PRA Incident Log

• Site Address
  Address

• Incident Date

  Date

• Sentinel No.

• Duty Manager

  Select Gary Monaghan Brad Dyer Johan Snyman David Holhouse Michael Wright Rob Pesce Other

  • Gary Monaghan
  • Brad Dyer
  • Johan Snyman
  • David Holhouse
  • Michael Wright
  • Rob Pesce
  • Other

• Incident Manager

  Select Adam Purton Ken McNeil Gavin Hanley Vlado Dimitrovski Jeff Webber Matt Sutherland Other

  • Adam Purton
  • Ken McNeil
  • Gavin Hanley
  • Vlado Dimitrovski
  • Jeff Webber
  • Matt Sutherland
  • Other

• Prepared by (name)

• Work order number

• Is this a water incident?

  Yes

  No

• Failure Mode

  Select Cracking Fitting failure Tree roots Damaged by others Joint failure

  • Cracking
  • Fitting failure
  • Tree roots
  • Damaged by others
  • Joint failure

• Provide the name /company who damaged this

• Any additional information

• Size of pipe (e.g 230mm)

• Pipe type

  Select Cast Iron Asbestos Cement Ductile Iron Reinforced Concrete Polyvinyl Chloride Medium Density Polyethylene High Density Polyethylene High Performance Polyethylene Copper Lead Galvanised Iron Vitrified Clay

  • Cast Iron
  • Asbestos Cement
  • Ductile Iron
  • Reinforced Concrete
  • Polyvinyl Chloride
  • Medium Density Polyethylene
  • High Density Polyethylene
  • High Performance Polyethylene
  • Copper
  • Lead
  • Galvanised Iron
  • Vitrified Clay

• Describe the burst (e.g water squirting 10mtrs in to air hitting customers roof)

• Describe the flow rate

  Select Trickle Gushing Flowing Intermittent Stopped

  • Trickle
  • Gushing
  • Flowing
  • Intermittent
  • Stopped

• Traffic Management in place

  Yes

  No

• Is this a main road

  Yes

  No

• Number of lanes closed

  Select one two three four

  • one
  • two
  • three
  • four

• Direction of traffic affected

  Select North South East West

  • North
  • South
  • East
  • West

• Description of traffic management

• Estimated time for road opening

  Date

• Is a road reinstatement required

  Yes

  No

• Permanent reinstatement must be completed with in 24 hours. If this can not be left safe traffic management must be left in place until permanent reinstatement is completed.

• Water off time (last valve turned)

• Water on time (first valve turned)

• Is it likely to exceed six hours

  Yes

  No

• Estimated time to repair

• Number of affected properties

• Are there any key customers affected (refer Key Customer Manager Contact list)

Key Customer

• Customer name

• Customer contact number

• Name, Street, Suburb

• Key Customer Manager must be contacted

• Any additional information / remedial action taken

• Are there any home dialysis customers affected (refer Home Dialysis Listing)

Home Dialysis Customer

• Customer name

• Customer contact number

• Name, Street, Suburb

• Contact must be made with the customer

• Additional information / remedial action taken

• Bottled water on site

  Yes

  No

• Enter location of bottled water

• Did the burst cause damage to property

  Yes

  No

• Did it cause any internal property damage

Property

• Does customer have insurance

  Yes

  No

  Unknown

• Building Insurance

• Contents Insurance

• Customer name

• Customer contact number

• Number, Street, Suburb

• Description of damage

• Estimated value of damage

• Was a loss adjuster engaged

  Yes

  No

• Loss Adjuster

  Select Main Insurance Assessors, Laurie Butler, 0411 186 730 Richstar Holdings, Brian Sowden, 0418 952 220 Encompass Construction Risk Services, Douglas Bicknell, 0419 929 095 Western Assessors, John Riley, 0418 959 611 LAC, Chris Cook, 0418 924 015

  • Main Insurance Assessors, Laurie Butler, 0411 186 730
  • Richstar Holdings, Brian Sowden, 0418 952 220
  • Encompass Construction Risk Services, Douglas Bicknell, 0419 929 095
  • Western Assessors, John Riley, 0418 959 611
  • LAC, Chris Cook, 0418 924 015

• Remedial action taken

• Did it cause any external property damage (Gardens, fences, etc)

