Inquiry Search
Rec-ID | Code | Recommendation |
---|---|---|
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. |
REC314-3272 | 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). |
REC314-3268 | 12 - EM agency and authority | Incorporate Farm Firefighting Units (FFUs) into the Australasian Inter Service Incident Management System (AIIMS) so that IMTs are aware of their presence on the fireground and their welfare and risks are understood. |
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. |
Rec-ID | Code | Recommendation |
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REC301-2389 | 12 - EM agency and authority | The proposed Tasmania State Air Desk should have a finance officer attached to its staff. |
REC301-2392 | 39 - Disaster Risk Management | TFS should engage in discussions with government about the construction of purpose-built State Control Centre facilities for emergency management in Tasmania. |
REC301-2391 | 12 - EM agency and authority | TFS, PWS and STT should jointly carry out work to identify acceptable shift lengths and patterns – including requirements for rest days – for all personnel working on emergency operations. Once these have been identified, systems should be put in place to ensure that HR rostering practices follow these fatigue management guidelines. And senior staff should lead by example and ensure that they, as well as the people working under them, take adequate rest breaks. |
REC301-2390 | 12 - EM agency and authority | TFS, PWS and STT should jointly reach a decision on whether a winch capable remote area firefighting capability should be maintained in Tasmania; which agency or agencies should be responsible for that program; and how a winch capable remote area firefighting capability can be safely trained and kept current, to include consideration of the availability of winching aircraft. If the decision is taken not to maintain this capability in the state, TFS, PWS and STT should identify how the gap in capability that this represents should be filled in future fire seasons. |
Rec-ID | Code | Recommendation |
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REC297-1271 | 1 - Land-use and building regs | That the organisations responsible for construction, maintenance and ownership of bridges review their design guidelines and, if necessary, update them to specifically include consideration of debris and flood impacts on bridge design. A review of existing bridges by the responsible organisations could also be undertaken to highlight any potential issues. |
REC297-1272 | 1 - Land-use and building regs | That, to provide greater clarity for building development, design and approval within tolerable risk levels, the Tasmanian Planning Scheme, including a relevant Riverine Flood Hazard Code, is finalised and approved as soon as practicable. |
Rec-ID | Code | Recommendation |
---|---|---|
REC296-1356 | 10 - Infrastructure | Accurate records need to be provided as to what is done for each service. |
REC296-1361 | 10 - Infrastructure | Prepare and carry out a testing regime and testing strategy and ensure testing of the generator is done every month for 4 hours over that month and under full Hospital load with test result recorded every 15 minutes. |
REC296-1350 | 10 - Infrastructure | Remove any loads that do not need to be on essential power. |
REC296-1355 | 10 - Infrastructure | Replacement of all original pipes and hoses not yet done. |
REC296-1360 | 10 - Infrastructure | Carry out regular load bank testing on the generator with a load bank large enough to fully load the generator to 110% which will clean out the engine and also identify whether the generator is capable of providing full load for a sustained length of time. |
REC296-1349 | 10 - Infrastructure | Conduct an assessment of the current essential loads and determine if there are loads that should not be on essential power. |
REC296-1354 | 10 - Infrastructure | Monthly and annual maintenance servicing needs to be scheduled for the generator to DPTI or CHSA schedule requirements. |
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. |
Rec-ID | Code | Recommendation |
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REC295-1305 | 18 - Access to fire ground | That the annexure to the State Emergency Management Plan, ‘Traffic management during emergencies’, be updated to include: responsibilities and processes for road closures; and, Department of Planning, Transport and Infrastructure requirements in regards to provision of road closure information, notification of changes in road closure status and publishing of that information. |
REC295-1298 | 12 - EM agency and authority | That the State Emergency Service, in consultation with key stakeholders, identify and implement a robust system and procedures for prioritising, allocating and coordinating multiple tasks. |
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. |
REC295-1335 | 12 - EM agency and authority | Explore alternative emergency management models including the alternative model proposed above to establish a South Australian Emergency Management Office and State Relief and Recovery Office within the South Australian Fire and Emergency Services Commission, to ensure that all the objects and guiding principles of the Emergency Management Act 2004, and State Emergency Management Plan are addressed efficiently and effectively. |
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. |
REC295-1325 | 12 - EM agency and authority | Review and reinstate the State Emergency Management Training Officer and State Emergency Management Planning Officer (capability development) positions to operate with a broad, strategic and leadership focus. |
REC295-1322 | 12 - EM agency and authority | Consider opportunities to identify synergies between the incident management systems used in SA being the, Australasian Interservice Incident Management System (AIIMS) and ICCS Plus. This might include joint training and exercising in roles that are common across both systems. |
