Inquiry Search
Rec-ID | Code | Recommendation |
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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: |
REC324-4319 | 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: |
REC324-4294 | 34 - Local knowledge | Environment: That, to maximise protection for the environment in and around floodplains, Government, working with local communities especially Indigenous communities, the NSWRA, other agencies and local councils ensure Indigenous voices are well heard in land use planning and natural resource management by: |
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. |
REC324-4313 | 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: |
Rec-ID | Code | Recommendation |
---|---|---|
REC323-4288 | 8 - Communications and warnings | That the NSW Government work with the Commonwealth to develop a national cross-agency app to integrate all community services and agencies into a single platform so that everyone can receive accurate and timely information from one source during emergencies. |
REC323-4275 | 34 - Local knowledge | That the NSW Government, in partnership with community groups, including First Nations groups, develop initiatives to build community resilience, particularly in regions at high risk of future natural disaster events. |
REC323-4276 | 34 - Local knowledge | That the NSW Government ensure that community groups, both existing and emerging, including First Nations groups, are well integrated into disaster recovery, by incorporating them into state recovery plans and engaging with them in between and in the lead up to natural disasters. |
REC323-4259 | 3 - Biodiversity | That the NSW Government provide immediate support to the Hawkesbury City Council to remediate the riverbank erosion affecting Cornwallis Road, Cornwallis without any further delay. |
REC323-4283 | 8 - Communications and warnings | That the NSW Government work with the community broadcasting sector to identify ways in which community broadcasters could be better supported to provide critical services during natural disasters, with a view to providing them adequate long term funding. |
REC323-4260 | 3 - Biodiversity | That the NSW Government invest in the restoration of the Wilsons and Richmond Rivers to include riparian restoration, water quality and river health improvement. |
REC323-4284 | 8 - Communications and warnings | That the NSW Government review its public awareness and communication strategies in relation to natural disasters. |
REC323-4264 | 34 - Local knowledge | That the NSW Government work in partnership with key Aboriginal stakeholders, including the Jali Local Aboriginal Land Council, to prioritise the rebuild of Cabbage Tree Island, and ensure a safe and resourced evacuation plan is in place. |
REC323-4287 | 34 - Local knowledge | That the NSW State Emergency Service, in partnership with the Bureau of Meteorology, investigate ways in which local communities and local media with local knowledge can play a stronger role in flood predictions and warnings. |
REC323-4265 | 34 - Local knowledge | That the NSW Government work with First Nations peoples to support Aboriginal organisations in their capacity to operate and respond in times of natural disasters. |
Rec-ID | Code | Recommendation |
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REC315-3839 | 29 - Operational Health and Safety | That, to ensure firefighters can access mental health support through GPs, Government work with the Commonwealth Government to: |
REC315-3859 | 25 - Inquiry, audit, lessons management and after action review | That, in order to ensure State Emergency Operations Centre (SEOC) interoperability during all natural disasters, Resilience NSW review the current SEOC arrangements and location including responsibilities for ongoing resourcing and maintenance. |
REC315-3812 | 25 - Inquiry, audit, lessons management and after action review | That Government commit to: |
REC315-3838 | 29 - Operational Health and Safety | That, in order to ensure all NSW RFS members can access the mental health support they need, the NSW RFS expands in-house mental health support for members. |
REC315-3858 | 25 - Inquiry, audit, lessons management and after action review | That, in order to improve cross-agency communication and coordination during bush fires, the NSW RFS review Fire Control Centres (FCCs) in areas that were heavily affected by fire. The results should be combined with the Emergency Operations Centre (EOC) Facilities Review to identify areas that would benefit from a purpose-built FCC, enabling co-location with the EOC. |
REC315-3811 | 8 - Communications and warnings | That in order to provide greater consistency in public information and warnings, especially in border areas: |
REC315-3873 | 25 - Inquiry, audit, lessons management and after action review | That Resilience NSW review existing functional area arrangements to ensure they are closely aligned to agencies responsible for direct service delivery. |