Property

• Customer name

• Customer contact number

• Number, Street, Suburb

• Description of damage

• Estimated value of damage

• Was a loss adjuster engaged

  Yes

  No

• Loss Adjuster

  Select Main Insurance Assessors, Laurie Butler, 0411 186 730 Richstar Holdings, Brian Sowden, 0418 952 220 Encompass Construction Risk Services, Douglas Bicknell, 0419 929 095 Western Assessors, John Riley, 0418 959 611 LAC, Chris Cook, 0418 924 015

  • Main Insurance Assessors, Laurie Butler, 0411 186 730
  • Richstar Holdings, Brian Sowden, 0418 952 220
  • Encompass Construction Risk Services, Douglas Bicknell, 0419 929 095
  • Western Assessors, John Riley, 0418 959 611
  • LAC, Chris Cook, 0418 924 015

• Remedial action taken

• Does the customer have insurance

  Yes

  No

  Unknown

• Building Insurance

• Contents Insurance

• Did the burst cause damage to Canning / Swan River banks or erosion

  Yes

  No

• Contact must be made with Swan River Trust to obtain an emergency permit.

• How many valves involved in the shut off

• Were there any broken valves

  Yes

  No

• Enter the quantity of broken valves

• Is this a waste water incident?

  Yes

  No

• Failure Mode

  Select Blockage Pump Station Failure Pressure Main Failure/Pipe Collapse

  • Blockage
  • Pump Station Failure
  • Pressure Main Failure/Pipe Collapse

• Pipe type

  Select Cast Iron Asbestos Cement Ductile Iron Reinforced Concrete Polyvinyl Chloride Medium Density Polyethylene High Density Polyethylene High Performance Polyethylene Copper Lead Galvanised Iron Vitrified Clay

  • Cast Iron
  • Asbestos Cement
  • Ductile Iron
  • Reinforced Concrete
  • Polyvinyl Chloride
  • Medium Density Polyethylene
  • High Density Polyethylene
  • High Performance Polyethylene
  • Copper
  • Lead
  • Galvanised Iron
  • Vitrified Clay

• Size of pipe (e.g 230mm)

• Overflowing from

  Select Overflow Relief Gully Internal to building Access Chamber Inspection Shaft Other

  • Overflow Relief Gully
  • Internal to building
  • Access Chamber
  • Inspection Shaft
  • Other

• Overflowing to an environmentally sensitive area (Check Intranet)

  Yes

  No

• Describe the flow path (flowing across verge into road drain which joins the river)

• Describe the flow rate

  Select Trickle Gushing Flowing Intermittent Stopped

  • Trickle
  • Gushing
  • Flowing
  • Intermittent
  • Stopped

• What is the estimated discharge quantity (kL)

• Is the wastewater contained

  Yes

  No

• Where is it contained

• Number of customers affected

• Did the blockage cause any damage to customers property

  Yes

  No

• Did it cause any internal property damage

Property

• Customer name

• Customer contact number

• Number, Street, Suburb

• Description of damage

• Estimated value of damage

• Was a loss adjuster engaged

  Yes

  No

• Loss Adjuster

  Select Main Insurance Assessors, Laurie Butler, 0411 186 730 Richstar Holdings, Brian Sowden, 0418 952 220 Encompass Construction Risk Services, Douglas Bicknell, 0419 929 095 Western Assessors, John Riley, 0418 959 611 LAC, Chris Cook, 0418 924 015

  • Main Insurance Assessors, Laurie Butler, 0411 186 730
  • Richstar Holdings, Brian Sowden, 0418 952 220
  • Encompass Construction Risk Services, Douglas Bicknell, 0419 929 095
  • Western Assessors, John Riley, 0418 959 611
  • LAC, Chris Cook, 0418 924 015

• Remedial action taken

• Does the customer have insurance

  Yes

  No

  Unknown

• Building Insurance

• Content Insurance

• Did it cause any external property damage

Property

• Customer name

• Customer contact number

• Number, Street, Suburb

• Description of damage

• Estimated value of damage

• Was a loss adjuster engaged

  Yes

  No

• Loss Adjuster

  Select Main Insurance Assessors, Laurie Butler, 0411 186 730 Richstar Holdings, Brian Sowden, 0418 952 220 Encompass Construction Risk Services, Douglas Bicknell, 0419 929 095 Western Assessors, John Riley, 0418 959 611 LAC, Chris Cook, 0418 924 015

  • Main Insurance Assessors, Laurie Butler, 0411 186 730
  • Richstar Holdings, Brian Sowden, 0418 952 220
  • Encompass Construction Risk Services, Douglas Bicknell, 0419 929 095
  • Western Assessors, John Riley, 0418 959 611
  • LAC, Chris Cook, 0418 924 015