Rec-ID | Code | Recommendation |
---|---|---|
REC284-1373 | 10 - Infrastructure | Review generator installations details as noted in report and implement physical improvements where possible. |
REC284-1367 | 10 - Infrastructure | Add to generator test procedure a checklist at the end of testing which includes checking that all systems are back to normal positions and includes a requirement to leave the day tank full where there is a bulk tank/day tank arrangement. |
REC284-1372 | 10 - Infrastructure | As part of the electrical master plan update recommended above, a complete and consistent set of single line diagrams describing the electrical distribution network be prepared. Relevant diagrams to be laminated and displayed in the main substations. Labelling to all main electrical equipment be reviewed and updated in accordance with the final documents. |
REC284-1366 | 10 - Infrastructure | A detailed review of the fuel control and BMS systems (for all generators) be carried out and actions taken to: 1) Ensure that the fuel alarm system is operational and properly calibrated, and ensure that the alarms are connected to the BMS. 2) Ensure that the BMS transmits these alarms effectively to the maintenance staff. 3) If this review demonstrates risk of fuel control systems not adequately reporting alarms, consider an independent day tank level switch to be installed in each generator fuel tank, directly connected to the BMS. 4) Consider the feasibility of adding a “fuel system not in auto” or “fuel system fault/fail safe watchdog” or “pre-alarm identifying that the generator is about to shut down without intervention” feature to current systems – subject to details of each individual generator system. |
REC284-1371 | 10 - Infrastructure | Generator dual redundant starter systems should be considered. |
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. |
Rec-ID | Code | Recommendation |
---|---|---|
REC273-1142 | 18 - Access to fire ground | That SACFS consider the Traffic Management Procedures and guiding principles adopted in Tasmania as a model that could be implemented within SA. |
REC273-1137 | 12 - EM agency and authority | Review all current SACFS operational facilities (Group, ICC, RCC and SCC) to provide more effective communications, connectivity and resource management. |
REC273-1136 | 12 - EM agency and authority | Plan the establishment of one multi-agency Coordination Centre with sufficient capacity and capability to deal with all incidents in South Australia. |
REC273-1130 | 12 - EM agency and authority | Reviewing how Regional resources are managed and tracked and incorporate into COSO’s to ensure that there is complete situational awareness as to the location and tasking of CFS resources. |
Rec-ID | Code | Recommendation |
---|---|---|
REC258-2545 | 12 - EM agency and authority | The Australian Transport Safety Bureau transfers its safety education function to the Civil Aviation Safety Authority. |
REC258-2532 | 12 - EM agency and authority | The next Director of Aviation Safety has leadership and management experience and capabilities in cultural change of large organisations. Aviation or other safety industry experience is highly desirable. |
REC258-2558 | 12 - EM agency and authority | The Civil Aviation Safety Authority applies a project management approach to the completion of all Civil Aviation Safety Regulation Parts not yet in force, with drafting to be completed within one year and consultation completed one year later, with: |
REC258-2553 | 12 - EM agency and authority | The Civil Aviation Safety Authority establishes a safety oversight risk management hierarchy based on a categorisation of operations. Rule making and surveillance priorities should be proportionate to the safety risk. |
REC258-2547 | 12 - EM agency and authority | The Civil Aviation Safety Authority establishes small offices at specific industry centres to improve monitoring, service quality, communications and collaborative relationships. |
REC258-2546 | 12 - EM agency and authority | The Civil Aviation Safety Authority changes its organisational structure to a client-oriented output model. |
Rec-ID | Code | Recommendation |
---|---|---|
REC256-1570 | 1 - Land-use and building regs | All governments should put in place best-practice institutional and governance arrangements for the provision of public infrastructure, including road infrastructure. These should include: |
Rec-ID | Code | Recommendation |
---|---|---|
REC247-0899 | 18 - Access to fire ground | That appropriate plans are made to mobilise resources quickly to re-open roads affected by emergencies. |
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. |
REC247-0939 | 5 - Hazard reduction burns | That Tasmania Fire Service conducts a review of the fire permit system in the Fire Service Act 1979, and implements change to improve the efficiency and effectiveness of the system by: • considering whether it is appropriate to authorise persons or organisations to conduct fuel reduction burning during a permit period • providing a better match between the period, area and fire risk • maintaining a timely and efficient process for issuing permits • naming the period in a way that draws attention to bushfire risk • establishing a reporting and accountability process. |
REC247-0885 | 18 - Access to fire ground | That arrangements are made for and appropriate pre-planning occurs to effectively implement the policy on road closures and traffic management. |
REC247-0931 | 4 - Fire season preparation | That a specific risk prevention and mitigation advisory body be established for the State Emergency Management Committee. |
REC247-0938 | 5 - Hazard reduction burns | That Tasmania Fire Service or another suitable agency provides information to the community which shows, in simple form, the legislation applicable to approvals for lighting fires on private property and the various relationships between that legislation. |