REC315-3833 | 3 - Biodiversity | That Government invest in long-term ecosystem and land management monitoring, modelling, forecasting, research and evaluation, and harness citizen science in this effort. This will include, among other things: |
REC315-3850 | 3 - Biodiversity | That Government develop and implement a policy on injured wildlife response, rescue and rehabilitation including: |
REC315-3802 | 26 - Research | That Government establish NSW as a major world centre of bush fire research, and technology development and commercialisation. This should include: |
REC315-3865 | 8 - Communications and warnings | That the NSW RFS include the following priorities in the Fires Near Me improvements roadmap: |
REC315-3832 | 8 - Communications and warnings | That, in order to improve the provision of evidence-based public health messaging about air quality during bush fire events, Government develop a public education campaign and supporting systems before the next bush fire season. This should include: |
REC315-3845 | 26 - Research | That Government commission further research on the potential risks and benefits of backburning during severe, extreme and catastrophic conditions and/or in particular terrain, and that the NSW RFS use this research to inform future backburning protocols and training. |
REC315-3798 | 25 - Inquiry, audit, lessons management and after action review | That, in order to ensure recommendations accepted by the Government are implemented in a timely and transparent manner, Government establish a central accountability mechanism to track implementation of recommendations from bush fire-related reviews and inquiries and consider expanding this to other policy areas. |
REC315-3862 | 8 - Communications and warnings | That, in order to improve information flows and increase public awareness of ABC emergency broadcasts, Government: |
REC315-3831 | 26 - Research | That, in order to capture and understand the impacts of bush fire smoke better, Government invest in operational air quality forecasting and alert systems, and public health research and policy development. This would involve investment to: |
REC315-3840 | 29 - Operational Health and Safety | That, in order to ensure firefighter sustenance is of sufficient volume and quality, the NSW RFS reviews food standards and procedures in consultation with volunteers. The review should include catering service standards, including food safety, as well as the viability of sourcing commercial contracts and providing 12-hour food packs to firefighters. |
REC315-3860 | 25 - Inquiry, audit, lessons management and after action review | That, in order to ensure the guiding principles and approval processes are contemporary, streamlined and more flexible, the NSW and Commonwealth Governments review the Defence Assistance to the Civil Community (DACC) arrangements. This review should include the circumstances in which the State can request Commonwealth assistance, and the level of information provided by the ADF to the State on available resources and capabilities. |
REC315-3818 | 26 - Research | That, in order to improve understanding of optimal hazard reduction techniques and their application in the landscape: |
Rec-ID | Code | Recommendation |
---|---|---|
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 |
---|---|---|
REC002-4013 | 19 - Offences | Infringement of the regulations by either party should be followed by a summary form of justice, instituted before two Magistrates. |
REC002-4002 | 19 - Offences | Where safety-lamps are necessary - gas being present for (say) one month after being found in dangerous quantity - they should be securely locked by a man duly appointed, and tampering with them must be punishable by a simple and inexpensive process of law. |
Rec-ID | Code | Recommendation |
---|---|---|
REC292-2369 | 26 - Research | I recommend that the New South Wales Police Force evaluate whether the use of noise-attenuation devices should be mandated when explosive distraction devices are used. |
REC292-2339 | 19 - Offences | I recommend that the Law, Crime and Community Safety Council develop a mechanism to ensure that all information on criminal history (including bail) that is relevant to the investigation and prosecution of criminal offences is readily accessible to police and prosecutors across all Australian jurisdictions. |
REC292-2370 | 25 - Inquiry, audit, lessons management and after action review | I recommend that the New South Wales Police Force undertake a formal assessment of alternatives to the TOU’s current soft-point ammunition to determine whether a more appropriate form of ammunition is reasonably available. |
Rec-ID | Code | Recommendation |
---|---|---|
REC281-1201 | 25 - Inquiry, audit, lessons management and after action review | Preventing Flood Related Fatalities: The NSW Government consider the recommendations from the Preventing Flood Related Fatalities Report when it is released. |
Rec-ID | Code | Recommendation |
---|---|---|
REC280-1396 | 25 - Inquiry, audit, lessons management and after action review | That the Minister for Police and Emergency Services review the communications technologies used by the NSW Rural Fire Service, Fire and Rescue NSW, the NSW National Parks and Wildlife Service and Forestry NSW during fire fighting operations, to ensure that systems are standardised and effective. Within this context, the potential value of satellite phone technology should be investigated. |
REC280-1388 | 25 - Inquiry, audit, lessons management and after action review | That the NSW Rural Fire Service: |
Rec-ID | Code | Recommendation |
---|---|---|
REC261-1505 | 25 - Inquiry, audit, lessons management and after action review | That the NSW Rural Fire Service: |
REC261-1497 | 8 - Communications and warnings | That the NSW Rural Fire Service investigate mechanisms to enhance the predictability of megafires and how this information is communicated easily to the public. |
REC261-1509 | 34 - Local knowledge | That the NSW Rural Fire Service, in order to ensure greater respect for volunteer fire fighters’ knowledge and experience in the management of fires: |
REC261-1508 | 25 - Inquiry, audit, lessons management and after action review | That the NSW Rural Fire Service review its procedures, systems and infrastructure for notifying community members of bush fires, both when a fire has broken out and as it proceeds, to ensure the provision of timely and adequate information. |
Rec-ID | Code | Recommendation |
---|---|---|
REC260-1055 | 34 - Local knowledge | That the Rural Fire Service together with other land managers develop a program whereby local stakeholders come together regularly (every 2 months during non-fire season and monthly during the fire season) to share intelligence and to consider hazard and incident management measures for implementation. |
REC260-1051 | 8 - Communications and warnings | That the Rural Fire Service consider redrafting the disclaimer in its fire predictions to make abundantly clear where the potential errors or omissions may affect the prediction and how to detect them if they are there (for example, by comparing them with linescans) and what other factors (such as VLS) may affect the predictions and in what way. |
REC260-1059 | 8 - Communications and warnings | That the Rural Fire Service and National Parks and Wildlife Service consider amending their protocols for upgrading advices to higher levels to emphasise the significance and urgency of raising warning levels as soon as the potential dangers of fire to lives or property materially increase. |
Rec-ID | Code | Recommendation |
---|---|---|
REC259-1048 | 8 - Communications and warnings | That State and Local Government agencies maximise communication to the residents owning bushfire prone properties to be aware of their level of exposure by having access to the BAL relevant to their property. |
Rec-ID | Code | Recommendation |
---|---|---|
REC238-0804 | 26 - Research | Clarify roles, responsibilities and consider funding options for post-event collection of data and flood intelligence. |
REC238-0802 | 25 - Inquiry, audit, lessons management and after action review | Review the NSW state-wide governance arrangements for flood risk management so that broader issues identified by this Review can be most effectively addressed. |
REC238-0813 | 26 - Research | Develop and maintain a comprehensive flood model and flood modelling framework for the Hawkesbury-Nepean Valley. |
REC238-0807 | 26 - Research | Develop a comprehensive road evacuation network model for floods in the Hawkesbury-Nepean floodplain to inform evacuation capacity assessments and strategic transport and land use planning, and to assist with the real-time operational management of evacuation during floods. |
Rec-ID | Code | Recommendation |
---|---|---|
REC208-0526 | 25 - Inquiry, audit, lessons management and after action review | That OEH’s testing procedures for determining the impact of pollution incidents incorporate additional requirements for the checking and verification of results before those results are released. |
REC208-0524 | 8 - Communications and warnings | That the Premier issue clear and unambiguous guidelines to all Government Ministers specifying the timing of notifications to the public of any matters that may affect public health or safety. |
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 |
---|---|---|
REC163-1936 | 19 - Offences | The prescribed penalty notice penalty amount for section 66(7) of the Rural Fires Act 1997 be increased to $1,100. |
REC163-1935 | 19 - Offences | The prescribed penalty notice penalty amount for section 99(6) of the Rural Fires Act 1997 be increased to $1,100. |
REC163-1934 | 19 - Offences | The prescribed penalty notice penalty amount for section 100(2) of the Rural Fires Act 1997 be increased to $1,100. |
REC163-1941 | 19 - Offences | A working group be established to consider methods of preventing criminal firestarting. |
REC163-1940 | 19 - Offences | That legislation be prepared by the Criminal Law Review Division of the Attorney General’s Department allowing designated officers of the Rural Fire Service to apply for a warrant in certain circumstances. |
REC163-1937 | 19 - Offences | That the Attorney General’s Department’s Crime Prevention Division consider the causes of, and any solution to, the high number of juveniles involved in causing bushfires. |
Rec-ID | Code | Recommendation |
---|---|---|
REC129-3629 | 8 - Communications and warnings | We recommend that NSW Health continue with its good work and continue to improve communication mechanisms with those, such as GPs, likely to be affected in major infectious disease outbreaks. |
Rec-ID | Code | Recommendation |
---|---|---|
REC128-3600 | 34 - Local knowledge | The Department of Primary Industries continue to consult local community about emergency planning and sites for disposal to retain confidence in the event of a genuine emergency. |
REC128-3598 | 25 - Inquiry, audit, lessons management and after action review | That the Department of Primary Industries incorporates reviews of plans and operating procedures as a result of emergency incidents and exercises and ensures that there is adequate commitment from all participants in the review process. |
Rec-ID | Code | Recommendation |
---|---|---|
REC121-3732 | 29 - Operational Health and Safety | If ITSRR accepts such a plan as an appropriate response to the existing weak safety culture, ITSRR should approve it and monitor the effectiveness of the plan. |
REC121-3755 | 29 - Operational Health and Safety | The RailCorp Board should require a full review of the safety competence of RailCorp managers to ensure that each has the ability to bring about those safety reforms recommended in this report which are applicable to his or her position. |
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. |
REC121-3738 | 29 - Operational Health and Safety | All passenger trains must be fitted with an internal passenger emergency door release. |
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. |
REC121-3707 | 29 - Operational Health and Safety | The safety document management system should provide for the distribution of electronic versions of safety documentation to relevant staff. |
REC121-3743 | 29 - Operational Health and Safety | All passenger trains operating in New South Wales must have the external emergency door release clearly marked with the words “Emergency Door Release”. |
REC121-3731 | 29 - Operational Health and Safety | RailCorp should develop a plan to be submitted to ITSRR to address the deficiencies in the safety culture of RailCorp, including: |
REC121-3754 | 29 - Operational Health and Safety | The RailCorp Board should ensure that RailCorp has an adequate and integrated safety management system, including adequate systems for risk assessment, clearly defined safety responsibilities and accountabilities for persons holding management positions, and specific performance criteria against which evaluations can be made of safety performance and accountability for safety performance of all managers. |
REC121-3682 | 29 - Operational Health and Safety | All new rolling stock should be designed to be compatible with at least level 2 automatic train protection discussed in chapter 7 of this report. |
REC121-3737 | 29 - Operational Health and Safety | There must be a minimum of two independent methods of self-initiated emergency escape for passengers from all trains at all times. |
REC121-3764 | 29 - Operational Health and Safety | The ITSRR should not grant accreditation to any rail organisation unless it has an integrated safety management system in accordance with any safety management system regulation and the guidelines published from time to time by ITSRR. |
REC121-3706 | 29 - Operational Health and Safety | RailCorp should establish a comprehensive safety document management system. |
REC121-3742 | 19 - Offences | The risk of abuse of internal passenger emergency door releases should be further reduced by introducing significant penalties for any improper use of such an emergency facility. It should be a criminal offence for anyone to use or tamper improperly with an emergency escape facility in a train. |
REC121-3726 | 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. |
REC121-3753 | 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. |
REC121-3681 | 29 - Operational Health and Safety | RailCorp should progressively implement, within a reasonable time, level 2 automatic train protection with the features identified in chapter 8 of this report. |
REC121-3735 | 29 - Operational Health and Safety | Risk assessments of occupational health and safety issues by RailCorp should include an analysis of broader public safety risks and not be confined to narrow occupational health and safety issues. |
REC121-3759 | 29 - Operational Health and Safety | A Safety Reform Program Director (hereafter referred to as SRPD), reporting directly to the Chief Executive of RailCorp, should be retained to manage, as head of a Safety Reform Program Office, any safety reform program being undertaken by RailCorp. The SRPD should work with the Chief Executive and senior management to ensure the implementation of an integrated safety management system and the cultural change required. The SRPD must have qualifications suitable for recognition by the Australian Institute of Project Management as a master program director. He or she should report to and be under the control of the Chief Executive, to ensure that the accountability of the Chief Executive is not reduced. The SRPD should co-ordinate and integrate any existing rail safety reform programs and, in consultation with and with the authority of the Chief Executive he or she should: |
REC121-3702 | 29 - Operational Health and Safety | Random alcohol testing should be continued. |
REC121-3741 | 29 - Operational Health and Safety | The operation of the train doors should have an override facility whereby the train driver or the guard can override an internal passenger emergency door release system if the door release is interfered with when there is no emergency. There should be an alarm, together with an intercom, in the train guard’s compartment so that, if a passenger attempts to initiate an emergency door release, there is an appropriate delay during which time an alarm sounds in the train guard’s compartment and the guard can then, after first attempting to speak via the intercom to the person concerned, if necessary, override the door release, and make an appropriate announcement over the intercom system in the train. |
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. |
REC121-3749 | 29 - Operational Health and Safety | All new rolling stock must be designed with an area of the roof through which emergency services personnel can access a rail car without encountering wiring or other equipment. That access point must be clearly marked with words such as “emergency services cut here”. |
REC121-3680 | 29 - Operational Health and Safety | All trains must be fitted with a minimum of two independent engineering defences to minimise the risk of derailment or collision in the event of train driver incapacitation. |
REC121-3734 | 29 - Operational Health and Safety | RailCorp should integrate its management of occupational health and safety into its overall safety management. |
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. |
REC121-3740 | 29 - Operational Health and Safety | The internal passenger emergency door release should be fitted with a facility which prevents it from operating unless the train is stationary. |
REC121-3711 | 29 - Operational Health and Safety | The ITSRR should establish an electronic document control system to enable effective and reliable information to be gathered for monitoring the safety of the New South Wales rail system. |
REC121-3748 | 29 - Operational Health and Safety | All new rail cars must have appropriate signage and lighting identifying escape routes in the case of emergency. |
REC121-3733 | 29 - Operational Health and Safety | RailCorp’s approach to occupational health and safety should be proactive and involve the systematic analysis of all current hazards, risks and controls and an assessment of their adequacy to reduce the risk of injury to, or death of, employees to an acceptable level. |
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. |
REC121-3739 | 29 - Operational Health and Safety | All passenger trains operating in New South Wales must be fitted with external emergency door releases which do not require any special key or other equipment to operate. |
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. |
REC121-3709 | 29 - Operational Health and Safety | RailCorp should provide access to electronic versions of safety documentation for all operational staff at their workplace. |
REC121-3747 | 29 - Operational Health and Safety | All trains should have windows available through which passengers can escape. |
Rec-ID | Code | Recommendation |
---|---|---|
REC119-3649 | 25 - Inquiry, audit, lessons management and after action review | It is recommended that the Board: |
Rec-ID | Code | Recommendation |
---|---|---|
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_3983 | 19 - Offences | To prohibit persons throwing lighted cigarettes, cigars and tobacco among any straw, stubble, grass or herbage during the months of September to March in any Bush Fire area, under a penalty not exceeding $10. |
REC013_3982 | 19 - Offences | To prohibit persons taking into a harvest field or through any grass or bush lands any motor, tractor, harvester, &c., which is not supplied with an approved fire extinguisher or without the exhaust being properly fitted and protected, under a penalty not exceeding $50. |
REC013_3981 | 3 - Biodiversity | To prohibit the preparation of baits for the destruction of rabbits and other noxious animals in which stick phosphorus is used at the time of mixing on any farm, pastoral or grazing area. |