Inquiry Search
Rec-ID | Code | Recommendation |
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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. |
REC324-4312 | 17 - Assets and technology | Impact to essential services: That, to minimise disruption to essential services, including outages which compromise basic communication coverage, and to ensure access to safe water supply and power during flood events, Government work directly or together with the Australian and other state governments and/or their relevant power and telecommunications regulatory, policy and market bodies to: |
REC324-4313 | 8 - Communications and warnings | NSW disaster app: That, to improve community confidence in government messaging and warnings, the SEOCON and DCS develop a single ‘NSW disaster app’. This: |
REC324-4314 | 8 - Communications and warnings | PIFAC function: That, to ensure the community can better understand the threat of flood, storm and tsunami activity, the Department of Customer Service (DCS) be made accountable for PIFAC in all emergencies. This will improve access to clear, reliable and consistent messaging prior to and during emergencies. This transfers the PIFAC role from NSW Police Force to Service NSW. Under this PIFAC function, DCS would be responsible for: |
REC324-4293 | 17 - Assets and technology | Essential services and floodplain infrastructure: That, to minimise disruption to essential services (power, communications, water, sewerage) and to ensure flood infrastructure is fully serviceable before flooding, Government ensure: |
Rec-ID | Code | Recommendation |
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REC317-4063 | 23 - Climate Change | Australian, state and territory governments should produce downscaled climate |
REC317-4101 | 24 - Govt responsibility | Australian, state and territory governments should develop national air quality forecasting capabilities, which include broad coverage of population centres and apply to smoke and other airborne pollutants, such as dust and pollen, to predict plume behaviour. |
REC317-4073 | 24 - Govt responsibility | State and territory governments should take steps to ensure that there is better interaction, planning and ongoing understanding of Australian Defence Force capabilities and processes by state and territory fire and emergency service agencies and local governments. |
REC317-4108 | 4 - Fire season preparation | Australian, state and territory governments should review the assessment and approval processes relating to vegetation management, bushfire mitigation and hazard reduction to: |
REC317-4053 | 24 - Govt responsibility | Australian, state and territory governments should restructure and reinvigorate ministerial forums with a view to enabling timely and informed strategic decision-making in respect of: |
REC317-4083 | 10 - Infrastructure | The Australian Government should work with state and territory governments and critical infrastructure operators to improve information flows during and in response to natural disasters: |
REC317-4060 | 13 - Mapping and data quality | Australian, state and territory governments should create common information platforms and share technologies to enable collaboration in the production, analysis, access, and exchange of information, data and knowledge about climate and disaster risks. |
REC317-4099 | 8 - Communications and warnings | Australian, state and territory governments should continue to explore the feasibility of a national, all-hazard emergency warning app. |
REC317-4070 | 10 - Infrastructure | Australian, state and territory governments should expedite the delivery of a Public Safety Mobile Broadband capability. |
REC317-4107 | 4 - Fire season preparation | Public land managers should clearly convey and make available to the public their fuel load management strategies, including the rationale behind them, as well as report annually on the implementation and outcomes of those strategies. |
REC317-4082 | 10 - Infrastructure | The Australian Government, working with state and territory governments and critical infrastructure operators, should lead a process to: |
REC317-4132 | 26 - Research | The material published as part of this Royal Commission should remain available and accessible on a long-term basis for the benefit of individuals, communities, organisations, businesses and all levels of government. |
REC317-4059 | 13 - Mapping and data quality | Australian, state and territory governments should prioritise the implementation of harmonised data governance and national data standards. |
REC317-4098 | 8 - Communications and warnings | The Australian Government should facilitate state and territory governments working together to develop minimum national standards of information to be included in bushfire warnings apps. |
REC317-4069 | 24 - Govt responsibility | State and territory governments should update and implement the National Framework to Improve Government Radio Communications Interoperability, or otherwise agree a new strategy, to achieve interoperable communications across jurisdictions. |
REC317-4106 | 13 - Mapping and data quality | Australian, state and territory governments should ensure greater consistency and collaboration in the collation, storage, access and provision of data on the distribution and conservation status of Australian flora and fauna. |
REC317-4078 | 24 - Govt responsibility | Australian, state and territory governments should adopt procurement and contracting strategies that support and develop a broader Australian-based sovereign aerial firefighting industry. |
REC317-4131 | 24 - Govt responsibility | Each state and territory government should establish an independent accountability and assurance mechanism to promote continuous improvement and best practice in natural disaster arrangements. |
REC317-4058 | 24 - Govt responsibility | The Australian Government should enhance national preparedness for, and response to, natural disasters, building on the responsibilities of Emergency Management Australia, to include facilitating resource sharing decisions of governments and stress testing national disaster plans. |
REC317-4096 | 8 - Communications and warnings | State and territory governments should urgently deliver and implement thevall-hazard Australian Warning System. |
REC317-4068 | 13 - Mapping and data quality | Australian, state and territory governments should establish a national register of fire and emergency services personnel, equipment and aerial assets. |
REC317-4105 | 13 - Mapping and data quality | Australian, state and territory governments should agree to: |
REC317-4077 | 26 - Research | Australian, state and territory governments should support ongoing research and evaluation into aerial firefighting. This research and evaluation should include: |
REC317-4123 | 24 - Govt responsibility | Australian, state and territory governments should ensure that personal information of individuals affected by a natural disaster is able to be appropriately shared between all levels of government, agencies, insurers, charities and organisations delivering recovery services, taking account of all necessary safeguards to ensure the sharing is only for recovery purposes. |
REC317-4056 | 24 - Govt responsibility | Australian Government agencies should work together across all phases of disaster management. |
REC317-4094 | 8 - Communications and warnings | State and territory governments should expedite the development and implementation of the Australian Fire Danger Rating System. It should ensure that there is national consistency in the visual display of the AFDRS and action to be taken in response to each rating. |
REC317-4065 | 13 - Mapping and data quality | Australian, state and territory governments should continue to develop a greater capacity to collect and share standardised and comprehensive natural disaster impact data. |
REC317-4102 | 25 - Inquiry, audit, lessons management and after action review | Australian, state and territory governments should review Australian Medical Assistance Team capabilities and procedures and develop necessary training, exercising and other arrangements to build capacity for domestic deployments. |
REC317-4074 | 25 - Inquiry, audit, lessons management and after action review | The Australian Government should review the content of the Defence Assistance to the Civil Community manual to ensure consistency of language and application with a revised COMDISPLAN. |
REC317-4109 | 13 - Mapping and data quality | Australian, state and territory governments should develop consistent processes for the classification, recording and sharing of fuel load data. |
REC317-4054 | 24 - Govt responsibility | Australian, state and territory governments should establish an authoritative advisory body to consolidate advice on strategic policy and relevant operational considerations for ministers in relation to natural disasters. |
REC317-4087 | 4 - Fire season preparation | State and territory governments, working with local governments and fire and emergency service agencies, should ensure that there are appropriate arrangements for roadside vegetation management that take into account, among other things: |
Rec-ID | Code | Recommendation |
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REC314-3271 | 8 - Communications and warnings | Better coordinate public information and warnings including evacuation plans and provide a single source of information about, the location and direction of fires, how and when to use Safer Places, Places of Last Resort, relief and recovery centres and directed evacuations. |
REC314-3270 | 17 - Assets and technology | Review the use of aviation assets including facilities to operate them given the increased pressure from extended fire seasons on northern and southern hemisphere resources. Review line scanning capability with a view to providing real time data to the IMTs on where fires are burning using aviation assets as an intelligence tool rather than just a fire suppression capability. |
REC314-3263 | 4 - Fire season preparation | Clarify and streamline processes and educate the community about their roles and responsibilities in managing native vegetation to improve hazard reduction on both public and private land. Provide additional resources to manage fuel in a shorter off fire season and develop a risk reduction target linked to prioritised objectives. |
REC314-3262 | 10 - Infrastructure | Invest in upgrading and integrating ICT platforms to eliminate manual data transfers, and ensure IT and radio communication interoperability across the agencies, together with a dedicated focus on the development of a coordinated risk intelligence capability to provide all stakeholders with a common operating picture and rapid damage assessments. |
REC314-3273 | 26 - Research | Collate data and research the impact of bushfires upon communities, firefighters and animals (both native and domestic) to identify appropriate medium and long-term welfare and support requirements. |
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. |
REC314-3272 | 10 - Infrastructure | Clarify business continuity and restoration of critical infrastructure in the planning and response phases to facilitate water replenishment, fireground remediation and access to businesses (including farming properties). |
Rec-ID | Code | Recommendation |
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REC302-2402 | 17 - Assets and technology | Explore better options for call and dispatch, telecommunications and information sharing capability across the emergency management portfolio including the adoption of a multi-agency emergency management operations complex |
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 |
REC302-2398 | 17 - Assets and technology | As a matter of priority commence the roll out of AVL capability for the Rural Fire Service fleet, completing as much work as possible before the 2018/19 bushfire season, capitalising where necessary on current and future work undertaken with the NSW Government Radio Network to ensure both officer safety and situational awareness |
REC302-2404 | 8 - Communications and warnings | Review the effectiveness of emergency public information arrangements, and give consideration to embedding an ABC Manager (not a journalist) into the RFS headquarters during emergencies to broadcast warnings to the community that can be pooled to commercial media outlets |
Rec-ID | Code | Recommendation |
---|---|---|
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 |
---|---|---|
REC002-4006 | 17 - Assets and technology | The Commisison would not insist upon a barometer being provided at each mine. Experience has proved that this is a tardy index to atmospheric conditions. Serious changes in the atmospheric pressure occur and are felt before they are indicated by a barometer. |
Rec-ID | Code | Recommendation |
---|---|---|
REC297-1266 | 8 - Communications and warnings | That Government supports the anticipated SES State Flood Warning proposals aimed at improving public warnings and communication, and that the proposed warning system is consistent with the National Frameworks. |
REC297-1258 | 25 - Inquiry, audit, lessons management and after action review | That DPIPWE examines the WMAwater report along with its own, analyses the differences, consults with the Forest Practices Authority and Environment Protection Authority, and proposes an appropriate course of action to Government. |
REC297-1265 | 13 - Mapping and data quality | That BoM and the Flood Warning Consultative Committee, in consultation with gauge owners, review flood gauges and develop a program to update data used to support hydrologic modelling. This should include reviewing gauge maintenance before and after floods. |
REC297-1273 | 25 - Inquiry, audit, lessons management and after action review | That the State Emergency Management Committee allocates resources to reviewing all findings and recommendations in the Productivity Commission Report No. 74 relevant to Tasmania and, for those identified as relevant, actions taken and, if none, why not. |
REC297-1255 | 24 - Govt responsibility | That Government establishes a central flood policy unit responsible for coordinating flood policy across all government agencies, including Government Businesses, and ensures that such a unit has a whole-of-government and community focus. |
REC297-1264 | 25 - Inquiry, audit, lessons management and after action review | That the Flood Warning Consultative Committee reviews flood classification levels in the Service Level Specifications with BoM specifically relating to flood level triggers on gauges. |
REC297-1270 | 24 - Govt responsibility | That, in the event of a major emergency such as the June floods, a government department (DPAC or State Growth) be appointed to coordinate infrastructure repair, to the extent that funding allows, for the whole state. Individual entities will still have the right and responsibility to repair and maintain their own assets, but some central oversight and coordination is, in our view, likely to be beneficial. |
REC297-1254 | 13 - Mapping and data quality | That Government: |
REC297-1263 | 13 - Mapping and data quality | Subject to funding, that the Flood Warning Consultative Committee investigates the hydrological matters and advice received during this Review and detailed in this Report in Sections 4.1.9 and 4.1.11. |
REC297-1268 | 24 - Govt responsibility | That DPAC becomes the Management Authority for recovery in Tasmania. |
REC297-1253 | 13 - Mapping and data quality | That agencies undertaking flood studies adopt a standardised approach, based on Australia Handbook 7, maintain public ownership of underlying data sets to support future modelling, and ensure open access to these studies. |
REC297-1262 | 13 - Mapping and data quality | That the Flood Warning Consultative Committee considers the merits of delineating the Ouse River as a separate catchment from the Derwent River Basin. |
REC297-1267 | 8 - Communications and warnings | That emergency management authorities react with heightened awareness and action when BoM issues flood watches and related warnings. |
REC297-1252 | 13 - Mapping and data quality | That SES uploads current flood studies and plans to the Common Operating Platform as a flood plan layer and that councils, subject to resolving licence restrictions, arrange to have appropriate access. |