REC247-0884 | 18 - Access to fire ground | That Tasmania Police reviews its Emergency Traffic Management Points policy; and develops a multi-agency policy in the emergency management plans for road closures and traffic management, including clarity in decision making, coordination and sufficient operational flexibility. |
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. |
REC247-0937 | 19 - Offences | That the legislation and enforcement arrangements are reviewed to ensure there are suitable offences and penalties, investigation and enforcement capabilities, and a rigorous approach is taken to breaches of the law. |
REC247-0866 | 26 - Research | That fire agencies continue to develop their predictive modelling capability for use in actively managing fires. |
REC247-0906 | 18 - Access to fire ground | That emergency management plans recognise the need to provide priority access to areas of emergency operations for critical infrastructure providers. |
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. |
REC247-0849 | 26 - Research | That Tasmania Fire Service supports the relevant authorities to continue developing methodologies to forecast and simulate fire risk. |
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. |
REC247-0934 | 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. |
REC247-0942 | 1 - Land-use and building regs | That the Government makes land use planning and building construction to prevent and mitigate bushfire risk a high priority and establishes a means to progress improvements in this area, such as a designated body or group, as soon as possible. |
Rec-ID | Code | Recommendation |
---|---|---|
REC244-2618 | 12 - EM agency and authority | SES be given a power ‘to register, subject to any conditions the Chief Officer SES considers appropriate, suitable organisations (such as Volunteer Marine Rescue Associations) as affiliated organisations of the State Emergency Service’. |
REC244-2605 | 39 - Disaster Risk Management | A thorough consultative process be developed and implemented between the CFS and local government. This will determine how bushfire management planning can enable improved process and practice to mitigate bushfire risk, and ensure that fire permits are issued and complied with. |
REC244-2634 | 12 - EM agency and authority | If possible the terms of election for CFS Health and Safety Representatives be aligned with group elections. |
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. |
REC244-2619 | 12 - EM agency and authority | Should the SES be given the power ‘to register suitable organisations’, then the ‘other person’ in Section 127 – Protection from liability, could be defined to include members of organisations affiliated to emergency service organisations. |
Rec-ID | Code | Recommendation |
---|---|---|
REC207-2882 | 39 - Disaster Risk Management | Review disaster recovery and business continuity plans. |
Rec-ID | Code | Recommendation |
---|---|---|
REC205-1901 | 1 - Land-use and building regs | The Council of Australian Governments’ Building Ministers’ Forum should provide formal direction to the Australian Building Codes Board to: |
REC205-1900 | 1 - Land-use and building regs | As a priority, state and territory governments should ensure that land-use planning systems are sufficiently flexible to enable a risk management approach to incorporating climate change risks into planning decisions at the state, territory, regional and local government levels. Consideration should be given to: |
Rec-ID | Code | Recommendation |
---|---|---|
REC177-3356 | 39 - Disaster Risk Management | The regulator should pre‐assess and review in a generic sense, and in conjunction with the offshore petroleum industry, available options for well control in the event of a blowout. Being ‘match fit’ in this sense will enable a quicker and more effective response in terms of safety assessment, and will ensure that expectations of both operator and regulator are more readily aligned. |
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). |
REC177-3338 | 12 - EM agency and authority | Licensees and rig operators should be astute in ensuring that corporate systems and culture encourage rather than discourage raising of well control issues. For instance, do performance bonuses or rewards actually encourage or discourage reporting of issues? Is there a system in place to enable anonymous reporting of well control concerns? What whistleblower protections are in place? |
REC177-3291 | 39 - Disaster Risk Management | Removal of a barrier must be the subject of consultation between licensees and rig operators prior to removal. A proper risk assessment should be carried out and agreed upon, and documented in writing before removal. Joint written certification as to the appropriateness of removal should take place before removal. Senior onshore representatives of stakeholder entities should be involved in that certification process. |
REC177-3337 | 12 - EM agency and authority | Supervision/oversight of well control operations (within licensees, rig operators and by regulators) must occur without assuming adherence to good oilfield practice. The opposite assumption should prevail: namely adherence to good oilfield practice may well be compromised by the pursuit of time and cost savings. |
REC177-3289 | 39 - Disaster Risk Management | The use/type of barriers (including any change requests relating thereto) must be the subject of consultation between licensees and rig operators prior to installation. A proper risk assessment should be carried out, agreed upon, and documented in writing before installation. Joint written certification as to the appropriateness of the use of particular barriers should take place before installation. Senior onshore representatives of stakeholder entities should be involved in that certification process. |
