ESV Incident Investigation (Updated)

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Date and Time

  Date

• Notified by

  Select TMC Police Fire Brigade PIC WorkSafe Other

  • TMC
  • Police
  • Fire Brigade
  • PIC
  • WorkSafe
  • Other

• Details

• Site Contact - Name

• Phone

• CMIS Case Number

• Address

• Suburb

• Occupier of Premises

• Date of Birth

  Date

• Type of Premises

  Domestic

  Commercial

  Industrial

  MEC/DB

  Other

• Form of Energy

  Gas

  Electricity

  Not Gas or Electricity

• Type of Incident (ADD LATER)

  Domestic

  Commercial

  Industrial

  MEC/DB

  Other

• Site Contact - Name and Phone Number

• Manager / Duty Manager

  Select TMC Police Fire Brigade PIC WorkSafe Other

  • TMC
  • Police
  • Fire Brigade
  • PIC
  • WorkSafe
  • Other

• Executive Manager

  Select TMC Police Fire Brigade PIC WorkSafe Other

  • TMC
  • Police
  • Fire Brigade
  • PIC
  • WorkSafe
  • Other

• Director

  Select TMC Police Fire Brigade PIC WorkSafe Other

  • TMC
  • Police
  • Fire Brigade
  • PIC
  • WorkSafe
  • Other

• CAMS

  Select TMC Police Fire Brigade PIC WorkSafe Other

  • TMC
  • Police
  • Fire Brigade
  • PIC
  • WorkSafe
  • Other

• Work-Safe

  Select TMC Police Fire Brigade PIC WorkSafe Other

  • TMC
  • Police
  • Fire Brigade
  • PIC
  • WorkSafe
  • Other

• Other

• Event / Incident Location
  Address

• ESV attendance at scene

  Yes

  No

• Do you require further resources / staff to assist?

  Yes

  No
Add Appliance & Vehicle Details

• Appliance Type

  Select Gas Readings Meter Number Registration Number Serial Number / VIN Other

  • Gas Readings
  • Meter Number
  • Registration Number
  • Serial Number / VIN
  • Other

• Appliance Number

• Type

• Make

• Model

• Is a Vehicle/Mobile Plant involved?

  Yes

  No

• Type

• Make

• Model

Person Details

• Who is incharge on the site?

  Select Police MFB/CFA Work Safe Tradesman/Supplier General Witness

  • Police
  • MFB/CFA
  • Work Safe
  • Tradesman/Supplier
  • General Witness

• Name

• Station

• Phone Number

• Ref Number

• Other Details

• Name

• Licence Number

• Contact Number

• GFN/COC Number

• Name

• Address

• Date of Birth

  Date

• Phone Number

• Email

• Summary of Scene

Initial Attendance at Incident - CHANGE RESPONSES

• Ensure you have appropriate OH&S gear

  Yes

  No

  Not Required

• Determine if investigation is technical or legal

  Yes

  No

  Not Required

• Wear identification

  Yes

  No

  Not Required

• Ensure scene is preserved

  Yes

  No

  Not Required

• Liaise with officials at scene and obtain details

  Yes

  No

  Not Required

• Complete Investigation checklist

  Yes

  No

  Not Required

• Establish the cause of incident

  Yes

  No

  Not Required

• Determine whether Statute / Regulations have been breached

  Yes

  No

  Not Required

• Identify Exhibits – for court and analysis

  Yes

  No

  Not Required

• Identify witnesses and obtain details

  Yes

  No

  Not Required

Conduct Incident Scene Examination

• Take readings and record

  Yes

  No

  Not Required

• Observe and sketch scene

  Yes

  No

  Not Required

• Photograph scene (prior to touching or moving any objects)

  Yes

  No

  Not Required

• Search scene

  Yes

  No

  Not Required

• Photograph exhibits as located

  Yes

  No

  Not Required

• Measure location of exhibits

  Yes

  No

  Not Required

• Collect / Label exhibits individually as located

  Yes

  No

  Not Required

Prior to Leaving Scene

• If serious incident –briefing of Manager Investigations / Executive Manager

  Yes

  No

  Not Required

• Have you been released by the Officer in charge (VICPOL / MFB / CFA)?

  Yes

  No

  Not Required

• Organise time and date for witnesses to have statements obtained

  Yes

  No

  Not Required

• Do you or other staff require debrief (EAP)? – Contact Manager or individually

  Yes

  No

  Not Required

• Ensure you have all your equipment

  Yes

  No

  Not Required

At the Office

• Create Incident Management System (CIMS/PEGA) entry

  Yes

  No

  Not Required

• Create hard file

  Yes

  No

  Not Required

• Create E-File

  Yes

  No

  Not Required

• Obtain witness statements

  Yes

  No

  Not Required

• Complete brief of evidence (BOE)

  Yes

  No

  Not Required

• Complete Final Investigation Report (FIR)

  Yes

  No

  Not Required

• Submit BOE or Final Investigation Report to Manager Investigations

  Yes

  No

  Not Required

• When FIR / BOE returned – refer to Legal and Policy section for review

  Yes

  No

  Not Required

• Upload all files to IMS

  Yes

  No

  Not Required

Form of Energy

• Forms of Energy

  Select Gas Electricity Not Gas or Electricity

  • Gas
  • Electricity
  • Not Gas or Electricity

Type of Incident

• Type of Incident

  Select Arching/Explosion Asphyxiation Breach of Regulation Combustion Products Contact with Piping Electric Shock Escape Explosion Fire Fire of Electrical Cause HV Injection Incorrect LPG Composition NG Quality Excursion Other Shock - Burns Shock - Electrocution Unsafe Situation Water Blockage

  • Arching/Explosion
  • Asphyxiation
  • Breach of Regulation
  • Combustion Products
  • Contact with Piping
  • Electric Shock
  • Escape
  • Explosion
  • Fire
  • Fire of Electrical Cause
  • HV Injection
  • Incorrect LPG Composition
  • NG Quality Excursion
  • Other
  • Shock - Burns
  • Shock - Electrocution
  • Unsafe Situation
  • Water Blockage

• Sketch of Scene

  Drawing

• Enter details into CIMS/PEGA

  Yes

  No

  Not Required

• Create hard file

  Yes

  No

  Not Required

• Create E-File

  Yes

  No

  Not Required

• Obtain witness statements

  Yes

  No

  Not Required

• Complete brief of evidence (BOE)

  Yes

  No

  Not Required

• Complete Final Investigation Report (FIR)

  Yes

  No

  Not Required

• Submit BOE or Final Investigation Report to Manager Investigations

  Yes

  No

  Not Required

• When FIR / BOE returned – refer to Legal and Policy section for review

  Yes

  No

  Not Required

• Upload all files to IMS

  Yes

  No

  Not Required