REC297-1259 | 25 - Inquiry, audit, lessons management and after action review | That DPIPWE examines the Forest Practice Code 2015 for relevance of its concepts to farming and other business activities near rivers, streams and naturally occurring dams and makes recommendations to Government accordingly. |
Rec-ID | Code | Recommendation |
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REC296-1354 | 10 - Infrastructure | Monthly and annual maintenance servicing needs to be scheduled for the generator to DPTI or CHSA schedule requirements. |
REC296-1359 | 10 - Infrastructure | Renegotiate the maintenance contract at the end of the current contract and have DPTI through AGFMA take on the maintenance contract. |
REC296-1353 | 10 - Infrastructure | Regular annual testing at 100% on a load bank needs to be scheduled into a maintenance schedule. |
REC296-1358 | 10 - Infrastructure | If the existing generator is capable of providing the current essential power requirements then the generator needs a major inspection and overhaul all items that may need to be replaced due to age and condition. This includes checking compression, oil pressure, coolant pumping and all other critical components and may actually require providing a temporary generator while the Hospital generator receives a major inspection and possible re build. A ball park figure to do this would be $50,000.00 plus cranage and transport to Detroit workshop probably another $10,000.00 then a temporary generator would need to be hired and installed which could run into $10’s of thousands of dollars depending on how long the engine was out of service. For the money that would be spent checking and rebuilding the existing engine it would be recommended to replace the generator with a new generator. |
REC296-1363 | 10 - Infrastructure | Due to the age of the generator, reliability and reparability risk due to age and the apparent under capacity of the generator it is recommend to replace the generator with a new generator and associated control system designed for the current load requirements and allowance for some future expansion. |
REC296-1352 | 10 - Infrastructure | A monthly testing regime needs to be developed that will allow the generator to be tested at full essential load capacity and to ensure that 4 hour monthly testing can be done every month. |
REC296-1357 | 10 - Infrastructure | Monthly test results need to be accurately recorded. |
REC296-1362 | 10 - Infrastructure | Carry out a detailed audit of the current Hospital essential loads to determine the current load requirements of the Hospital. |
REC296-1351 | 10 - Infrastructure | From the above assessment determine the existing generator load requirements and provide a new generator to meet those loads. |
REC296-1356 | 10 - Infrastructure | Accurate records need to be provided as to what is done for each service. |
REC296-1361 | 10 - Infrastructure | Prepare and carry out a testing regime and testing strategy and ensure testing of the generator is done every month for 4 hours over that month and under full Hospital load with test result recorded every 15 minutes. |
REC296-1350 | 10 - Infrastructure | Remove any loads that do not need to be on essential power. |
REC296-1355 | 10 - Infrastructure | Replacement of all original pipes and hoses not yet done. |
REC296-1360 | 10 - Infrastructure | Carry out regular load bank testing on the generator with a load bank large enough to fully load the generator to 110% which will clean out the engine and also identify whether the generator is capable of providing full load for a sustained length of time. |
REC296-1349 | 10 - Infrastructure | Conduct an assessment of the current essential loads and determine if there are loads that should not be on essential power. |
Rec-ID | Code | Recommendation |
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REC295-1308 | 24 - Govt responsibility | That the Department of the Premier and Cabinet revise the ministerial documents relating to emergency management. |
REC295-1276 | 25 - Inquiry, audit, lessons management and after action review | That SA Health undertake a review of their emergency management arrangements. Health State Controllers should be consulted during this review and arrangements should be consistent throughout the department and across the State and compatible with State emergency management arrangements and information systems |
REC295-1318 | 24 - Govt responsibility | That the recommendation made following the Pinery bushfire, ‘to review control facilities at State, region and incident level’, be expanded to include all emergency services facilities that will be utilised for major incidents other than bushfire e.g. flood and earthquake and to also be extended into metropolitan areas, and implemented. |
REC295-1293 | 13 - Mapping and data quality | That the Flood Reform Task Group identify an appropriate mechanism for stakeholder agencies (including the State Emergency Service, Department of Environment and Natural Resources, Bureau of Meteorology and SA Water, as a minimum) to share data and information and develop plans and strategies for management of water levels in reservoirs and spill management during floods in South Australian water catchments |
REC295-1329 | 8 - Communications and warnings | Review and update Part 3, Annex C, of the SEMP ‘Public Information and Warnings’ to: a) clarify the role and responsibilities of the Public Information Functional Support Group and control agencies in relation to public information b) define requirements and processes for liaising with the community, including holding community meetings |
REC295-1300 | 17 - Assets and technology | That the State Emergency Service explores options for providing suitable personal protective clothing to personnel from supporting emergency services during major flooding events and sandbagging operations. |
REC295-1317 | 25 - Inquiry, audit, lessons management and after action review | Review representation in the State Emergency Centre including: a) determining if there is a more suitable functional support group e.g. the Procurement Functional Support Group, to replace the Logistics Functional Support Group, and if so, Chief Procurement Officer, DPC, has responsibility for the management of this role within the State Emergency Centre. b) That when the State Crisis Centre is not operating from a physical location, a State Crisis Centre liaison officer is attached to the State Emergency Centre. |
REC295-1291 | 24 - Govt responsibility | That the Flood Reform Task Group, as proposed by the Department |
REC295-1328 | 25 - Inquiry, audit, lessons management and after action review | Update the SEMP Part 3, Annex F ‘Debriefs’ to provide more guidance regarding the types of debriefs, when they are required to be undertaken and at what level and guidance for undertaking and recording debriefs, and implementing lessons identified. |
REC295-1299 | 17 - Assets and technology | That systems for Automatic Vehicle Location and personnel tracking be implemented within the emergency services sector. |
REC295-1316 | 24 - Govt responsibility | That the position of Deputy Director, Office for Digital Government is dedicated to the Office for Digital Government; and that people throughout DPC are identified and trained to perform appropriate roles within the State Crisis Centre |
REC295-1288 | 24 - Govt responsibility | That Attorney General’s Department explore options to overcome fatigue and welfare issues of SAGRN staff associated with emergency events of extended duration. |
REC295-1327 | 25 - Inquiry, audit, lessons management and after action review | Establish a lessons management capability across the SA emergency management sector to collect, analyse and track lessons identified during debriefs and reviews following events and other sources such as interstate and oversees reviews and inquiries. |
REC295-1297 | 25 - Inquiry, audit, lessons management and after action review | Engage an independent business analyst to review the current call, receipt and dispatch process for emergency services i.e. the Metropolitan Fire Service, Country Fire Service and State Emergency Service, from the initial call for assistance through to response of emergency service resources, including the allocation and coordination of multiple taskings. |
REC295-1315 | 25 - Inquiry, audit, lessons management and after action review | That a review of the role and effectiveness of the State Emergency Management Committee (SEMC) including: the legislative functions; membership including the chair; roles and responsibilities; and, SEMC Advisory Groups be undertaken. |
REC295-1286 | 10 - Infrastructure | That the Attorney General’s Department consult with local government regarding potential for them to provide logistical support associated with backup power supply to SA Government Radio Network towers in the event of an emergency. |
REC295-1320 | 17 - Assets and technology | Review existing electronic information systems used by emergency services organisations and other government agencies, and: a) establish a single incident information system across the Emergency Services Sector (MFS, CFS and SES), and b) identify opportunities to consolidate incident information systems of other agencies |
REC295-1296 | 8 - Communications and warnings | That the SES in collaboration with MFS Communications Centre (Comcen) investigate and implement options to reduce the number of calls coming into the Comcen, (particularly on 132500). Options could include better utilisation of the available options on the Interactive Voice Recording and community education to increase community resilience. |
REC295-1312 | 24 - Govt responsibility | That the Department of Education and Child Development be included as a member of State Emergency Management Council and represented in the State Emergency Centre. |
REC295-1279 | 10 - Infrastructure | Install UPS on traffic lights on main Central Business District (CBD) and arterial roads to allow an effective movement of traffic during a loss of power. |
REC295-1319 | 24 - Govt responsibility | That a single emergency service multi-agency control centre be established with sufficient capacity and capability to deal with all types of emergency incidents in SA. Also consider Police and State Emergency Centre. |
REC295-1294 | 13 - Mapping and data quality | That consideration and resources be given to support the implementation of recommendations in the report prepared on behalf of Department of Environment, Water and Natural Resources (Australian Water Environments, 2016), for flood warning classification of stream gauges and other locations. |
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. |
REC291-1243 | 8 - Communications and warnings | The Department of Fire and Emergency Services to investigate and adopt a system that will allow the public to opt in, monitor and receive, through a ‘push mechanism’, bushfire and other emergency warnings, maps and information using a wide variety of devices including personal hand held smart devices. |
REC291-1236 | 4 - Fire season preparation | The Departments of Parks and Wildlife and Fire and Emergency Services to develop options for the expansion of the ‘Bushfire Mitigation Grant Scheme’ 20 January 2016 Waroona Fire Special Inquiry utilising both State and Commonwealth Government funding to enable the implementation of hazard reduction works identified through the Bushfire Risk Management Planning process. This will target hazard reduction projects on land owned by private landholders in rural-urban interface areas, critical infrastructure protection, local government land, roadsides and land managed by utilities. |
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. |
REC287-1185 | 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. |
Rec-ID | Code | Recommendation |
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REC284-1371 | 10 - Infrastructure | Generator dual redundant starter systems should be considered. |
REC284-1365 | 10 - Infrastructure | The electrical master plan for the site should be updated to include planning for the scheduled replacement or refurbishment of those parts of the infrastructure that have not been renewed in the last 10 years. This planning to consider other upgrades or plans for the FMC overall. |
REC284-1370 | 10 - Infrastructure | Review control system for the main generator normal/essential changeover system and ensure that it has effective backup/manual or redundant operations, and suitable testing facilities. The Essential board that supplies the main generator power to Blocks A, B, C (except theatres), D, E (except certain critical engineering plant) (MD-1-4P-10E), is a potential single point of failure of a significant portion of the emergency power system and as part of the Master Plan update should be considered as a priority. |
REC284-1369 | 10 - Infrastructure | Review all generator locations for arrangements for temporary generator installation, including design of modifications as required for electrical connections and spatial requirements at installation locations, to be documented in an emergency procedure. |
REC284-1374 | 10 - Infrastructure | Provide walls around critical electrical infrastructure within the main plant area to provide security and protection from catastrophic water system failures. |
REC284-1368 | 10 - Infrastructure | Improvements to installation to be implemented as follows: - Lighting within the generator enclosure and immediately adjacent to be emergency battery-backed type. - Improvements to the spatial layout within the main generator enclosure should be investigated, including allowance for the control panel door to open 180o (only 90o currently); moving the fuel pumps to a more accessible location, and ensuring clear access to the day tank for manual filling if required. - Improvements to communications facilities between critical areas, including fixed phone line connections between the main control room, main generator control panel in the P (energy) Building, and the generator enclosure, and allowing link to offsite specialist advice. - Where generator maintenance requires operations outdoors (not applicable to main generator, but applicable to others), a shelter over the relevant area should be provided to allow safe work during wet or hot weather. - Written emergency procedures to be prepared covering credible failure scenarios with step by step checklists and recommended actions. |
REC284-1373 | 10 - Infrastructure | Review generator installations details as noted in report and implement physical improvements where possible. |
REC284-1367 | 10 - Infrastructure | Add to generator test procedure a checklist at the end of testing which includes checking that all systems are back to normal positions and includes a requirement to leave the day tank full where there is a bulk tank/day tank arrangement. |
REC284-1372 | 10 - Infrastructure | As part of the electrical master plan update recommended above, a complete and consistent set of single line diagrams describing the electrical distribution network be prepared. Relevant diagrams to be laminated and displayed in the main substations. Labelling to all main electrical equipment be reviewed and updated in accordance with the final documents. |
REC284-1366 | 10 - Infrastructure | A detailed review of the fuel control and BMS systems (for all generators) be carried out and actions taken to: 1) Ensure that the fuel alarm system is operational and properly calibrated, and ensure that the alarms are connected to the BMS. 2) Ensure that the BMS transmits these alarms effectively to the maintenance staff. 3) If this review demonstrates risk of fuel control systems not adequately reporting alarms, consider an independent day tank level switch to be installed in each generator fuel tank, directly connected to the BMS. 4) Consider the feasibility of adding a “fuel system not in auto” or “fuel system fault/fail safe watchdog” or “pre-alarm identifying that the generator is about to shut down without intervention” feature to current systems – subject to details of each individual generator system. |
Rec-ID | Code | Recommendation |
---|---|---|
REC273-1140 | 8 - Communications and warnings | Review the current practise of issuing an ‘emergency alert’ telephone message or an emergency warning and/or watch and act alert to ensure that it is consistent, relevant and necessary. Prior to issuing an emergency alert message, consider state level involvement so that other agencies are made aware of message and intent. |
REC273-1134 | 8 - Communications and warnings | That future declarations be undertaken to ensure that the areas affected by the declaration are clear and concise. |
Rec-ID | Code | Recommendation |
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REC264-1076 | 13 - Mapping and data quality | The State equip itself to undertake rapid air quality monitoring in any location in Victoria, to: • collect all relevant data, including data on PM , carbon monoxide and ozone; and 2.5 • ensure this data is used to inform decision-making within 24 hours of the incident occurring. |
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 |
REC264-1072 | 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. |
REC264-1086 | 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 |
REC264-1085 | 10 - Infrastructure | GDF Suez establish enhanced back-up power supply arrangements that do not depend wholly on mains power, to: • ensure that the Emergency Command Centre can continue to operate if mains power is lost; and • ensure that the reticulated fre services water system can operate with minimal disruption if mains power is lost. |
REC264-1082 | 8 - Communications and warnings | The State review and revise its communication strategy, to: • needed for effective and rapid public communications during an emergency; and ensure all emergency response agencies have, or have access to, the capability and resources • ensure, where appropriate, that private operators of essential infrastructure are included in the coordination of public communications during an emergency concerning that infrastructure. |
REC264-1081 | 26 - Research | The State should continue the long-term health study, and: • extend the study to at least 20 years; • appoint an independent board, which includes Latrobe Valley community representatives, to govern the study; and • direct that the independent board publish regular progress reports |
REC264-1089 | 8 - Communications and warnings | GDF Suez improve its crisis management communication strategy for the Hazelwood mine in line with international best practice. |
Rec-ID | Code | Recommendation |
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REC258-2548 | 17 - Assets and technology | The Civil Aviation Safety Authority shares the risk assessment outputs of Sky Sentinel, its computerised risk assessment system, with the applicable authorisation holder. |
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. |
REC258-2530 | 24 - Govt responsibility | The Australian Government appoints an additional Australian Transport Safety Bureau Commissioner with aviation operational and safety management experience. |
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. |
REC258-2528 | 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. |
REC258-2552 | 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. |
REC258-2526 | 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. |
REC258-2551 | 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. |
REC258-2549 | 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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REC257-1541 | 17 - Assets and technology | A Stryker unit, or an upgraded firefighting unit, be present at the range sentry point, remain manned and ready to deploy during range activites, with its driver in direct radio contact with the Range Safety Officer. Upon the range being declared clear by the Safety Officer inspecting the range after a demolition serial, the firefighting unit must proceed forward to the range wile the periphery of the range continues to be inspected by the Safety Officer, and remain on the range until the Safety officer declares that the area is clear of fire or that it is otherwise appropriate for the fireghting unit to leave the range area. |
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. |
REC257-1548 | 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: |
REC257-1546 | 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. |
REC257-1544 | 17 - Assets and technology | Defence should not procure any firefighting vehicle for Marrangaroo Training Area without first consulting relevant personnel within the Rural Fire Service on an appropriate type of vehicle, and obtaining training for the personnel proposed to use it. Alternatively, Defence should explore contracted firefighitng support during periods of live-fire on Marrangaroo Training Area. |
REC257-1542 | 17 - Assets and technology | Firefighitng capability at Marrangaroo Training Area be upgraded so that Australian Defence Force members are not placed in situations of unacceptable risk. Specifically, those participating in range practices must have access to a firefighting vehicle close by and easily deployed, and capable of throwing a large quantity of water an appreciable distance into areas adjacent to the ranges, should a fire occur. |
Rec-ID | Code | Recommendation |
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REC256-1571 | 24 - Govt responsibility | State and territory taxes and levies on general insurance should be phased out and replaced with less distortionary taxes. |
REC256-1561 | 24 - Govt responsibility | State and territory governments should be required to report on the following accountability requirements: |
REC256-1568 | 24 - Govt responsibility | State governments, where they have not already done so, should provide local governments with statutory protection from liability for releasing natural hazard information and making changes to local planning schemes where such actions have been taken ‘in good faith’ and in accordance with state planning policy and legislation. |
REC256-1567 | 24 - Govt responsibility | State and territory governments should: |
REC256-1566 | 24 - Govt responsibility | State and territory governments should prioritise and accelerate implementation of the Enhancing Disaster Resilience in the Built Environment Roadmap, including reviewing the regulatory components of vendor disclosure statements. The Land Use Planning and Building Codes Taskforce should be tasked to identify and consider options for regular, low-cost dissemination of hazard information to households by governments and insurers. |
REC256-1575 | 24 - Govt responsibility | State and territory governments should develop benchmark prices for the reconstruction of essential public assets and submit these to the Australian Government for approval within one year. In developing these prices, they should consult with local governments and relevant experts, and draw on asset management plans. The prices should be reviewed and updated over time. |
REC256-1565 | 13 - Mapping and data quality | Governments should task the Australia–New Zealand Emergency Management Committee with leading the development of guidelines for the collection and dissemination of natural hazard mapping, modelling and metadata. Guidelines should be developed for all hazards that need to be modelled and mapped at the local/regional level and where consistency across regions is desirable. |
REC256-1573 | 25 - Inquiry, audit, lessons management and after action review | The Australian Government should schedule an independent and public review of the progress of reforms to natural disaster funding arrangements five years after implementation has commenced. This review should examine the operation and efficacy of the arrangements, including the: |
REC256-1563 | 13 - Mapping and data quality | Governments at all levels should make new and currently held natural hazard data publicly available in accordance with open public sector information principles. When collecting new natural hazard data or undertaking modelling, all levels of government should: |
Rec-ID | Code | Recommendation |
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REC247-0934 | 4 - Fire season preparation | That the State Fire Management Committee considers developing a structured, systemic and proactive bushfire hazard reduction program with municipal councils and Tasmania Fire Service; and advises the Government on any legislative or other changes required to implement such a program. |
REC247-0849 | 26 - Research | That Tasmania Fire Service supports the relevant authorities to continue developing methodologies to forecast and simulate fire risk. |
REC247-0905 | 8 - Communications and warnings | That the Government consider whether it should discuss options for greater mobile phone coverage and redundancy in areas of high risk in emergency situations where there are presently telecommunications limits. |
REC247-0866 | 26 - Research | That fire agencies continue to develop their predictive modelling capability for use in actively managing fires. |
REC247-0918 | 8 - Communications and warnings | That the State Emergency Management Committee makes arrangements to actively manage the use of social media in the community during an emergency, to avoid negative consequences for emergency operations. |
REC247-0892 | 17 - Assets and technology | That a review be conducted of the resource capacity and capability to provide effective and efficient emergency operations, including approved improvements. |
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. |
REC247-0933 | 4 - Fire season preparation | That the Government considers whether a peak body should be established, with authority to effectively implement a bushfire mitigation plan. |
REC247-0904 | 10 - Infrastructure | That the Department of Infrastructure Energy and Resources consult Aurora Energy on the use of wooden poles for overhead infrastructure with a view to mitigating the risk in bushfires. |
REC247-0860 | 13 - Mapping and data quality | That Tasmania Fire Service establishes suitable systems and practices for recording fire management objectives and tactics. |
REC247-0917 | 8 - Communications and warnings | That the State Emergency Management Committee makes timely decisions and resource commitments on the appropriate use of social media in emergency management. |
REC247-0880 | 17 - Assets and technology | That bushfire agencies develop, implement and maintain air operations procedures. |
REC247-0922 | 8 - Communications and warnings | That Tasmania Fire Service develops a research base from which to inform the design of communication campaigns for communities threatened by bushfire. |
REC247-0931 | 4 - Fire season preparation | That a specific risk prevention and mitigation advisory body be established for the State Emergency Management Committee. |
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. |
REC247-0951 | 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. |
REC247-0855 | 17 - Assets and technology | That a structure and facilities be established for the State Controller or other person managing multi-agency response and recovery operations. |
REC247-0916 | 8 - Communications and warnings | That Tasmania Fire Service ensures that the priority on warning communities at risk of active bushfires is not confined to when bushfires are burning out of control. |
REC247-0879 | 17 - Assets and technology | That bushfire agencies develop procedures for the automatic activation of aircraft to fires at pre-determined trigger points on high fire risk days. |
REC247-0921 | 26 - Research | That Tasmania Fire Service promotes a structured approach to research across Australia, to provide a shared understanding and the capacity to benchmark and judge performance. |
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. |
REC247-0900 | 8 - Communications and warnings | That a public information plan be developed as a part of the State Special Emergency Plan–Recovery, for implementation in the immediate recovery phase. |
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. |
REC247-0851 | 13 - Mapping and data quality | That if a sound business case is developed, the Emergency Information Management and Sharing Project be supported. |
REC247-0915 | 8 - Communications and warnings | That Tasmania Fire Service actively uses predictive modelling to design emergency communications for communities threatened by bushfire, unless there is a compelling reason for not doing so. |
REC247-0878 | 17 - Assets and technology | That bushfire agencies evaluate the use and effectiveness of fixed wing water bombing aircraft. |
REC247-0920 | 8 - Communications and warnings | That Tasmania Fire Service reviews its approach to communicating with communities threatened by bushfire and consider the matters referred to in this Report. |
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. |
REC247-0894 | 17 - Assets and technology | That the police and other emergency service organisations discuss their resource issues for emergency operations with the Government. |
REC247-0935 | 4 - Fire season preparation | That the State Emergency Management Committee includes in its planning, the development of contingency emergency management plans for areas of high risk due to local conditions. |
REC247-0850 | 13 - Mapping and data quality | That police and other emergency service agencies establish and maintain effective recording systems for emergency operations. |
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. |
REC247-0873 | 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. |
REC247-0919 | 8 - Communications and warnings | That Tasmania Fire Service and Tasmania Police review their use of modern forms of communication with the community, including social media, and commit resources to fully use this capability where appropriate. |
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. |
REC247-0893 | 17 - Assets and technology | That further options to appropriately supplement the resources available for emergency management operations be examined. |
Rec-ID | Code | Recommendation |
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REC244-2627 | 4 - Fire season preparation | Government in conjunction with the CFS identify the ownership of disused railway corridors which may pose a significant fire risk and ensure the agency or individual responsible for the land complies with legislative requirements. |
REC244-2620 | 25 - Inquiry, audit, lessons management and after action review | Review employment conditions under the F&ES Act to align with those under the Public Sector Act unless there is a compelling reason to the contrary. |
REC244-2617 | 25 - Inquiry, audit, lessons management and after action review | When judging major incidents in the future, consideration be given to Eburn and Dover’s proposal to establish processes with a statutory basis that sufficiently balance the community’s interests in ensuring that true lessons, including lessons of error or neglect, are identified, whilst also protecting members of the emergency services. Processes need to be developed for emergency services such as those used in aviation and medicine, to facilitate open and honest disclosure of errors. |
REC244-2604 | 8 - Communications and warnings | Notification of a total fire ban should be broadcast to the public via any means reasonably available. Section 80, parts (2), (5) and (6) be amended so that broadcast fire ban warnings include, but not be limited to, radio stations, internet sites, social media outlets etc. |
REC244-2601 | 25 - Inquiry, audit, lessons management and after action review | That an independent review of the operational and geographic boundaries of the ESOs be conducted recognising the limitations of the current governance structures to adequately address such issues. Such a review needs to be performed periodically, but not less than every 8 years. |
REC244-2631 | 25 - Inquiry, audit, lessons management and after action review | Review Section 134 to ensure that it is not a deterrent to a group of farm fire units operating at an incident. |
REC244-2600 | 25 - Inquiry, audit, lessons management and after action review | An external audit of shared services performed by SAFECOM and services now provided by the three ESOs which have the potential to be shared, be undertaken to determine the most efficient and cost effective way such services can be delivered to the sector. The three ESO Chiefs need to have input into this process. |
Rec-ID | Code | Recommendation |
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REC239-2701 | 24 - Govt responsibility | That the Inspector General Emergency Management provide continuing advice to Government on the level of interoperability in disaster management arrangements, as well as the level of interoperability being achieved within the new portfolio. |
REC239-2776 | 25 - Inquiry, audit, lessons management and after action review | That the proposed efficiency review of the Queensland Police Service examine whether: |
REC239-2661 | 24 - Govt responsibility | That Queensland Corrective Service remains a separate program within the Department of Justice and Attorney-General so that while opportunities for improved services and efficacy can be realised, there is a clear separation from the youth justice services. |
REC239-2721 | 24 - Govt responsibility | That the Chief Executive Officer Portfolio Business collaborate with the two portfolio Commissioners to: |
REC239-2685 | 24 - Govt responsibility | That primacy of control for disaster operations remains with the Queensland Police Service and be reinforced. |
REC239-2749 | 24 - Govt responsibility | That the Prostitution Licensing Authority be moved to the Department of Justice and Attorney General Office of Fair Trading. |
REC239-2700 | 24 - Govt responsibility | That the position of Inspector General Emergency Management (in addition to some of the responsibilities of the chief executive officer under the current Disaster Management Act 2003) will: |
REC239-2775 | 17 - Assets and technology | That efforts by the courts, the Director of Public Prosecutions, the legal profession, Queensland Corrective Services and the Queensland Police Service to adopt technology for court processes should be supported through Government funding in so far as they create efficiencies, result in lower costs and produce better human rights outcomes. |
REC239-2660 | 24 - Govt responsibility | That Queensland Corrective Services be transferred to the Department of Justice and Attorney-General by a machinery-of-Government change as soon as is practicable. |
REC239-2712 | 24 - Govt responsibility | That Emergency Management Queensland be integrated with the current Queensland Fire and Rescue to become the Department of Fire and Emergency Services. |
REC239-2679 | 24 - Govt responsibility | To remove the Queensland Ambulance Service and Queensland Corrective Services from the Department of Community Safety—we recommend that it be renamed the Department of Fire and Emergency Services and be led by a Commissioner. |
REC239-2732 | 24 - Govt responsibility | There be a formation of an Office of Portfolio Business, providing support and governance across a range of corporate functions, which are essential to the delivery of frontline services. The Review team considers that the functions of the Operations Business and Strategy Directorate should become part of that Office and that any exception should be carefully considered by those charged with implementation of approved recommendations. |
REC239-2699 | 24 - Govt responsibility | That the Minister establish a public sector office to be headed by an Inspector General of Emergency Management. The Inspector General of Emergency Management will be responsible for most of the functions listed under part 16A of the current Disaster Management Act 2003. |
REC239-2764 | 25 - Inquiry, audit, lessons management and after action review | That the proposed efficiency review consider whether special service functions are core business, whether this practice is sustainable, and other options such as the use of casual employees. |
REC239-2657 | 24 - Govt responsibility | That negotiation takes place between Queensland Health and the Queensland Ambulance Service to determine the broad governance requirements of any such arrangements. |
REC239-2710 | 13 - Mapping and data quality | That all agencies participating in these activities should, as far as legally possible, share data sets whether or not the relevance is immediately obvious. |
REC239-2782 | 24 - Govt responsibility | That transparency of the Ministerial direction be achieved through publishing and monitoring for effectiveness. |
REC239-2678 | 24 - Govt responsibility | That probation and parole should continue to work together with the Queensland Police Service to reduce the risk of reoffending and reduce crime. |
REC239-2727 | 25 - Inquiry, audit, lessons management and after action review | That as part of its efficiency review, the Queensland Fire and Rescue Service instigate an independent review of commercial operations in terms of statutory obligations and current ‘full cost pricing’ methodology to ensure: |
REC239-2690 | 8 - Communications and warnings | That the Chief Executive Officer Portfolio Business and Commissioners establish a high level working group with the ABC and commercial media to identify and implement an improved information flow to the community on disasters. |
REC239-2763 | 25 - Inquiry, audit, lessons management and after action review | That the proposed efficiency review includes a focus on the rank structure of both the Queensland Police Service and the proposed Fire and Emergency Services. |
REC239-2655 | 24 - Govt responsibility | That the Queensland Ambulance Service is transferred to Queensland Health by a machinery-of-Government change as soon as is practicable and that the Commissioner report directly to the Director General Queensland Health. |
REC239-2709 | 17 - Assets and technology | That the information and communication technology solution being developed to provide situational awareness, decision support, event management and that logs critical decisions receives urgent attention to ensure timely completion. |
REC239-2778 | 17 - Assets and technology | That as the Queensland Police Service moves to a digital platform the strategy around effective targeting and alternative ANPR models should form part of the design architecture considerations. |
REC239-2664 | 17 - Assets and technology | That Queensland Corrective Service should increase the use of technology as an alternative to court appearances and ensure the provision of appropriate number and level of facilities under its control. |
REC239-2725 | 25 - Inquiry, audit, lessons management and after action review | That the Queensland Fire and Rescue Service community safety operations be joined in the efficiency review of the Queensland Police Service focussing on both the community safety outcomes achieved and the extent to which they support the Government’s economic priorities. |
REC239-2687 | 24 - Govt responsibility | That funding, staffing and responsibility associated with administration of the NDRP be transferred from Emergency Management Queensland to the Department of Local Government, Community Recovery and Resilience. |
REC239-2759 | 24 - Govt responsibility | That the new Chief Executive Officer Portfolio Business be accountable for delivering the reformed Communications Centre arrangement by the 2017–18 financial year in time for the Commonwealth Games of 2018. |
REC239-2708 | 24 - Govt responsibility | That the role of the Inspector General Emergency Management not extend to conducting reviews on behalf of agencies and that the role consider the effectiveness of all agencies and how their work contributes to a whole of Government response. |
REC239-2777 | 25 - Inquiry, audit, lessons management and after action review | That the review of this Queensland Fire and Rescue Services business unit be done in conjunction with the efficiency review proposed for the Queensland Police Service. |
REC239-2662 | 24 - Govt responsibility | That responsibility for prisoner transport and non-managerial roles within the larger watch-houses is transferred to Queensland Corrective Service. |
REC239-2724 | 25 - Inquiry, audit, lessons management and after action review | That the Queensland Fire and Rescue Service undertake a review of all standing orders, incident directives and guidelines regarding response protocols with a view to reducing risk to staff and other road users associated with urgent duty driving. |
REC239-2686 | 24 - Govt responsibility | That primacy of control should rest with the State Disaster Coordinator. This position should, by default, be the Deputy Commissioner, Regional Operations, Queensland Police Service. |
REC239-2758 | 25 - Inquiry, audit, lessons management and after action review | That the Chief Executive Officer Portfolio Business leads an efficiency review of portfolio agencies beginning with the Queensland Police Service. |
Rec-ID | Code | Recommendation |
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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. |
REC223-0517 | 26 - Research | The Department of Environment and Conservation be supported to conduct further research into the fuel management of coastal heath in the south west of Western Australia exploring alternatives to burning as well as best practice for burning. |
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. |
Rec-ID | Code | Recommendation |
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REC210-0715 | 24 - Govt responsibility | The Queensland Government should prepare a procedural guide for officers deciding whether to grant a relaxation of environmental authority conditions, by transitional environmental program or otherwise, with guidance as to: • the meaning of each criterion • examples of the types of things that may be relevant to each criterion • the priority, if any, to be afforded to different criteria. |
REC210-0745 | 24 - Govt responsibility | The Queensland Government should ensure that all flood mitigation manuals include the requirement that those operating the dam during flood events hold current registrations as professional engineers. |
REC210-0600 | 26 - Research | Brisbane City Council, Ipswich City Council and Somerset Regional Council and the Queensland Government should ensure that, as soon as practicable, a flood study of the Brisbane River catchment is completed in accordance with the process determined by them under recommendation 2.5 and 2.6. The study should: |
REC210-0722 | 26 - Research | The Queensland Government should seek information about the size, features and condition of abandoned mines, including whether the mine or its surrounding environment were adversely affected by flood, from private landholders who have abandoned mines on their properties. |
REC210-0753 | 24 - Govt responsibility | The Department of Environment and Resource Management should prepare formal work procedures for the review of flood event reports created under emergency action plans and flood mitigation manuals. These should include procedures for: • making enquiries with the owners of referable dams that have catchments that have been subject to heavy rainfall (or where there is other reason to believe the emergency action plan has been triggered) as to whether the emergency action plans have been triggered • reminding owners of referable dams that have had emergency action plans triggered of their obligation to submit a flood event report • upon receipt of a flood event report, reviewing it, identifying any dam safety or other issues or areas where insufficient detail has been provided, raising those matters with the dam owner or other affected party and identifying appropriate remedial steps 28 Queensland Floods Commission of Inquiry | Final Report Complete list of Final Report recommendations • raising any issues identified in the report that are beyond the expertise of the Department of Environment and Resource Management, or are likely to be of particular interest to another body, with the appropriate body • keeping a record of the process and results of the review of the flood event report • fixing an appropriate timeline for the completion of each of the above steps: the time required may depend on specific circumstances, but must allow for any potential safety issues to be identified and remedied efficiently. |
REC210-0618 | 24 - Govt responsibility | The Queensland Government should endeavour to ensure that Queensland conditions are appropriately considered in the National Flood Risk Advisory Group’s review of best practice principles. |
REC210-0678 | 26 - Research | Queensland Urban Utilities should make the results of its trials on the use of caps for overflow relief gully grates available to other authorities responsible for sewerage infrastructure. Consideration should be given by those authorities as to how the results can be used to improve the flood resilience of their sewerage networks. |
REC210-0706 | 24 - Govt responsibility | The Department of Environment and Resource Management should prepare a list of relevant considerations to be taken into account in performing a risk assessment to decide which sites to inspect. Bureau of Meteorology forecasts should be one consideration. |
REC210-0739 | 26 - Research | The Queensland Government should resolve the discrepancy in recorded peak river height for the January 2011 flood of the Brisbane River between the Brisbane City and Port Office gauges. |
REC210-0765 | 24 - Govt responsibility | As part of the longer term review of the Manual of Operational Procedures for Flood Mitigation at Wivenhoe Dam and Somerset Dam, the Queensland Government should consider the impact of possible upgrades of bridges downstream of Wivenhoe Dam on different operating strategies for the dam. |
REC210-0713 | 24 - Govt responsibility | The Queensland Government should refine the criteria which must be considered in assessment of applications for relaxation of environmental authority conditions, by transitional environmental program or otherwise, in response to flood. |
REC210-0744 | 26 - Research | The conditions for the use of a particular strategy in all flood mitigation manuals should reflect objective standards. |
REC210-0774 | 24 - Govt responsibility | The Department of Environment and Resource Management and Emergency Management Queensland should ensure that each has copies of current emergency action plans for all dams in Queensland. |
REC210-0599 | 26 - Research | The steering committee of the Wivenhoe Dam and Somerset Dam Optimisation Study should consider whether it would be more effective for the floodplain management investigation to be removed from the Wivenhoe Dam and Somerset Dam Optimisation Study. |
REC210-0721 | 26 - Research | The Department of Employment, Economic Development and Innovation should assemble all information currently available to the abandoned mine land program into a single database. The Queensland Government should ensure, using whatever information is available, that the list of abandoned mines is as complete as possible. This should at least include a review of all information held by the Department of Environment and Resource Management and the Department of Employment, Economic Development and Innovation. |
REC210-0752 | 24 - Govt responsibility | Prior to approving a flood mitigation manual, the Queensland Government should be satisfied that its terms are expressed in a manner that allows a determination of compliance with it to be made by reference to objective standards. |
REC210-0609 | 26 - Research | The Queensland Government and Commonwealth Government should ensure the existence and maintenance of a repository of data of the type used in flood studies. The database should include the types of data which the expert panel specified as needed for a comprehensive flood study. Councils, Queensland and Commonwealth Government agencies and dam operators should be able to deposit and obtain access to data. |
REC210-0665 | 13 - Mapping and data quality | Councils should make their flood and overland flow maps and models available to applicants for development approvals, and to consultants engaged by applicants. |
REC210-0705 | 26 - Research | Any mine operator of a site at high risk of flood should obtain the best forecast information available (seasonal and short term) for the region in which the mine is located. |
REC210-0738 | 25 - Inquiry, audit, lessons management and after action review | Seqwater should ensure that any future peer review process: • is co-ordinated by someone independent of those who wrote the report • entails the provision of all relevant information to the peer reviewers • permits sufficient time for the review • documents all contact between those whose actions are under review and the reviewers. |
REC210-0764 | 24 - Govt responsibility | The Department of Transport and Main Roads, in conjunction with Brisbane City Council and Somerset Regional Council, should investigate options for the upgrade of Brisbane River crossings between Wivenhoe Dam and Colleges Crossing and undertake a cost-benefit analysis of these to determine the outcome which best serves the public interest. |
REC210-0695 | 10 - Infrastructure | The Queensland Government should consider implementing mandatory requirements to ensure that all conduits for the purpose of providing electrical supply below the applicable defined flood level are sealed to prevent floodwaters from entering them or flowing into them. |
REC210-0711 | 24 - Govt responsibility | Unless the Department of Environment and Resource Management has decided not to permit discharges, it should assist each mine operator in its application for an environmental authority to ensure, as far as possible, that each authority includes provisions for discharges during times of heavy rainfall and flood. |
REC210-0743 | 25 - Inquiry, audit, lessons management and after action review | Seqwater should, in creating the new Wivenhoe and North Pine flood mitigation manuals, comprehensively consider: • the amount of discretion that is able to be exercised by the flood engineers and the senior flood engineers, and the description of the circumstances in which such discretion may be exercised • the circumstances in which it might be appropriate to release water in advance of an impending flood on the basis of forecasts from the Bureau of Meteorology • if strategies of the form of strategy W2 and W3 in Revision 7 are included in the revised manual, or any strategy defined as a ‘transition strategy’, when and how those strategies should be implemented • if the concept of ‘urban inundation’ is relevant to the operation of the dam, how it should be defined, and if the definition involves diverse concepts, how those concepts can be related back to the strategies, so that flood engineers can reach a clear understanding of their objectives and primary considerations • if the concept of ‘natural peak flow’ is relevant, how it should be defined. |
REC210-0773 | 25 - Inquiry, audit, lessons management and after action review | The Department of Environment and Resource Management should prioritise dam safety audits according to risk. The risk assessment should be informed by criteria including: • structure and materials used in construction • age of the dam • time since last inspection • occurrence of a flood event since last audit and the size of that flood event • population at risk if the dam were to fail • experience and capability of dam owner • dam owner compliance history • time since last audit. |
REC210-0720 | 24 - Govt responsibility | The Queensland Government should determine which of its agencies should take responsibility for the management of all existing and new abandoned mine sites in Queensland. |
REC210-0751 | 24 - Govt responsibility | The Queensland Government should continue to assess and review the adequacy of work procedures DS 5.1 and 5.3, having regard to the need for flood mitigation manuals to reflect the will of the executive. |
REC210-0606 | 26 - Research | When commissioning a flood study, the body conducting the study should: • check whether others, such as surrounding councils which are not involved in the study, dam operators, the Department of Environment and Resource Management, and the Bureau of Meteorology, are doing work that may assist the flood study or whether any significant scientific developments are expected in the near future, and decide whether to delay the study • discuss the scope of work with the persons to perform the flood study as well as surrounding councils which are not involved in the study, dam operators, the Department of Environment and Resource Management, and the Bureau of Meteorology |
REC210-0664 | 13 - Mapping and data quality | Councils should, resources allowing, maintain flood maps and overland flow path maps for use in development assessment. For urban areas these maps should be based on hydraulic modelling; the model should be designed to allow it to be easily updated as new information (such as information about further development) becomes available. |
REC210-0704 | 26 - Research | Mine operators should obtain all public seasonal forecasts issued by the Bureau of Meteorology relevant to the regions in which their operations are located. |
REC210-0737 | 25 - Inquiry, audit, lessons management and after action review | The Department of Environment and Resource Management should ensure that an independent and appropriately qualified person immediately starts the task of reviewing the March flood event report to ensure that the review is completed before the start of the 2012/2013 wet season. |
REC210-0762 | 25 - Inquiry, audit, lessons management and after action review | Seqwater should consider commissioning an investigation into the extent of cracking below the level of the upper gallery of Somerset Dam and the impact of any such cracking on the dam’s stability and, in turn, its operation. |
REC210-0693 | 10 - Infrastructure | Electricity distributors should consider installing connection points for generators to provide electricity supply to non-flooded areas that have had their supply cut during floods. |
REC210-0710 | 24 - Govt responsibility | The Department of Environment and Resource Management should assist mine operators in their applications for amended environmental authorities to ensure, as far as possible, that each environmental authority contains a tailored version of Table 4 of the model conditions. The Department of Environment and Resource Management should provide to mining companies its monitoring data and its suggested values for Table 4 on the basis of an assessment of the catchment which takes into account the cumulative effect of different operators’ releases. |
REC210-0742 | 24 - Govt responsibility | The Queensland Government should ensure that, when it considers options for the operational strategies to |
REC210-0772 | 25 - Inquiry, audit, lessons management and after action review | Prior to each wet season, the Department of Environment and Resource Management should audit the compliance of each owner of a referable dam with the obligation to have an emergency action plan approved by the Queensland Government. |
REC210-0718 | 24 - Govt responsibility | The Queensland Government should make public the procedural guide used by Department of Environment and Resource Management officers to decide whether to grant an emergency direction. |
REC210-0748 | 24 - Govt responsibility | The Queensland Government should consider whether North Pine Dam should be operated as a flood mitigation dam when it considers possible operating strategies and full supply levels as part of the longer term review of the Manual of Operational Procedures for Flood Mitigation at North Pine Dam. |
REC210-0602 | 26 - Research | A recent flood study should be available for use in floodplain management for every urban area in Queensland. Where no recent study exists, one should be initiated. |
REC210-0620 | 24 - Govt responsibility | The Queensland Government should determine whether existing guidelines are sufficient for councils to understand best practice in the performance of flood studies and the production of flood maps. If a lack of current guidelines is identified, the government should create and circulate guidance material for councils. |
REC210-0736 | 25 - Inquiry, audit, lessons management and after action review | Seqwater should ensure that proper support and oversight mechanisms are put in place around both the substantive and procedural aspects of drafting flood event reports. Seqwater should consider engaging consultants with expertise in the production of reports following significant events to advise on these mechanisms. Measures to be considered should include: • ensuring appropriate systems are in place to ensure the recollections of flood engineers and other parties are recorded immediately after the event, perhaps by engaging an external party to interview the flood engineers and other parties • ensuring that a methodology for writing the report is set out clearly in advance, in writing, and that the final report includes a statement of that methodology • putting in place systems to ensure that members of senior management have sufficient understanding of both the methodology and process by which the report is prepared to allow themselves to be satisfied that these are appropriate. |
REC210-0758 | 10 - Infrastructure | CS Energy should put in place contingency measures to ensure email and telephone communications at Wivenhoe Power Station are not entirely dependent on a network located off-site. |
REC210-0692 | 10 - Infrastructure | The Queensland Government should consider measures to ensure that requirements are included in the designation of land for community infrastructure under the Sustainable Planning Act 2009 to ensure that critical infrastructure for operating works under the Electricity Act is built to remain operational during and immediately after a flood of a particular magnitude. That magnitude should be determined by an appropriate risk assessment. |
REC210-0709 | 26 - Research | The Queensland Government should determine, as far as possible, the impact of mine discharges during the 2010/2011 wet season on freshwater and marine water quality and fauna and flora. |
REC210-0741 | 26 - Research | The steering committee of the North Pine Dam Optimisation Study should consider whether it would be beneficial for the floodplain management investigation to be removed from the North Pine Dam Optimisation Study. |
REC210-0771 | 24 - Govt responsibility | The Queensland Government should, in consultation with the Department of Environment and Resource Management and Emergency Management Queensland, determine which agency is appropriate to review and approve emergency action plans for referable dams. |
REC210-0716 | 24 - Govt responsibility | The Queensland Government should make public the procedural guide used by Department of Environment and Resource Management officers to decide whether to grant a transitional environmental program. |
REC210-0746 | 13 - Mapping and data quality | Seqwater should consider engaging a technical writer to develop completely new manuals after the operational strategies for Wivenhoe, Somerset and North Pine dams are set by the Queensland Government. |
REC210-0601 | 26 - Research | Ipswich City Council should determine whether the results, models and maps produced by the Brisbane River flood study are sufficient for its floodplain management. If they are not, Ipswich City Council should ensure appropriate work is done by way of data collection and creation and hydrologic and hydraulic modelling for use in its floodplain management. |
REC210-0726 | 25 - Inquiry, audit, lessons management and after action review | The Queensland Fire and Rescue Service should require that each region records in writing the results of its risk assessment undertaken as part of its annual review of its special operations functional plan. |
REC210-0755 | 13 - Mapping and data quality | CS Energy should supplement physical monitoring of Splityard Creek Dam with visual monitoring by installing surveillance cameras or similar devices. |
REC210-0619 | 24 - Govt responsibility | In the event that the review does not adequately account for Queensland conditions, the Queensland Government should produce a document that provides appropriate guidelines for floodplain management in the Queensland context. |
REC210-0683 | 13 - Mapping and data quality | All councils should, resources allowing, map the overland flow paths of their urban areas. |
REC210-0707 | 24 - Govt responsibility | The Department of Environment and Resource Management should conduct risk assessments in time for site inspections, and the implementation of solutions to problems identified at inspections, to take place before 1 November of each year. |
REC210-0740 | 26 - Research | The steering committees of the Wivenhoe Dam and Somerset Dam Optimisation Study and the North Pine Dam Optimisation Study should consider removing the water supply security investigation from each study. |
REC210-0767 | 26 - Research | The Department of Environment and Resource Management should require Wide Bay Water, in advance of every wet season, to provide details of its expectation as to the operability of the crest gates if a flood occurs, until such time as all gates have been demonstrated to work as designed. |
Rec-ID | Code | Recommendation |
---|---|---|
REC207-2885 | 13 - Mapping and data quality | Increased automation and outsourcing of observations |
REC207-2881 | 17 - Assets and technology | Extend ICT governance arrangements to all applications and subject in-house development to rigorous approval processes. |
Rec-ID | Code | Recommendation |
---|---|---|
REC205-1902 | 25 - Inquiry, audit, lessons management and after action review | The Council of Australian Governments should commission an independent public inquiry to develop an appropriate response to managing the risks of climate change to existing settlements. The inquiry should: |
REC205-1899 | 24 - Govt responsibility | Local governments’ uncertainty about their legal liability is a barrier to effective climate change adaptation. State governments should clarify the legal liability of councils with respect to climate change adaptation matters and the processes required to manage that liability. |
REC205-1898 | 24 - Govt responsibility | To help clarify roles and responsibilities of local government for climate change adaptation, the state and Northern Territory governments should publish and maintain a comprehensive list of laws that delegate regulatory roles to local governments. This would assist both state and local governments to assess whether local governments have the capacity to discharge their roles effectively. |
REC205-1896 | 24 - Govt responsibility | Australian governments should implement policies that help the community deal with the current climate by improving the flexibility of the economy. This would also build adaptive capacity to deal with future climate change. This includes reforms to: |
REC205-1904 | 24 - Govt responsibility | State and territory taxes and levies on general insurance constitute a barrier to effective adaptation to climate change. State and territory governments should phase out these taxes and replace them with less distortionary taxes. |
REC205-1903 | 25 - Inquiry, audit, lessons management and after action review | The Australian Government should commission an independent public review of disaster prevention and recovery arrangements. This should be broader than the review currently being conducted by the Attorney-General’s Department. The review should cover the Natural Disaster Relief and Recovery Arrangements, as well as the funding mechanisms for disaster mitigation, including the National Partnership Agreement on Natural Disaster Resilience. This review should: |
Rec-ID | Code | Recommendation |
---|---|---|
REC201-0250 | 8 - Communications and warnings | Initial StateAlert messages should provide timely broad advice to a wide audience authorised by the SDD, while subsequent messages may provide more detail. |
REC201-0249 | 17 - Assets and technology | FRS fire appliance allocation and training needs to be reviewed to enhance offensive bushfire capability within the metropolitan area. |
Rec-ID | Code | Recommendation |
---|---|---|
REC200-0360 | 4 - Fire season preparation | The Interagency Bushfire Management committee develop and oversee a work program to: conduct site specific assessments to assess current fuel loads assess, analyse and prioritise bushfire risk on land within and adjacent to communities develop a three year rolling mitigation works program with annual implementation and review. This work should commence independently of any decision on the most effective online integrated system. All data collected should be uploaded to the SLIP. |