REC177-3336 | 12 - EM agency and authority | Achievement and maintenance of well control should be written into the job responsibilities of key personnel, at every level up to and including CEOs. That is, a functional line of accountability for well control must exist up to, and including, CEOs. |
REC177-3286 | 39 - Disaster Risk Management | Problems which arise in the course of installing barriers must be the subject of consultation between licensees, rig operators, and contractors (if used). A proper risk assessment should then be carried out and remedial steps (including further testing/verification) should be agreed upon, and documented in writing before the performance of remedial work whenever practicable. Joint written certification as to resolution of the problem should take place before resumption of drilling operations. Senior onshore representatives of stakeholder entities should be involved in that certification process. |
REC177-3336 | 12 - EM agency and authority | Achievement and maintenance of well control should be written into the job responsibilities of key personnel, at every level up to and including CEOs. That is, a functional line of accountability for well control must exist up to, and including, CEOs. |
REC177-3285 | 39 - Disaster Risk Management | Pre‐drilling assessments should include a risk assessment of the worst‐case blowout scenario. |
REC177-3330 | 39 - Disaster Risk Management | Decision‐making about well control issues should be professionalised. Industry participants must recognise that decision‐makers owe independent duties to the public, not just their employer or principal, in relation to well control. Risk management in the context of well control needs to be understood as an ethical/professional duty. Self‐regulation contemplates self‐regulation by the industry, not just by individual licensees and operators. |
Rec-ID | Code | Recommendation |
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REC161-3034 | 12 - EM agency and authority | That National Offshore Petroleum Safety Authority critically review its regulatory manning levels based on its current workload and the recommendations for additional areas of focus and increased auditing presented in this Report. To meet these requirements, we estimate that National Offshore Petroleum Safety Authority requires up to 50 inspectors in total plus associated support staff to bring overall staffing from about 55 to 75. RET should help facilitate the necessary ongoing levy funding in consultation with industry. |
Rec-ID | Code | Recommendation |
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REC151-3080 | 12 - EM agency and authority | The United Firefighters Union of Australia – SA Branch (UFU) be given full voting rights on the Advisory Board. |
REC151-3078 | 12 - EM agency and authority | All members of the proposed reconstituted SAFECOM Board be given full voting rights. |
REC151-3099 | 12 - EM agency and authority | The selection procedures in the Regulations for SACFS officer positions be reviewed in terms of ensuring that appropriate skills and experience are considered. |
REC151-3077 | 12 - EM agency and authority | The presiding member of the Advisory Board appointed under Section 18(4) be also appointed as a member of the SAFECOM Board. |
REC151-3098 | 12 - EM agency and authority | Nominations for candidates for SACFS group elections be received both by written nomination and by oral nomination. |
REC151-3067 | 12 - EM agency and authority | Fresh consideration be given to the title of Commissioner of Fire and Emergencies so as to ensure it does not give the impression that it is operationally superior to the Chief Officers of the emergency service agencies. |
REC151-3092 | 19 - Offences | Expiation fees be reviewed so as to be consistent with the seriousness of the offences. |
REC151-3066 | 12 - EM agency and authority | Accountability for matters of policy, strategy and resource allocation for the emergency services sector, currently the province of the Board, be given to the position created in Recommendation 3 above. |
REC151-3083 | 12 - EM agency and authority | Provisions remain in the FES Act relating to the emergency service organisations being separate legal entities. |
Rec-ID | Code | Recommendation |
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REC149-3142 | 19 - Offences | NOPSA should use encouragement as the primary tool of enforcing compliance provided willingness to improve is exhibited by the players. |
REC149-3139 | 39 - Disaster Risk Management | The industry should develop in conjunction with the Regulator a process for addressing the need to maintain the risk profile of a facility moving into extended life operation at the same risk profile as when it was within design life. |
Rec-ID | Code | Recommendation |
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REC140-3570 | 12 - EM agency and authority | The fragmentation and duplication of fixed wing and helicopter clinical coordination should be eliminated through centralisation to TAS Communications. |
REC140-3569 | 12 - EM agency and authority | A senior Tasmanian NETS representative be confirmed on the Tasmanian Medical Retrieval Services Committee. |
REC140-3566 | 12 - EM agency and authority | Launceston General and Burnie Hospital’s Emergency Departments require sufficient equipment, monitors and human resources to provide occasional safe local retrieval in their region. |
REC140-3562 | 12 - EM agency and authority | A rapidly responsive helicopter and road retrieval capability to be developed out of RHH. |
REC140-3557 | 12 - EM agency and authority | Royal Flying Doctor Service fixed wing to remain in Launceston for the duration of the current contract. |
REC140-3571 | 12 - EM agency and authority | A senior, experienced, clinically trained ambulance officer to be based in TAS Communications in Hobart for at least 14 hours a day. |
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. |