catchments should be completed within 3 years. These revised flood planning levels will need to be factored into all development applications (in-progress and new) in those high-risk catchments. The risk profile of high-risk catchments should be revisited at appropriate time intervals to check that levels are current. A review should take place if there has been a significant trigger event (i.e. changed rainfall, development) or at least every 5 years. As well as reviewing the flood planning level, this 5-yearly review should include reviewing any floodplain lease conditions and adjusting them as necessary in the light of better knowledge of climate change impacts. In working out a tolerable, risk-based flood planning level, consideration should be given to the PMF, 1% AEP, 0.02% AEP, existing development, approved but not yet constructed developments, and existing and approved but not yet constructed evacuation routes. |
REC324-4310 | 41 - Emergency Management exercises | Task Force Hawk: That, to ensure disaster readiness, Government establish a high-level Government standing committee, Task Force ‘Hawk’, comprising key Cabinet Ministers, Secretaries and Commissioners that meets, trains and exercises to ensure Government is prepared to respond to any emergency. Task Force ‘Hawk’ should resonate with the community in difficult times to ensure the highest level of confidence in Government’s response. |
REC324-4304 | 1 - Land-use and building regs | Landholders can access information on previous disasters: That, to ensure there is a single source of ground truth to prepare for and respond to emergencies, and to provide people with a better understanding of their individual property and community risk exposure, an online visualisation tool be developed to display, for all land parcels (land titles) in NSW, the extent of known disasters that have affected each piece of land in NSW in the past. This information should be made available through the Planning Portal and, particularly in light of climate change, the data involved should be revised and updated at least every two years and after each major natural disaster. |
Rec-ID | Code | Recommendation |
---|---|---|
REC316-4015 | 12 - EM agency and authority | The working group should report to SEMSOG on progress. |
REC316-4042 | 25 - Inquiry, audit, lessons management and after action review | ACT Government undertake a detailed legislative review to ensure that information regarding vulnerable community members can be appropriately accessed, provided and used during an emergency event. |
REC316-4026 | 12 - EM agency and authority | The role, level, requirements and expectations of an ECC LO be clarified in the Emergency Plan and ECC Ops Sub-plan. |
REC316-4033 | 25 - Inquiry, audit, lessons management and after action review | The BFC Terms of Reference be reviewed to ensure they are contemporary and reflect learnings from this and recent bushfire seasons. |
REC316-4014 | 25 - Inquiry, audit, lessons management and after action review | That Justice and Community Safety Directorate (JACS) lead a working group from across relevant organisations to undertake the five year review of the Emergencies Act in conjunction with a wholistic review of the Emergency Plan and relevant sub-plans; and recommendations from this review, to the extent they are accepted by Government. Bringing together a small Taskforce of staff from across government for a set period would assist the working group in delivering the work needed to address these and other recommendations. |
REC316-4041 | 9 - Community education | The ESA Community Education and Engagement program be adapted to include an expanded role for RFS volunteers and include a wider set of stakeholders who are more vulnerable to the impact of bushfire. A plan would require wider involvement across stakeholder organisations such as Directorates who have existing relationships with vulnerable groups. |
REC316-4023 | 41 - Emergency Management exercises | An opportunity to exercise and test the formation and functioning of a Management Executive through desktop and/or limited scenario-based exercises be provided. |
REC316-4032 | 41 - Emergency Management exercises | Concurrent and/or non–standard emergencies such as energy supply impacts be included in future exercise programs. |
REC316-4040 | 41 - Emergency Management exercises | The PICC be exercised in conjunction with any and all Emergency Plan exercises to test and refine strengthened arrangements. |
REC316-4022 | 12 - EM agency and authority | That when determining their Management Executive, at a minimum the EC should consider appointing Director-General JACS and the PIC as standing members. |
REC316-4031 | 12 - EM agency and authority | The ESA hold bi-lateral executive level meetings with the utility providers on a regular basis in consultation with other relevant Government stakeholders. |
REC316-4039 | 12 - EM agency and authority | Establish a Communications Working Group (CWG) with representatives from across key Directorates (CMTEDD, ESA, ACT Policing, Health, CHS, EPSDD for example) to review the CCIP and to further identify how the CCIP can be best implemented and utilised. The CWG should report its progress though SEMSOG and coordinate with other WG’s. Bringing together a small Taskforce of staff from across government for a set period would assist the working group in delivering the work needed to address these and other recommendations. |
REC316-4018 | 25 - Inquiry, audit, lessons management and after action review | The five year review of the Emergencies Act examine amendments to better define the rationale for a State of Alert / State of Emergency whilst ensuring that the relevant Minister / Chief Minister still has sufficient discretion to make a declaration based on advice from relevant Government officials and committees. |
REC316-4028 | 41 - Emergency Management exercises | Any changes to the ECC structure and role be exercised both within ESA and across a WHoG exercise and testing program. |
REC316-4038 | 25 - Inquiry, audit, lessons management and after action review | The CCIP be reviewed in conjunction with the review of the Emergency Plan and the two synchronised. A workable approach to delivering operational emergency communications and strategic WhoG communications is developed with simple and clear reporting arrangements. |
REC316-4016 | 12 - EM agency and authority | That the Emergency Plan be amended to include considerations for declaring a State of Alert or Emergency (and also wind back from these) and guidance as to what actions and decisions at a minimum should be taken as a consequence of such a declaration. |
REC316-4045 | 42 - Culture and Heritage | WHoG desktop exercise should be conducted to test and support relocation and evacuation planning. |
REC316-4027 | 12 - EM agency and authority | All organisations who have a role in the ECC should review their existing arrangements to ensure there is a sufficient cohort of staff to maintain a presence in the ECC at a level and with an imprimatur sufficient to make decisions and allocate resources and have access to senior executive levels if needed. |
REC316-4036 | 12 - EM agency and authority | Government give consideration to investment in professional specialities such as fire behaviour analysts, airbase managers, aerial firefighting technical specialists etc for the RFS. |
Rec-ID | Code | Recommendation |
---|---|---|
REC315-3813 | 35 - Business and Industry in relation to industry | That, in order to ensure tourism businesses are prepared for natural disasters including bush fires, Resilience NSW work with NSW RFS and Destination NSW to develop bush fire preparedness support for tourism businesses, based on research into existing models. Over time, this support could be expanded to include other natural hazards. |
REC315-3834 | 12 - EM agency and authority | That, in order to ensure all firefighters understand how local situational awareness reflects (or may not reflect) the broader scale situation presented by a large/extreme bush fire and the implications this may have on asset protection and fire suppression strategies, the NSW RFS: |
REC315-3822 | 42 - Culture and Heritage | That Government adopt the principle that cultural burning is one component of a broader practice of traditional Aboriginal land management and is an important cultural practice, not simply another technique of hazard reduction burning. |
REC315-3850 | 3 - Biodiversity | That Government develop and implement a policy on injured wildlife response, rescue and rehabilitation including: |
REC315-3859 | 25 - Inquiry, audit, lessons management and after action review | That, in order to ensure State Emergency Operations Centre (SEOC) interoperability during all natural disasters, Resilience NSW review the current SEOC arrangements and location including responsibilities for ongoing resourcing and maintenance. |
REC315-3798 | 25 - Inquiry, audit, lessons management and after action review | That, in order to ensure recommendations accepted by the Government are implemented in a timely and transparent manner, Government establish a central accountability mechanism to track implementation of recommendations from bush fire-related reviews and inquiries and consider expanding this to other policy areas. |
REC315-3827 | 10 - Infrastructure | That, in order to minimise communication outages and extend basic communication coverage during bush fires, the NSW Government work directly, or together with other Australian governments and/or their relevant power and telecommunications regulatory, policy and market bodies, to: |
REC315-3812 | 25 - Inquiry, audit, lessons management and after action review | That Government commit to: |
REC315-3833 | 3 - Biodiversity | That Government invest in long-term ecosystem and land management monitoring, modelling, forecasting, research and evaluation, and harness citizen science in this effort. This will include, among other things: |
REC315-3821 | 4 - Fire season preparation | That government agencies managing land (at all levels and through all agencies) be the best neighbours possible by considering their neighbours when undertaking activities related to bush fire preparation and having clear, two-way communication about these activities, with the aspiration that government landholders will be seen as highly desirable neighbours. |
REC315-3846 | 12 - EM agency and authority | That, in order to maximise the efficiency and effectiveness of heavy plant used in dry fire fighting techniques, the NSW RFS expand and introduce the following in respect to heavy plant: |
REC315-3826 | 10 - Infrastructure | That, in order to maximise the protection of critical infrastructure in a bush fire, Australian governments revise the regulatory framework for the provision to government authorities of information about all critical infrastructure (public and private) including a possible change to compel the owners of critical assets to provide all needed metadata, updated annually, for appropriate planning, preparation and response for bush fire. This would include information about location, ownership, access, details of service the infrastructure supports, and fire treatments of building and surrounding zones. |
REC315-3858 | 25 - Inquiry, audit, lessons management and after action review | That, in order to improve cross-agency communication and coordination during bush fires, the NSW RFS review Fire Control Centres (FCCs) in areas that were heavily affected by fire. The results should be combined with the Emergency Operations Centre (EOC) Facilities Review to identify areas that would benefit from a purpose-built FCC, enabling co-location with the EOC. |
REC315-3873 | 25 - Inquiry, audit, lessons management and after action review | That Resilience NSW review existing functional area arrangements to ensure they are closely aligned to agencies responsible for direct service delivery. |
REC315-3810 | 24 - Govt responsibility | That, to ensure updated resource-sharing arrangements are in place, the NSW and Victorian Governments progress and finalise a multi-agency Memorandum of Understanding before the 2020-21 fire season commences. |
REC315-3831 | 26 - Research | That, in order to capture and understand the impacts of bush fire smoke better, Government invest in operational air quality forecasting and alert systems, and public health research and policy development. This would involve investment to: |
REC315-3818 | 26 - Research | That, in order to improve understanding of optimal hazard reduction techniques and their application in the landscape: |
REC315-3845 | 26 - Research | That Government commission further research on the potential risks and benefits of backburning during severe, extreme and catastrophic conditions and/or in particular terrain, and that the NSW RFS use this research to inform future backburning protocols and training. |
REC315-3825 | 39 - Disaster Risk Management | That Government, acknowledging that a strategic approach to planning for bush fire will take time, and in order to protect, prepare and build resilience into existing communities better, should immediately: |
REC315-3857 | 12 - EM agency and authority | That, in order to ensure timely payment and maintain positive ongoing supplier relationships during large-scale bush fires, the NSW RFS implements an automated logistics solution, informed by the outcomes of the Emergency Logistics Project. |
REC315-3869 | 42 - Culture and Heritage | That, in order to ensure Aboriginal people can access appropriate support during evacuation, Resilience NSW work with Local Emergency Management Committees and Aboriginal Affairs to ensure: |
REC315-3808 | 22 - Role of local Gvt | That, in order to strengthen the capability of local councils in future emergency events: |
REC315-3830 | 39 - Disaster Risk Management | That as a matter of urgency, in order to accelerate and finalise a State-wide strategic fire trail network, the NSW RFS Commissioner and Bush Fire Coordinating Committee (BFCC): |
REC315-3817 | 5 - Hazard reduction burns | That Government, noting that hazard reduction targeted in proximity to assets is on balance more likely to provide help than hinder, should: |
REC315-3842 | 24 - Govt responsibility | That, in order to prioritise early suppression and keep fires small: |
REC315-3824 | 1 - Land-use and building regs | That Government commit to shifting to a strategic approach to planning for bush fire, and develop a new NSW Bush Fire Policy similar to the NSW Flood Prone Land Policy in order to accommodate changing climate conditions and the increasing likelihood of catastrophic bush fire conditions; to build greater resilience into both existing and future communities; and to decrease costs associated with recovery and rebuilding. |
REC315-3856 | 10 - Infrastructure | That, in order to improve response times to Triple Zero calls, the NSW RFS implements the integrated dispatch system before the 2020-21 fire season commences. |
REC315-3864 | 9 - Community education | That, in order to ensure people can access clear information on cross-border fires, the NSW RFS: |
REC315-3802 | 26 - Research | That Government establish NSW as a major world centre of bush fire research, and technology development and commercialisation. This should include: |
REC315-3829 | 4 - Fire season preparation | That, in order to ensure outcomes-based roadside vegetation management to reduce roadside tree fall and grass ignitions in planning and preparing for bush fire, Transport for NSW, working with local government and NSW RFS, establish a consistent framework for roadside vegetation management that analyses road priority, utility, amenity, strategic value and risk. The framework should: |
REC315-3816 | 5 - Hazard reduction burns | That Government re-commit to the current, regionally based approach to planning and coordinating hazard reduction activities across all tenures through Bush Fire Management Committees but ensure that it is actually being implemented at a high-level of quality across NSW. Getting it to a high-level of quality requires: |
REC315-3841 | 12 - EM agency and authority | That, in order to ensure suitably skilled and experienced personnel operate as Divisional Commanders during major fire incidents, Bush Fire Management Committees identify appropriate personnel as part of their plan of operations. |
REC315-3823 | 42 - Culture and Heritage | That, in order to increase the respectful, collaborative and effective use of Aboriginal land management practices in planning and preparing for bush fire, Government commit to pursuing greater application of Aboriginal land management, including cultural burning, through a program to be coordinated by Aboriginal Affairs and Department of Planning, Industry and Environment working in partnership with Aboriginal communities. This should be accompanied by a program of evaluation alongside the scaled-up application of these techniques. |
REC315-3851 | 10 - Infrastructure | That, to ensure mobile generators are sourced and distributed on a priority basis during natural disasters, the EUSFAC work with the NSW Telco Authority, relevant NSW government agencies and commercial stakeholders to develop a mobile asset deployment strategy. The strategy should reduce duplication in purchasing, maintaining and housing mobile generators and improve agility in deployment. |
REC315-3860 | 25 - Inquiry, audit, lessons management and after action review | That, in order to ensure the guiding principles and approval processes are contemporary, streamlined and more flexible, the NSW and Commonwealth Governments review the Defence Assistance to the Civil Community (DACC) arrangements. This review should include the circumstances in which the State can request Commonwealth assistance, and the level of information provided by the ADF to the State on available resources and capabilities. |
REC315-3799 | 9 - Community education | That at the start of each fire season, based on advice from the Bush Fire Coordinating Committee, Government provide a public statement with an evaluation of the likely fire season risk and the effectiveness of the planning and preparation for the upcoming season. This should be based on sophisticated monitoring of the key risk factors and signals for an extreme fire season. It should form the basis for clear public communication about these risks on a regional basis and the actions that Government proposes in preparation. |
REC315-3828 | 9 - Community education | That, in order to improve bush fire planning and protection of road infrastructure and to ensure communities, freight movers and fire fighting agencies have appropriate access and egress in a bush fire event, Government, working with local government as needed: |
Rec-ID | Code | Recommendation |
---|---|---|
REC302-2403 | 12 - EM agency and authority | Take steps to ensure that both fire commissioners are seeking opportunities to engender a culture in their respective organisations that seeks to attract and foster the volunteer ethos and experience |
REC302-2401 | 12 - EM agency and authority | While the proposal to establish an integrated call and dispatch centre is being implemented, Fire and Rescue NSW should take steps to civilianise ComCen and maintain experienced senior officers from both agencies as supervisors similar to how the NSW Police Force and Ambulance Service of NSW operate |
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 |
REC302-2397 | 12 - EM agency and authority | Use the model and system in place at the Ambulance Service of NSW as a benchmark for call taking, dispatch and the provision of situational awareness when deploying resources. This will overcome the lack of a feedback loop in current bushfire operations |
Rec-ID | Code | Recommendation |
---|---|---|
REC237-0829 | 9 - Community education | That Bush Fire Risk Management Plans be posted on the NSW Rural Fire Service website. |
REC237-0828 | 9 - Community education | That the NSW Rural Fire Service develop a strategy to better inform the community and NSW Rural Fire Service members about the NSW bush fire management system and its components. |
REC237-0825 | 1 - Land-use and building regs | That the NSW Rural Fire Service hold discussions with the Department of Planning and Infrastructure and Local Government NSW on ways to improve compliance with development consents under section 76A of the Environmental Planning and Assessment Act 1979. |
REC237-0830 | 9 - Community education | That Bush Fire Risk Management Plans be tabled at Local Emergency Management Committees for comment. |
Rec-ID | Code | Recommendation |
---|---|---|
REC164-0073 | 25 - Inquiry, audit, lessons management and after action review | SERCon consider that the proposed State Recovery Committee provide an interim report to government on these and |
REC164-0074 | 9 - Community education | SERCon consider a review of existing community-based educational programs, with a view to informing the community |
Rec-ID | Code | Recommendation |
---|---|---|
REC121-3697 | 38 - Agency/Department Reporting | All train drivers’ defects reports should be entered by RailCorp into a computerised record and tracked to finalisation. |
REC121-3753 | 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. |
REC121-3658 | 12 - EM agency and authority | All emergency services stations should be provided with access keys to, and maps showing, all gates providing access to RailCorp tracks within their geographic area of responsibility. |
REC121-3710 | 39 - Disaster Risk Management | The ITSRR should have permanent access to the RailCorp intranet. |
REC121-3767 | 24 - Govt responsibility | All accredited rail organisations should be required to re-apply every three years to ITSRR for accreditation. |
REC121-3687 | 10 - Infrastructure | There must be compatibility of communications systems throughout the rail network. It is essential that all train drivers, train controllers, signallers, train guards and supervisors of trackside work gangs in New South Wales be able to communicate using the same technology. |
REC121-3722 | 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. |
REC121-3695 | 10 - Infrastructure | There should be interoperability of communications equipment between all trains operating on the New South Wales rail network. |
REC121-3752 | 12 - EM agency and authority | RailCorp should establish clear safety accountability statements and reporting lines for all management positions. |
REC121-3657 | 10 - Infrastructure | All signal telephones must be maintained by RailCorp in proper working order. |
REC121-3708 | 12 - EM agency and authority | RailCorp should employ a Chief Safety Information Officer to manage the collection, collation, and dissemination of safety information within RailCorp. |
REC121-3766 | 12 - EM agency and authority | Staffing arrangements for ITSRR should be reviewed by it to ensure that adequate staff are employed in field positions, actively monitoring the safety of rail operations and compliance with conditions of accreditation. |
REC121-3684 | 39 - Disaster Risk Management | The ITSRR should conduct its own risk assessment in relation to the risk of any such high consequence, low probability accident and, if necessary, direct RailCorp to conduct a further risk assessment to reduce the level of residual risk to a level ITSRR regards as acceptable. |
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. |
REC121-3776 | 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. |
REC121-3694 | 25 - Inquiry, audit, lessons management and after action review | The ITSRR should conduct random audits of accredited rail organisations for compliance with communications protocols. |
REC121-3742 | 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. |
REC121-3653 | 10 - Infrastructure | The RMC should be equipped by RailCorp with a transcriber system, or mimic board, or such other system as is necessary to enable identification of the precise location at any time of any train on the RailCorp network. |
REC121-3704 | 28 - Personal responsibility | RailCorp should continue its system of voluntary self-identification and rehabilitation of employees with alcohol or drug related problems. |
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. |
REC121-3683 | 39 - Disaster Risk Management | RailCorp should undertake risk assessments of each of its activities as follows: |
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. |
REC121-3775 | 38 - Agency/Department Reporting | The Minister for Transport Services must table in Parliament, each such quarterly report by ITSRR. |
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. |
REC121-3729 | 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. |
REC121-3651 | 10 - Infrastructure | A dedicated telephone line should be established by RailCorp between the RMC and any Emergency Services Control Centre for use during any emergency. |
REC121-3700 | 39 - Disaster Risk Management | Maintenance plans on all trains should be revised annually. |
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. |
REC121-3678 | 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. |
REC121-3713 | 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. |
REC121-3774 | 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: |
REC121-3691 | 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. |
REC121-3726 | 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. |
REC121-3700 | 12 - EM agency and authority | The RailCorp defects unit should be combined with the passenger fleet maintenance division of RailCorp. |
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. |
REC121-3673 | 41 - Emergency Management exercises | Regular field training exercises should be conducted by RailCorp with the emergency services to ensure that the incident command system and rail displan are able to be fully implemented as quickly as possible and are reviewed and improved. |
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. |
REC121-3768 | 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. |
REC121-3689 | 12 - EM agency and authority | All RMC communications related staff should be selected upon the basis of the ability to convey information clearly, accurately and concisely and to follow strict communications protocols. |
REC121-3723 | 38 - Agency/Department Reporting | All ATSB accident investigation reports should be made public. |