• Remedial action taken

• Does the customer have insurance

  Yes

  No

  Unknown

• Building Insurance

• Content Insurance

• Are you aware of any history of complaints/sewer blockages

  Yes

  No

  Unknown

• Has there been any odour complaints

  Yes

  No

• Identified cause of blockage

  Select Fats Debris Roots Rags Sand Other

  • Fats
  • Debris
  • Roots
  • Rags
  • Sand
  • Other

• Name of Station, Street, Suburb

• Identified cause

  Select SCADA failure Mechanical failure Electrical failure Other

  • SCADA failure
  • Mechanical failure
  • Electrical failure
  • Other

• Provide details

• Is the pump station on the Environmentally Sensitive List? (Check Intranet)

  Yes

  No

• WW Visible

  Yes

  No

• Overflowing from

  Select Pump Station Access Chamber Inspection Shaft Designated Overflow Point Other

  • Pump Station
  • Access Chamber
  • Inspection Shaft
  • Designated Overflow Point
  • Other

• Describe the flow path (flowing across verge into road drain which joins river)

• Describe the flow rate

  Select Trickle Gushing Flowing Intermittent Stopped

  • Trickle
  • Gushing
  • Flowing
  • Intermittent
  • Stopped

• What is the estimated discharged quantity? (kL)

• Where is the location of the pump stations overflow point? (Check AMOSS for contingency plans)

• Time to overflow

• Are there any upstream stations pumping into the catchment

  Yes

  No

• Enter the name of upstream station

• Can these be remotely inhibited/isolated with minimal risk

  Yes

  No

• Contact the Operations Centre to remotely inhibit

• Is the wastewater contained

  Yes

  No

• Where is it contained?

• Where is the nominated tankering point

• Did the WWO cause any damage to customers property

  Yes

  No

• Did it cause any internal property damage

Property

• Customer name

• Customer contact number

• Number, Street, Suburb

• Description of damage

• Estimated value of damage

• Was a loss adjuster engaged

  Yes

  No

• Loss adjuster

  Select Main Insurance Assessors, Laurie Butler, 0411 186 730 Richstar Holdings, Brian Sowden, 0418 952 220 Encompass Construction Risk Services, Douglas Bicknell, 0419 929 095 Western Assessors, John Riley, 0418 959 611 LAC, Chris Cook, 0418 924 015

  • Main Insurance Assessors, Laurie Butler, 0411 186 730
  • Richstar Holdings, Brian Sowden, 0418 952 220
  • Encompass Construction Risk Services, Douglas Bicknell, 0419 929 095
  • Western Assessors, John Riley, 0418 959 611
  • LAC, Chris Cook, 0418 924 015

• Remedial action taken

• Does the customer have insurance

  Yes

  No

  Unknown

• Building Insurance

• Content Insurance

• Did it cause any external property damage

Property

• Customer name

• Customer contact number

• Number, Street, Suburb

• Description of damage

• Estimated value of damage

• Was a loss adjuster engaged

  Yes

  No

• Loss Adjuster

  Select Main Insurance Assessors, Laurie Butler, 0411 186 730 Richstar Holdings, Brian Sowden, 0418 952 220 Encompass Construction Risk Services, Douglas Bicknell, 0419 929 095 Western Assessors, John Riley, 0418 959 611 LAC, Chris Cook, 0418 924 015

  • Main Insurance Assessors, Laurie Butler, 0411 186 730
  • Richstar Holdings, Brian Sowden, 0418 952 220
  • Encompass Construction Risk Services, Douglas Bicknell, 0419 929 095
  • Western Assessors, John Riley, 0418 959 611
  • LAC, Chris Cook, 0418 924 015

• Remedial action taken

• Does the customer have insurance

  Yes

  No

  Unknown

• Building Insurance

• Content Insurance

• Has there been odour complaints in the area

  Yes

  No

• Is there the potential for a reportable overflow to occur

  Yes

  No

• Likely to overflow from

  Select Pump Station Access Chamber Inspection Shaft Designated Overflow Point Other

  • Pump Station
  • Access Chamber
  • Inspection Shaft
  • Designated Overflow Point
  • Other

• Likely flow path (flowing across verge into road drain which joins river)

• Where is the location of the pump stations overflow point? (Check AMOSS for contingency plans)

• What is the time to overflow for the pump station? (Check AMOSS)

• Are there any upstream stations pumping into the catchment?

  Yes

  No

• Enter name of upstream station

• Can these be remotely inhibited/isolated with minimal risk

  Yes

  No

• Contact the Operations Centre to remotely inhibit

• Where is the nominated tankering point?

• Is this a result of damage by others

  Yes

  No

• Provide the name / company who damaged this

• Any additional information

• Pipe type

  Select Cast Iron Asbestos Cement Ductile Iron Reinforced Concrete Polyvinyl Chloride Medium Density Polyethylene High Density Polyethylene High Performance Polyethylene Copper Lead Galvanised Iron Vitrified Clay

  • Cast Iron
  • Asbestos Cement
  • Ductile Iron
  • Reinforced Concrete
  • Polyvinyl Chloride
  • Medium Density Polyethylene
  • High Density Polyethylene
  • High Performance Polyethylene
  • Copper
  • Lead
  • Galvanised Iron
  • Vitrified Clay

• Size of pipe (e.g 230mm)

• Overflowing from

  Select Overflow Relief Gully Internal to building Access Chamber Inspection Shaft Other

  • Overflow Relief Gully
  • Internal to building
  • Access Chamber
  • Inspection Shaft
  • Other

• Overflowing to an environmentally sensitive area

  Yes

  No

• Describe the flow path (flowing across verge into road drain which joins river)

• Describe the flow rate

  Select Trickle Gushing Flowing Intermittent Stopped

  • Trickle
  • Gushing
  • Flowing
  • Intermittent
  • Stopped

• What is the estimated discharge quantity (kL)

• Is the wastewater contained

  Yes

  No

• Where is it contained

• Number of customers affected

• Did it WWO cause any damage to customers property

  Yes

  No

• Did it cause any internal property damage

Property

• Customers name

• Customers contact number

• Number, Street, Suburb

• Description of damage

• Estimated value of damage

• Was a loss adjuster engaged

  Yes

  No

• Loss Adjuster

  Select Main Insurance Assessors, Laurie Butler, 0411 186 730 Richstar Holdings, Brian Sowden, 0418 952 220 Encompass Construction Risk Services, Douglas Bicknell, 0419 929 095 Western Assessors, John Riley, 0418 959 611 LAC, Chris Cook, 0418 924 015

  • Main Insurance Assessors, Laurie Butler, 0411 186 730
  • Richstar Holdings, Brian Sowden, 0418 952 220
  • Encompass Construction Risk Services, Douglas Bicknell, 0419 929 095
  • Western Assessors, John Riley, 0418 959 611
  • LAC, Chris Cook, 0418 924 015

• Remedial action taken

• Does the customer have insurance

  Yes

  No

  Unknown

• Building Insurance

• Content Insurance

• Did it cause any external property damage

Property

• Customers name

• Customer contact number

• Number, Street, Suburb

• Description of damage

• Estimated value of damage

• Was a loss adjuster engaged

  Yes

  No

• Loss Adjuster

  Select Main Insurance Assessors, Laurie Butler, 0411 186 730 Richstar Holdings, Brian Sowden, 0418 952 220 Encompass Construction Risk Services, Douglas Bicknell, 0419 929 095 Western Assessors, John Riley, 0418 959 611 LAC, Chris Cook, 0418 924 015

  • Main Insurance Assessors, Laurie Butler, 0411 186 730
  • Richstar Holdings, Brian Sowden, 0418 952 220
  • Encompass Construction Risk Services, Douglas Bicknell, 0419 929 095
  • Western Assessors, John Riley, 0418 959 611
  • LAC, Chris Cook, 0418 924 015

• Remedial action taken

• Does the customer have insurance

  Yes

  No

  Unknown

• Building Insurance

• Contents Insurance

• Traffic management in place

  Yes

  No

• Is this a main road

  Yes

  No

• Number of lanes closed

  Select one two three four

  • one
  • two
  • three
  • four

• Direction of traffic affected

  Select North South East West

  • North
  • South
  • East
  • West

• Estimated time for road opening

  Date

• Is a road reinstatement required

  Yes

  No

• Permanent reinstatement must be completed with in 24 hours. If this can not be left safe traffic management must be left in place until permanent reinstatement is completed.

• Is this a drainage incident?

  Yes

  No

• Is there a main drain overflow due to heavy rain event

  Yes

  No

• Are the drainage inlet/outlet structures clear of debris

  Yes

  No

• