Inquiry Search
Rec-ID | Code | Recommendation |
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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. |
REC210-0738 | 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. |
REC210-0761 | 2 - Emergency powers | The Queensland Government should consider whether to empower Seqwater, through the flood operations centre, to direct CS Energy to stop or delay releases from Splityard Creek Dam where a flood event is declared under the Manual of Operational Procedures for Flood Mitigation at Wivenhoe Dam and Somerset Dam. |
REC210-0775 | 16 - Training and behaviour | The Department of Environment and Resource Management should conduct periodic dam safety information and education sessions with emergency management personnel including those from Emergency Management Queensland, local and district disaster management groups and local councils. Priority should be given to sessions if the Bureau of Meteorology forecasts a wet season with a greater than 50 per cent chance of above median rainfall. |
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. |
REC210-0757 | 15 - Inter-service cooperation | The protocol should make provision for the use of telephone and/or radio where communication by email is not possible. Where necessary, CS Energy and Seqwater should make additional radio equipment available to relevant personnel. |
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. |
REC210-0736 | 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. |
REC210-0756 | 15 - Inter-service cooperation | CS Energy and Seqwater should agree upon and adhere to a formal communication protocol that requires CS Energy personnel to advise Seqwater, through the Flood Operations Centre, of water movements between Splityard Creek Dam and Wivenhoe Dam or Pryde Creek once a flood event is declared under the Manual of Operational Procedures for Flood Mitigation at Wivenhoe Dam and Somerset Dam. The protocol should ensure that a direct line of communication is established between CS Energy personnel physically located at the power station and the Flood Operations Centre. |
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. |
REC210-0734 | 16 - Training and behaviour | Emergency Management Queensland should simplify the process by which SES members gain recognition for prior qualifications so that unnecessary duplication of training can be avoided. |
REC210-0754 | 2 - Emergency powers | 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 whether the dam operators should be able to extend the drawdown of the lake beyond seven days in order to reduce downstream bank slumping |
REC210-0766 | 16 - Training and behaviour | Wide Bay Water should, in addition to its usual wet season preparations and maintenance, undertake the following activities in advance of each wet season: Queensland Floods Commission of Inquiry | Final Report 29 Complete list of Final Report recommendations • conduct training for personnel on dam operation, including contingency plans for the situation in which one or more of the gates is inoperable • hold meetings of key personnel of Wide Bay Water involved in the operation of the dam during floods, which: – in addition to any other matters, inform staff about the current status of the gates, dam operation strategies and contingency plans for the situation in which one or more of the gates is inoperable – are recorded in minutes which document the information provided and are made available to all operational staff. |
REC210-0727 | 2 - Emergency powers | The Disaster Management Act 2003 should be amended to give the chief executive of the department administering the Act (or his or her delegate) the authority to appoint an officer of Emergency Management Queensland to direct SES operations in extraordinary circumstances |
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. |
REC210-0762 | 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. |
Rec-ID | Code | Recommendation |
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REC181-0174 | 29 - Operational Health and Safety | The Country Fire Authority and the Department of Sustainability and Environment amend their procedures for investigating safety incidents and ‘near-misses’ to ensure that all dangerous incidents, including back-burns, are fully investigated and that all relevant people are consulted and informed of the results. |
REC181-0151 | 11 - Evacuation and shelters | The State revise its bushfire safety policy. While adopting the national Prepare. Act. Survive. framework in Victoria, the policy should do the following: ■ enhance the role of warnings—including providing for timely and informative advice about the predicted passage of a fire and the actions to be taken by people in areas potentially in its path; ■ emphasise that all fires are different in ways that require an awareness of fire conditions, local circumstances and personal capacity; ■ recognise that the heightened risk on the worst days demands a different response; ■ retain those elements of the existing bushfire policy that have proved effective; ■ strengthen the range of options available in the face of fire, including community refuges, bushfire shelters and evacuation; ■ ensure that local solutions are tailored and known to communities through local bushfire planning; ■ improve advice on the nature of fire and house defendability, taking account of broader landscape risks. |
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. |
REC181-0165 | 14 - Incident Mgt Teams | The Country Fire Authority and the Department of Sustainability and Environment: ■ amend their procedures to require that an incident action plan summary be completed within the first four hours of an incident being reported and be provided to the State Control Centre and, where established, to the relevant Area of Operations Control Centre; ■ adopt DSE’s incident action plan summary as the template to be used by all incident management teams and ensure that the template is included in the online IMT Tool Box; ■ provide regular training to IMT staff, highlighting the importance of information and reinforcing the support available from specialists within the State Control Centre. |
REC181-0173 | 7 - Inter-agency communication | The Country Fire Authority review and improve its communications strategy as a matter of priority and develop a program for identifying and responding to black spots in radio coverage. |
REC181-0204 | 2 - Emergency powers | The State amend the Country Fire Authority Act 1958 to enable the Chief Officer to delegate the power to issue fire prevention notices. |
REC181-0160 | 20 - Role of police | The State clarify whether, during major fires, Victoria Police should discharge its coordination functions from the State Emergency Response Coordination Centre or from the State Control Centre. |
REC181-0172 | 15 - Inter-service cooperation | The Country Fire Authority and the Department of Sustainability and Environment standardise their operating systems and information and communications technologies with the aim of achieving greater efficiency and interoperability between agencies. |
REC181-0185 | 20 - Role of police | Victoria Police continue to pursue a coordinated statewide approach to arson prevention and regularly review its approach to ensure that it contains the following elements: ■ high-level commitment from senior police; ■ a research program aimed at refining arson prevention and detection strategies; ■ centralised coordination that includes comprehensive training, periodic evaluation of arson prevention strategies and programs, and promotion of best-practice prevention approaches; ■ a requirement that all fire-prone police service areas have arson prevention plans and programs, according to their level of risk. |
REC181-0159 | 14 - Incident Mgt Teams | The Country Fire Authority and the Department of Sustainability and Environment prescribe and audit the minimum number and nature of level 3 joint training exercises in which incident management team staff (including volunteers) are required to participate. |
REC181-0169 | 18 - Access to fire ground | The Country Fire Authority provide to all CFA volunteers an identification card or similar to facilitate their passage through roadblocks established in accordance with the 2009 Guidelines for the Operation of Traffic Management Points during Wildfires. |
REC181-0176 | 29 - Operational Health and Safety | The Country Fire Authority and the Department of Sustainability and Environment adopt the title ‘safety officer’ (as opposed to ‘safety adviser’) and require without exception that a safety officer be appointed to every level 3 incident management team. |
REC181-0155 | 11 - Evacuation and shelters | The State introduce a comprehensive approach to evacuation, so that this option is planned, considered and implemented when it is likely to offer a higher level of protection than other contingency options. The approach should: ■ encourage individuals—especially vulnerable people—to relocate early; ■ include consideration of plans for assisted evacuation of vulnerable people; ■ include consideration of plans for assisted evacuation of vulnerable people. |
REC181-0168 | 14 - Incident Mgt Teams | The Country Fire Authority and the Department of Sustainability and Environment amend their procedures to require that a suitably experienced, qualified and competent person be appointed as Incident Controller, regardless of the control agency for the fire. |
REC181-0175 | 16 - Training and behaviour | The Country Fire Authority and the Department of Sustainability and Environment require without exception that all relevant staff be trained in the need for Incident Controller approval to be obtained before a back-burn is lit. |
REC181-0154 | 11 - Evacuation and shelters | The State introduce a comprehensive approach to shelter options that includes the following: ■ developing standards for community refuges as a matter of priority and replacing the 2005 Fire Refuges in Victoria: Policy and Practice; ■ designating community refuges—particularly in areas of very high risk—where other bushfire safety options are limited; ■ working with municipal councils to ensure that appropriate criteria are used for bushfire shelters, so that people are not discouraged from using a bushfire shelter if there is no better option available; ■ acknowledging personal shelters around their homes as a fallback option for individuals. |
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. |
REC181-0167 | 14 - Incident Mgt Teams | The Country Fire Authority and the Department of Sustainability and Environment establish before the 2010–11 fire season: ■ a uniform, objective and transparent process based on the current DSE approach for the accreditation of level 3 Incident Controllers; ■ a performance review system for level 3 Incident Controllers; ■ a traineeship program for progression from level 2 to level 3 incident management team positions. |
Rec-ID | Code | Recommendation |
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REC016_3945 | 16 - Training and behaviour | It is recommended that a large proportion of men employed in and about the open-cut be systematically trained in the use of equipment and in the tactical disposition of it. |
REC016_3953 | 15 - Inter-service cooperation | It is therefore recommended that the State Electricity Commission should be advised by someone whose profession it is to consider and devise methods of forest fire protection and suppression; that he should collaborate with others to devise a general scheme of organized protection of the undertaking and township of Yallourn; and that above all, he should have direct access to the Commissioners themselves, lest his advice should lose something of its strength and reality in its journey through the “proper channels” of the Commission’s organization. |
REC016_3948 | 16 - Training and behaviour | It is recommended that workers and volunteers generally be instructed in accordance with a pre-arranged plan, as to what they should do in future times of emergency. Since the fighting of fires is for the greater part a matter of voluntary action, some estimate could perhaps be made, after investigation, of the numbers of men in each department who would be willing to volunteer. It would be necessary that each department should become a component part of an over-riding scheme and that it and its members should be fully instructed in the matter of whistle or siren warnings, places of assembly, reception of messages from the director of proceedings, use of equipment, and the various details which would necessarily be parts of an effective scheme. The training need not be onerous. If given once or twice at the beginning of possible danger periods, it would make for some degree of order and efficiency instead of a probable state of confusion. |
REC016_3947 | 15 - Inter-service cooperation | It is recommended that the services of this body [Air Raids Precautions Body] be used in future if to do so be thought desirable. |
Rec-ID | Code | Recommendation |
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REC004-3997 | 40 - Equipment and consumables | That suitable metal receptacles be fitted under the spittoons of all smoking compartments of country trains, to receive pipe ashes, lighted tobacco, cigars, cigarettes, matches, or other inflammable matter used by smokers. |