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. |
REC200-0371 | 8 - Communications and warnings | FESA develop in partnership with other emergency service agencies a ‘one source: one message’ multi layered system similar to that recommended by the Victoria Bushfire royal Commission. |
REC200-1689 | 8 - Communications and warnings | 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. |
REC200-1732 | 25 - Inquiry, audit, lessons management and after action review | The State Government review implementation of the Special Inquiry's recommendations in two years. |
REC200-0388 | 17 - Assets and technology | The Water Corporation immediately review the outstanding orders for hydrant repairs and develop strategies to reduce the backlog. |
REC200-1700 | 4 - Fire season preparation | The Interagency Bushfire Management committee develop and oversee a work program to: |
REC200-0359 | 13 - Mapping and data quality | 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. |
REC200-1716 | 24 - Govt responsibility | State and locals governments: |
REC200-0370 | 8 - Communications and warnings | The Fire and Emergency Services Authority and the ABC commence a thorough review of emergency warning messages. This review should give consideration to: The content, structure and presentation of emergency warning messages Media access to the Incident Management Team and State Operations Centre. This review should be expanded to include other media organisations should they demonstrate a willingness and capacity to contribute. 20 |
REC200-1682 | 24 - Govt responsibility | The State Government give legislative effect to the Planning for Bush Fire Protection Guidelines. |
REC200-1728 | 24 - Govt responsibility | The Water Corporation immediately review the outstanding orders for hydrant repairs and develop strategies to reduce the backlog. |
REC200-0387 | 17 - Assets and technology | 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. |
REC200-1699 | 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. |
REC200-0358 | 13 - Mapping and data quality | The Fire and Emergency Services Authority, the Department of Environment and Conservation and local governments jointly develop a single, integrated system for fuel load assessment and management. The system should enable public access to allow members of the community to access information about the fuel load in a given locality. |
REC200-1712 | 10 - Infrastructure | FESA and local governments jointly review radio communications capability prior to the 2011/12 bushfire season with a view to improving the current delivery of service to firefighters. |
REC200-0365 | 17 - Assets and technology | The Fire and Emergency Services Authority (FESA) review its program to decommission vehicles and ensure that when such vehicles are offered during an incident that FESA staff adhere to FESA’s own policy of ‘Use of Private Vehicles in Fires’. |
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. |
REC200-1727 | 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. |
REC200-0384 | 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. |
REC200-1697 | 26 - Research | The Fire and Emergency Services Authority, the Department of Environment and Conservation and local governments closely monitor the research and development of alternative fuel reduction techniques to ensure that the most efficient and effective programs are adopted. |
REC200-0357 | 26 - Research | The Fire and Emergency Services Authority, the Department of Environment and Conservation and local governments closely monitor the research and development of alternative fuel reduction techniques to ensure that the most efficient and effective programs are adopted. |
REC200-1711 | 8 - Communications and warnings | FESA develop in partnership with other emergency service agencies develop a 'one source: one message' multi layered system similar to that recommended by the Victoria Bushfire royal Commission. |
REC200-0364 | 17 - Assets and technology | 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. |
REC200-1723 | 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 |
REC200-0379 | 24 - Govt responsibility | The State Government recognise the projected changes in climate and potential impact on future fire events. |
REC200-1694 | 24 - Govt responsibility | The State Government give its full support to the Western Australian Local Government Association's Send to Solve initiative. |
REC200-0355 | 13 - Mapping and data quality | 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. |
REC200-1710 | 8 - Communications and warnings | The Fire and Emergency Services Authority and the ABC commence a thorough review of emergency warning messages. This review should give consideration to: |
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. |
REC200-1719 | 24 - Govt responsibility | The State Government recognise the projected changes in climate and potential impact on future fire events. |
REC200-0378 | 17 - Assets and technology | 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. |
REC200-1690 | 8 - Communications and warnings | 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. |
REC200-0352 | 13 - Mapping and data quality | The Fire and Emergency Services Authority and local governments ensure that the ability to: measure and map fuel loads maintain fuel load databases draw up prescriptions for, and oversee controlled burns are included as key competencies in any future recruitment of Chief Bushfire Control Officers and Community and Emergency Services Managers. |
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. |
REC200-1701 | 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. |
Rec-ID | Code | Recommendation |
---|---|---|
REC199-0407 | 25 - Inquiry, audit, lessons management and after action review | the state: • undertake a strategic review to identify areas at risk from flash or riverine flooding. Shortcomings in the flood gauging networks identified in the review should then be the focus of remedial action • seek to address as a priority any notable gaps in the total flood warning system as apparent in the 2010–11 floods (including south west Victoria, Wimmera and north central region) by enhancing mapping, gauging and education programs; and • seek a commitment from the Bureau of Meteorology to ensure any new gauges installed are utilised to enhance flood prediction capability and coverage. |
REC199-0440 | 8 - Communications and warnings | the state actively pursue the use of social media as part of its emergency warning and public information system. |
REC199-0420 | 13 - Mapping and data quality | the state establish standards for flood mapping to ensure they are kept contemporary and meet the purposes of landuse risk planning and emergency response. In doing so, maps should extend where appropriate to include Probable Maximum Flood, over a range of Annual Exceedence Probability levels and be explicitly linked to a stream gauge. |
REC199-0455 | 24 - Govt responsibility | the state conduct an ‘all hazards’ needs analysis to determine requirements for level 3 Incident Control Centres with a focus on ‘all hazards’ and multi-agency capability. Following this analysis, the state take steps to ensure the availability of sufficient and functional level 3 Incident Control Centres across the state with an ‘all hazards’ and multi-agency capability |
REC199-0434 | 8 - Communications and warnings | the state require that agencies operate in compliance with the guidelines of the Victorian Warning Protocol to ensure efficacy of warning messages. |
REC199-0482 | 25 - Inquiry, audit, lessons management and after action review | the state task the Emergency Services Commissioner with the responsibility to develop and undertake the regular audit of emergency management plans at all levels. |
REC199-0406 | 24 - Govt responsibility | the state expand the Regional Water Monitoring Partnerships model to include all flood warning gauges. |
REC199-0439 | 8 - Communications and warnings | the state review its Memoranda of Understanding with official emergency broadcasters to take account of increased usage of internet based information, including social media and the ability to broadcast community meetings |
REC199-0417 | 13 - Mapping and data quality | the state ensure that regional and local flood plans incorporate all available flood mapping and intelligence, including assessments of levees and flood consequence information. |
REC199-0452 | 17 - Assets and technology | the state ensure that any new systems and equipment purchased by state emergency management agencies are interoperable with other relevant agencies to the fullest extent possible. This should involve the state establishing a procurement gateway process with input from the Emergency Services Commissioner. |
REC199-0433 | 8 - Communications and warnings | the state develop and implement standards for Emergency Alert to ensure consistent use, training and application by accredited operators within agencies across ‘all hazards’. |
REC199-0481 | 24 - Govt responsibility | the state (consistent with recommendation 46) develop a model for determining the capability and capacity of departments and agencies with roles and responsibilities in large scale or protracted emergencies. The issues of capability and capacity should be addressed at all levels of emergency management planning. |
REC199-0402 | 8 - Communications and warnings | the state develop a flood warning system for each basin and location with community input and make relevant documents publicly available. Each warning system should include key performance indicators. |
REC199-0438 | 8 - Communications and warnings | the state investigate the ability to refine the Flood and Storm Information Line to enable it to receive as well as provide information. |
REC199-0416 | 26 - Research | the state establish appropriate arrangements to ensure the capacity to maintain technical expertise for flood intelligence is initiated, including appropriate agreements with commercial experts. |
REC199-0450 | 25 - Inquiry, audit, lessons management and after action review | the state ensure that appropriate record management processes are developed and implemented and that these processes also provide record accountability for multi-agency operations. Agency processes should be standardised to the fullest extent possible |
REC199-0432 | 8 - Communications and warnings | the state develop and implement a single web portal as a means of providing emergency information to communities and local government on an ‘all hazards’ basis, including the information referred to in recommendations 74, 89 and 92. |
REC199-0471 | 8 - Communications and warnings | the state and the commonwealth, during a flood event, make information available on providers who have capacity to accommodate patients and residents who require evacuation. |
REC199-0401 | 25 - Inquiry, audit, lessons management and after action review | the state task the Emergency Services Commissioner with the responsibility to establish an effective audit regime of the total flood warning system. |
REC199-0437 | 8 - Communications and warnings | the state engage with local government to ensure emergency services’ public information and warnings reflect the community demographic. |
REC199-0410 | 17 - Assets and technology | the state take the necessary measures to upgrade existing manual stream and rain gauges and ensure that all future gauges provide a seamless transfer of data from the gauges to the Bureau of Meteorology. |
REC199-0445 | 25 - Inquiry, audit, lessons management and after action review | the state develop and implement operational performance standards for each state agency involved in emergency management response and recovery and that: • each agency be assessed by the Emergency Services Commissioner periodically against these performance standards for both capability and capacity; and • where performance against these standards for either capability or capacity cannot be demonstrated by any agency – appropriate advice is communicated to the relevant Minister, departmental/agency head and State Emergency Response Coordinator; and – an action plan is developed and implemented to address the relevant capability or capacity deficiency in both the short and longer term. |
REC199-0429 | 13 - Mapping and data quality | the state take into account any outcomes from the Commonwealth Government’s flood mapping reviews in the continual development of the Victorian flood database and to incorporate into the database flood data currently held by Melbourne Water. |
REC199-0466 | 24 - Govt responsibility | the Departments of Health and Human Services finalise the definition of ‘vulnerable person’ and the list of facility types where vulnerable people are located and ensure that the definition and associated policy(ies) are applicable across ‘all hazards’. |
REC199-0400 | 24 - Govt responsibility | The state take the necessary measures to clarify roles, responsibilities and cost-sharing arrangements for flood warning systems, including tasking state and regional bodies to be responsible for the flood warning system. This will require engaging with the commonwealth to amend the 2001 arrangements, updating the 1998 floodplain management strategy accordingly and continuing to support commonwealth initiatives designed to improve flood mapping standards and associated issues. |
REC199-0436 | 8 - Communications and warnings | the state develop a standard approach to the provision of emergency warnings and information in formats – spoken and written – that recognise diverse community needs, including language and disability |
REC199-0408 | 13 - Mapping and data quality | the state, in consultation with Bureau of Meteorology and Melbourne Water, take the necessary action to ensure that all flood warnings issued are linked to the geographical location of the gauge the data was derived from. |
REC199-0441 | 4 - Fire season preparation | the state undertake further trials to explore the opportunity for greater use of social media as a credible source of information to and from the public during an emergency |
REC199-0428 | 25 - Inquiry, audit, lessons management and after action review | the state clarify which agency is responsible for collecting post-flood extent and related data. This should include: • the development of guidelines to ensure consistent standards are applied to post-flood data collection; and • an appropriate process to ensure funding availability for such activities. |
REC199-0465 | 24 - Govt responsibility | the state undertake major reform of Victoria’s emergency management arrangements to bring about an effective ‘all hazards, all agencies’ approach, incorporating: • clarity of command and control in all emergencies • common operating platforms, including communications and information technology • interoperability between all agencies • regular joint training and exercising by all agencies • the development and implementation of performance standards for each emergency management agency • the development and maintenance of effective planning arrangements at all levels of emergency management • a meaningful monitoring and audit regime for designated standards and planning requirements; and • an effective accountability mechanism to support the maintenance of legislative and other agency obligations. |
REC199-0435 | 8 - Communications and warnings | the state put in place appropriate measures to inform the community of the intended purpose of the Emergency Alert warning system. |
Rec-ID | Code | Recommendation |
---|---|---|
REC197-1733 | 25 - Inquiry, audit, lessons management and after action review | That a review of the Country Fire Authority Act 1958 and the Country Fire Authority Regulations 2004 be undertaken. |
Rec-ID | Code | Recommendation |
---|---|---|
REC183-0119 | 17 - Assets and technology | The development of a three year aerial firefighting strategy for W.A. would ensure optimal development of a joint air capability. |
REC183-0120 | 17 - Assets and technology | Maintaining the DEC fleet of tankers, bulldozers and low loaders is crucial to DEC’s fire management and control capability. |
Rec-ID | Code | Recommendation |
---|---|---|
REC182-0134 | 17 - Assets and technology | FESA reviews its air reconnaissance capability and determines if multiple multi-sensor air reconnaissance aircraft or unmanned aerial vehicles are required for managing concurrent and/or complex incidents. |
Rec-ID | Code | Recommendation |
---|---|---|
REC181-0170 | 17 - Assets and technology | The Country Fire Authority and the Department of Sustainability and Environment amend their policies on aerial preparedness and standby arrangements, their dispatch protocols and the management of aircraft in order to do the following: ■ require that at locations that attract the risk assessment or preparedness level A on code red days all personnel needed for air operations must be on standby by 10.00 am; ■ establish a system that enables the dispatch of aircraft to fires in high-risk areas without requiring a request from an Incident Controller or the State Duty Officer. |
REC181-0192 | 4 - Fire season preparation | The Department of Sustainability and Environment develop and administer a collective offset solution for individual landholders who are permitted to remove native vegetation for the purpose of fire protection. |
REC181-0179 | 10 - Infrastructure | The State (through Energy Safe Victoria) require distribution businesses to review and modify their current practices, standards and procedures for the training and auditing of asset inspectors to ensure that registered training organisations provide adequate theoretical and practical training for asset inspectors. |
REC181-0212 | 4 - Fire season preparation | VicRoads implement a systematic statewide program of bushfire risk assessment for all roads for which it is responsible, to ensure conformity with the obligations in s. 43 of the Country Fire Authority Act 1958 and with the objectives expressed in the VicRoads 1985 Code of Practice. |
REC181-0180 | 10 - Infrastructure | The State amend the regulatory framework for electricity safety to require that distribution businesses adopt, as part of their management plans, measures to reduce the risks posed by hazard trees—that is, trees that are outside the clearance zone but that could come into contact with an electric power line having regard to foreseeable local conditions. |
REC181-0166 | 13 - Mapping and data quality | The Country Fire Authority and the Department of Sustainability and Environment improve mapping support in the following ways: ■ DSE providing mapping data free of charge to emergency response agencies; ■ greatly increasing the CFA’s ‘write’ access to FireMap for incident management team staff; ■ establishing a joint DSE–CFA training program to ensure that mapping officers in level 2 and 3 incident management teams are fully trained in using FireMap, including in producing fire prediction maps; ■ requiring before the 2010–11 fire season that FireMap be used for joint incidents. |
REC181-0187 | 13 - Mapping and data quality | The State identify a central point of responsibility for and expertise in mapping bushfire risk to: ■ review urgently the mapping criteria at present used by the Country Fire Authority to map the Wildfire Management Overlay, to ensure that the mapping used to determine building and planning controls is based on the best available science and takes account of all relevant aspects of bushfire risk; ■ map and designate Bushfire-prone Areas for the purposes of planning and building controls, in consultation with municipal councils and fire agencies; ■ finalise the alignment of site-assessment methods for planning and building purposes, taking into account bushfire risk to human safety as well as to property. |
REC181-0211 | 4 - Fire season preparation | The State and Commonwealth provide for municipal councils adequate guidance on resolving the competing tensions arising from the legislation affecting roadside clearing and, where necessary, amend environment protection legislation to facilitate annual bushfire-prevention activities by the appropriate agencies. |
REC181-0184 | 10 - Infrastructure | The State amend the regulatory framework for electricity safety to strengthen Energy Safe Victoria’s mandate in relation to the prevention and mitigation of electricity-caused bushfires and to require it to fulfil that mandate. |
REC181-0178 | 10 - Infrastructure | The State (through Energy Safe Victoria) require distribution businesses to change their asset inspection standards and procedures to require that all SWER lines and all 22-kilovolt feeders in areas of high bushfire risk are inspected at least every three years. |
REC181-0210 | 4 - Fire season preparation | The State amend the exemptions in clause 52.17-6 of the Victoria Planning Provisions to ensure that the provisions allow for a broad range of roadside works capable of reducing fire risk and provide specifically for a new exemption where the purpose of the works is to reduce bushfire risk. |
REC181-0217 | 25 - Inquiry, audit, lessons management and after action review | The State consider the development of legislation for the conduct of inquiries in Victoria —in particular, the conduct of royal commissions. |
REC181-0183 | 10 - Infrastructure | The State (through Energy Safe Victoria) require distribution businesses to do the following: ■ fit spreaders to any lines with a history of clashing or the potential to do so; ■ fit or retrofit all spans that are more than 300 metres long with vibration dampers as soon as is reasonably practicable. |
REC181-0177 | 10 - Infrastructure | The State amend the Regulations under Victoria’s Electricity Safety Act 1998 and otherwise take such steps as may be required to give effect to the following: ■ the progressive replacement of all SWER (single-wire earth return) power lines in Victoria with aerial bundled cable, underground cabling or other technology that delivers greatly reduced bushfire risk. The replacement program should be completed in the areas of highest bushfire risk within 10 years and should continue in areas of lower bushfire risk as the lines reach the end of their engineering lives; ■ the progressive replacement of all 22-kilovolt distribution feeders with aerial bundled cable, underground cabling or other technology that delivers greatly reduced bushfire risk as the feeders reach the end of their engineering lives. Priority should be given to distribution feeders in the areas of highest bushfire risk. |
REC181-0208 | 13 - Mapping and data quality | The Department of Sustainability and Environment significantly upgrade its program of long-term data collection to monitor and model the effects of its prescribed burning programs and of bushfires on biodiversity in Victoria. |
REC181-0216 | 25 - Inquiry, audit, lessons management and after action review | The State appoint an independent monitor or the Victorian Auditor-General to assess progress with implementing the Commission’s recommendations and report to the Parliament and the people of Victoria by 31 July 2012. |
REC181-0182 | 10 - Infrastructure | The State (through Energy Safe Victoria) require distribution businesses to do the following: ■ disable the reclose function on the automatic circuit reclosers on all SWER lines for the six weeks of greatest risk in every fire season; ■ adjust the reclose function on the automatic circuit reclosers on all 22-kilovolt feeders on all total fire ban days to permit only one reclose attempt before lockout. |
REC181-0171 | 17 - Assets and technology | The State, in conjunction with Emergency Management Australia and the Department of Defence, develop an agreement that allows Commonwealth aerial resources that are suitable for firefighting and support activities to be incorporated in preparedness plans and used on days of high fire risk. |
REC181-0193 | 13 - Mapping and data quality | The Department of Sustainability and Environment conduct biodiversity mapping identifying flora, fauna and any threatened species throughout Victoria and make the results publicly available. The format used should be compatible with that used for Bushfire-prone Area mapping. |
REC181-0215 | 26 - Research | The Commonwealth establish a national centre for bushfire research in collaboration with other Australian jurisdictions to support pure, applied and long-term research in the physical, biological and social sciences relevant to bushfires and to promote continuing research and scholarship in related disciplines. |
Rec-ID | Code | Recommendation |
---|---|---|
REC177-3344 | 25 - Inquiry, audit, lessons management and after action review | There should be a review to determine whether it is appropriate to introduce a rigorous civil penalty regime and/or substantially increase some or all of the penalties that can be imposed for breaches of legislative requirements relating to well integrity and safety. |
REC177-3329 | 17 - Assets and technology | Logistics management of well control equipment should be conducted in such a way as to operate as a check against deficient well control practices, for example, use of serial numbers to track availability, testing, and deployment of well control equipment. |
REC177-3304 | 26 - Research | It is recommended that industry, regulators, and training/research institutions liaise with one another with a view to developing better techniques for testing and verifying the integrity of cemented casing shoes as barriers (particularly in atypical situations such as where the casing shoe is located within a reservoir in a horizontal or high angle position at great depth). |
REC144-3387 | 25 - Inquiry, audit, lessons management and after action review | In order that the ACT public can be reassured about the project management and financial planning in relation to the Fairbairn site as a proposed centralised accommodation facility for emergency services, the Auditor-General undertake a review of the project from a financial probity and project management perspective. |
REC177-3378 | 25 - Inquiry, audit, lessons management and after action review | In view of the numerous well integrity problems in all of the Montara Oilfield wells, the Minister should commission a detailed audit of all the other offshore wells operated by PTTEPAA to determine whether they too may suffer from well integrity problems. |
REC177-3374 | 25 - Inquiry, audit, lessons management and after action review | The Minister should, as the JA for the offshore area of the Territory of Ashmore and Cartier Islands, undertake a review of PTTEPAA’s permit and licence to operate at the Montara Oilfield. |
Rec-ID | Code | Recommendation |
---|---|---|
REC165-0098 | 24 - Govt responsibility | The SDMG take into account key improvement initiatives and change processes suggested when deciding on an effective implementation strategy for agreed recommendations. |
REC165-0097 | 24 - Govt responsibility | Revised governance arrangements be implemented involving Disaster Management Groups at the three levels supported by EMQ as outlined in this report to achieve continuous improvement in the Disaster Management arrangements in the State. A new provision in Section 5 emphasise the discretion available to all involved in the Disaster Management system to take action to prevent impending loss of life even if contrary to the agreed arrangements. |
REC165-0087 | 8 - Communications and warnings | The SDMG commission the Department of Community Safety and seek the necessary funding to develop and enhance the Statewide Disaster Management information and communications system building on alternatives already in place and in consultation with all levels of Government. |
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 |
Rec-ID | Code | Recommendation |
---|---|---|
REC161-3035 | 24 - Govt responsibility | That Ministerial Council on Mineral and Petroleum Resources liaise with Ministers with environmental and planning responsibilities, and if necessary Council of Australian Governments, to ensure that environmental requirements for oil and gas projects are not imposed subsequent to safety assessments and do not increase the risk of major accident events. |
REC161-3030 | 25 - Inquiry, audit, lessons management and after action review | That National Offshore Petroleum Safety Authority review the risk assessment of pipelines. National Offshore Petroleum Safety Authority should focus, in particular, on the efficacy of anti-corrosion systems, and recognise potential interference effects and MAE escalation risks associated with adjacent pipelines and unlicenced pipes even if they fall outside its direct regulatory responsibilities. |
REC161-3028 | 24 - Govt responsibility | That Ministerial Council on Mineral and Petroleum Resources continue to support a duty of care safety case regime for best practice offshore petroleum industry regulation augmented to include regulation of integrity. Since the safety case is at the centre of the duty of care co-regulatory regime, we consider that the requirement for the implementation of the safety case at facilities involved in the exploitation of petroleum resources should be provided for within the Offshore Petroleum and Greenhouse Gas Storage Act 2006 itself. |
Rec-ID | Code | Recommendation |
---|---|---|
REC151-3095 | 24 - Govt responsibility | SAFECOM re-evaluate and determine a more meaningful definition of fire districts. |
REC151-3071 | 24 - Govt responsibility | The comprehensive prevention, preparedness, response and recovery (PPRR) approach to the management of bushfires as recommended by the Ministerial Review of Bushfire Management in South Australia is supported: its implementation should consider issues raised by councils and should also be considerate of the recommendations of the Wangary Coronial Inquest. |
Rec-ID | Code | Recommendation |
---|---|---|
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 |
---|---|---|
REC148-3182 | 25 - Inquiry, audit, lessons management and after action review | That Biosecurity Australia review that formal import risk analysis at least once every two years to take into account any relevant developments in scientific knowledge—specifically testing methods, vaccines, vaccination procedures and other matters that affect biosecurity. Reports on the reviews should be provided to the officer responsible for the importation of horses and should contain recommendations for any necessary changes to policies for importation. |
REC148-3175 | 25 - Inquiry, audit, lessons management and after action review | That the officer responsible for the importation of horses arrange for Biosecurity Australia to review, at least once every two years, the operating procedures to ensure that they adequately identify and manage the risk of entry and spread of equine influenza associated with the importation of horses into Australia. The outcome of each such review should be the subject of a written report and recommendations to the person responsible for the importation of horses and the Executive Director of AQIS. A determination should then be made as to whether any, and if so what, changes should be made to the operating procedures. |
REC148-3170 | 25 - Inquiry, audit, lessons management and after action review | That the officer responsible for the importation of horses arrange for Biosecurity Australia to conduct within six months, an inspection and review of the process of horse importation from the time horses arrive in Australia until the completion of their post-arrival quarantine in order to: |
REC148-3167 | 25 - Inquiry, audit, lessons management and after action review | That the facilities at Eastern Creek and Spotswood Quarantine Stations be reviewed by AQIS in consultation with experts in biosecurity and interested parties including state and territory governments, import agents, veterinarians, farriers, operators of private quarantine stations, and representatives of horse owners, horse racing organisations and equestrian organisations. There should in any event be constructed without delay, an adequate supply of hygienic, modern showering facilities and places of entry and exit to the stations and the horse sections of them that can be supervised and monitored continually. There should also be provided at those stations as soon as is practicable suitable means of electronic surveillance, including closed-circuit television; a secure place to store chemicals, drugs, instruments and equipment for use by people attending the quarantined horses, and a set of horse stalls and yards separate from the main stalls and yards to enable isolation of horses suffering from contagious or infectious diseases. These reviews should also consider the desirability of separate areas in quarantine stations to hold horses forming part of a single quarantine intake but that have been imported from different regions or have undergone pre-export quarantine in different places. The reviews should be carried out without delay, and the two quarantine stations should be upgraded in accordance with the recommendations of the reviews. |
REC148-3154 | 25 - Inquiry, audit, lessons management and after action review | That the officer responsible for the importation of horses arrange for Biosecurity Australia or another qualified body to inspect and review the activities and events that occur from the time horses enter pre-export quarantine until the time they arrive at an airport in Australia, in order to identify any biosecurity risks and recommend any necessary changes to import conditions or other requirements. This inspection and review shall be performed without delay for each country or region from which horses are imported to Australia, and it should take account of my other recommendations and comments in this report. |
Rec-ID | Code | Recommendation |
---|---|---|
REC140-3563 | 17 - Assets and technology | An additional secure emergency oxygen supply source to be located in the BK 117 helicopter. An internal supply is preferred. |
REC140-3561 | 17 - Assets and technology | Development of a helipad at Mersey Hospital. |
REC140-3575 | 24 - Govt responsibility | The preferred model for the Tasmanian Medical Retrieval Services is to have TMRS and NETS staff based in RHH. The fixed wing would remain based in Launceston (for the present) with the helicopter to remain based in Hobart. |
REC140-3560 | 17 - Assets and technology | RHH requires a helipad. Plans to rebuild RHH must include a helipad at its earliest stage of conception. |
REC140-3573 | 13 - Mapping and data quality | Databases with a common minimum data set complete with incident monitoring should be established for TAS Air Ambulance, TMRS and NETS missions. |
REC140-3559 | 17 - Assets and technology | A service level agreement is negotiated with the Police department that will cover access, tasking, price, equipment and staffing. This will enable a more strategic use of the helicopter. |
REC140-3565 | 17 - Assets and technology | The TMRS medical equipment inventory requires an overhaul. The TMRS medical equipment should be located with the TMRS team. |
REC140-3556 | 17 - Assets and technology | The use of hospital transport vehicles to support retrieval operations be investigated. |
REC140-3564 | 17 - Assets and technology | The medical equipment used in retrieval and air ambulance duties undertaken by helicopter and fixed wing must be standardised. |
Rec-ID | Code | Recommendation |
---|---|---|
REC136-3526 | 8 - Communications and warnings | That consideration be given to additional ways and means to improve broadcast capability into disaster-affected regions, particularly for the early aftermath of any disaster when a loss of power characterises the event. |
REC136-3529 | 24 - Govt responsibility | The Queensland Government should consider the endorsement of transitional arrangements proposed in this report, in order to ensure as far as possible the smooth completion of the recovery and the ultimate return to government operations as usual in the cyclone-affected area. |
REC136-3528 | 8 - Communications and warnings | An early and high priority task in recovery from a natural disaster should be the development of a coordinated, succinct, practical and flexible public communications plan. |
REC136-3527 | 8 - Communications and warnings | In any future large-scale disaster or event, consideration be given to a centrally located Media Operations Centre. |
REC136-3525 | 24 - Govt responsibility | In any future disaster of comparable proportions, consideration should be given to the co-location of the Building Coordination Centre and the principal One Stop Shop. |
Rec-ID | Code | Recommendation |
---|---|---|
REC132-3590 | 8 - Communications and warnings | Investigate procedures for updating the Victoria Bushfire Information Line (VBIL) Integrated Voice Response recorded message system to allow recording of permanent bushfire safety, and incident-specific, messages, accessible when the VBIL is experiencing high call volumes during large and/or numerous significant incidents |
REC132-3594 | 8 - Communications and warnings | Need for scripting of messages by fire agency representatives when promoting VBIL services via radio, TV and newspapers. |
REC132-3593 | 26 - Research | Analysing information from the joint CFA/DSE Post 2006 Wildfire Community Survey about public perceptions of information provision during January bushfires. Note implications for the VBIL and other information provision methods |
Rec-ID | Code | Recommendation |
---|---|---|
REC121-3656 | 17 - Assets and technology | Satellite telephones should be provided by RailCorp to all rail commanders at any emergency. |
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. |
REC121-3694 | 25 - Inquiry, audit, lessons management and after action review | The ITSRR should conduct random audits of accredited rail organisations for compliance with communications protocols. |
REC121-3724 | 13 - Mapping and data quality | The ITSRR should establish a data and information management system, containing all data and information that it requires, to continually monitor the safety of the New South Wales rail system. |
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. |
REC121-3757 | 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. |
REC121-3693 | 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. |
REC121-3768 | 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. |
REC121-3721 | 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. |
REC121-3651 | 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. |
REC121-3753 | 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. |
REC121-3691 | 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. |
REC121-3767 | 24 - Govt responsibility | All accredited rail organisations should be required to re-apply every three years to ITSRR for accreditation. |
REC121-3720 | 24 - Govt responsibility | The New South Wales Government should make the necessary arrangements with the Australian Government, including any necessary legislation, for the Australian Transport Safety Bureau (ATSB) to have the power to investigate all rail accidents occurring on the New South Wales rail network the investigation of which may advance the knowledge of the causes of rail accidents in Australia. |
REC121-3687 | 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. |
REC121-3765 | 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. |
REC121-3713 | 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. |
REC121-3726 | 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. |
REC121-3657 | 10 - Infrastructure | All signal telephones must be maintained by RailCorp in proper working order. |
REC121-3695 | 10 - Infrastructure | There should be interoperability of communications equipment between all trains operating on the New South Wales rail network. |
REC121-3725 | 13 - Mapping and data quality | The data and information management system should be compatible with any data and information management system established by the ATSB for the designated interstate rail network, provided that the establishment of a compatible system does not reduce the amount or quality of the information obtained by ITSRR below the optimum levels which it needs to conduct trend analysis, and otherwise properly manage the safety of rail operations in New South Wales. |
Rec-ID | Code | Recommendation |
---|---|---|
REC118-3642 | 26 - Research | Establish a Regional Centre of Excellence for Tsunamis to focus Australian and international science/research and collaboration on the challenge of understanding tsunamis and mitigating their consequences. |
Rec-ID | Code | Recommendation |
---|---|---|
REC019-4148 | 10 - Infrastructure | The Commonwealth Government be asked to complete as far as practicable, the connection of telephones to outlying country centres before the end of 1961. |
REC019-4156 | 26 - Research | A fire control research advisory committee be formed to co-operate with the Forests Department in carrying out scientific research into fire control. |
REC019-4153 | 17 - Assets and technology | No opportunity be lost by the Forests Department to improve the efficiency of their fire fighting gangs, radio and other equipment in the light of the latest practical and scientific developments. |
REC019-4151 | 26 - Research | The Forests Department carry out more research into both the technical and practical side of fire control as a necessary accompaniment to the expenditure of money on other forest works and that forest fire control officers be sent overseas at intervals to gain information regarding the latest developments in this work. |
REC019-4149 | 10 - Infrastructure | A sub-committee of telecommunication officers and representatives of the Bush Fires Board be appointed to investigate and encourage the development of a modern system of radio equipment for bush fire brigades. |
Rec-ID | Code | Recommendation |
---|---|---|
REC016_3951 | 10 - Infrastructure | It is recommended that the State Electricity Commission adopt a policy of conciliation and good will towards its closer neighbours. It is not suggested that its policy has been essentially otherwise. In future that policy can best be assured of success by time conferring of material benefit upon its neighbours at some monetary cost to the Commission. It is suggested, with conviction, that it would prove to be of great advantage to time Commission if it were to take an active part in the clearing and bettering of its neighbours’ scrub and timber country at time cost of the Commission. The settler whose land is fully cleared and in production, or who knows that his land will be cleared for him, has no incentive to burn illegally or carelessly. If this suggestion should he adopted, it would be necessary that it should be carried out in all cases in accordance with the settler’s convenience, that he himself should take an active part in the operations, and that he should be left, not with a financial obligation, but with a definite material advantage. |
REC016_3950 | 4 - Fire season preparation | It is recommended that on days of abnormal danger loads of briquettes be not kept in the station yard. The real danger, which transcends in gravity the danger of time destruction of loads of briquettes, is that the prevailing wind or a change of wind might carry showers of burning embers to the town, which is but the width of a road away, and thereby cause material damage in the town. It is further recommended that the yard and its surroundings be kept clear of scrub and growth; and that special provision be made for quelling fire which may break out in the deposits of inflammable dust which lie in time yard. |
REC016_3949 | 17 - Assets and technology | It is recommended that the A.R.P. dams or earth tanks be kept filled during possible danger periods. |
REC016_3944 | 10 - Infrastructure | It is recommended that the water pressure be improved so that a greater volume and jet may be available for the suppression of fires on the faces and also for the purpose of wetting the berms more widely and thoroughly when necessary. It is suggested that there should be variable control of the pressure so that production need not be adversely affected in times of normal danger. |
REC016_3943 | 10 - Infrastructure | It is recommended that a more constant, running revision of the main and sprinkler system be maintained in future so that the service which it is intended to convey shall be closely and efficiently available to all parts of the berms and faces. It is emphasized that the reticulation system in the berms is fixed and stationary, whereas the faces are continually receding as their surfaces are scraped away by the dredges. |
REC016_3952 | 4 - Fire season preparation | It is recommended that the question of the future responsibility be made certain and that the body so made responsible keep the grounds of the hospital free from undergrowth and trees wherever their presence may be a possible source of future danger. |
Rec-ID | Code | Recommendation |
---|---|---|
REC015_3956 | 24 - Govt responsibility | It is strongly recommended that no public department of possible combination of public departments interested in forests should be permitted to gain control of this authority. |
REC015_3954 | 24 - Govt responsibility | It is recommended that each public department or body which may now or hereafter control forest areas be allowed to pursue its own policy of fire prevention and suppression. As each such body is responsible directly or indirectly to Parliament it must be allowed to carry its responsibility in its own manner. It is strongly recommended that no such department be given authority over any other body in matters relating to fire prevention or suppression. If it is ultimately shown that a department is unfit to discharge the duty involved other measures may be taken. |
Rec-ID | Code | Recommendation |
---|---|---|
REC013_3978 | 4 - Fire season preparation | Where possible to build stone or brick fireplaces for the use of travellers, teamsters, and drovers on the camping areas that are mostly used and where there is a risk of fire. |
REC013_3977 | 8 - Communications and warnings | To arrange with settlers who live on hills or have a clear view, and are connected by telephone, to act as " look-outs ", and to communicate with the brigade in the case of fire. |
REC013_3976 | 4 - Fire season preparation | To burn camping areas at suitable water and camping reserves. |
Rec-ID | Code | Recommendation |
---|---|---|
REC008-3989 | 17 - Assets and technology | The Commission recommends that there be continuous supervision of every chamber in which electrical machinery is worked by currents of medium pressure. |
REC008-3987 | 17 - Assets and technology | The Commission recommends that systematic tests be made and recorded of apparatus and circuits as a precaution against fire and so that any gradual deterioration of the system may be detected. |
REC008-3986 | 17 - Assets and technology | The Commission recommends that every precaution be taken to keep water off electrical machinery. |
REC008-3985 | 17 - Assets and technology | The Commission recommends that conductors carrying currents at medium pressure should not be encased in wood in damp places. |
Rec-ID | Code | Recommendation |
---|---|---|
REC004-3992 | 17 - Assets and technology | That the use of a spark-arrester and cinder-arrester by the Railway Department shall not constitute a defence to an action for damage caused by fire escaping from a locomotive, unless the Department proves that such spark-arrester and cinder-arrester were in a thoroughly efficient condition when the fire took place. |
REC004-3999 | 10 - Infrastructure | That, in view of the fact that along many of the lines, between the road-bed and the fences, there are numbers of dry inflammable stumps, which, when they catch fire, are very difficult to extinguish, and that the surface of the ground surrounding these stumps is usually chipped by the permanent-way men every summer, thus causing considerable expense without removing the risk of fire, the Railway Department should remove this source of danger, by grabbing them out and burning them as early as may be found practicable. |
REC004-3996 | 17 - Assets and technology | That the standard pattern of cinder arrester be affixed to the ash-pans in all locomotives during the summer months. |
REC004-3994 | 17 - Assets and technology | That the Railway Department, while gradually reducing the number of different types of locomotives, should steadily keep in view the adoption of English and American railway practice, by providing engines with larger boilers, fire boxers, and smoke-boxes, and with wide blast-pipes, in order to insure ample steaming power with a minimum of forced draught. |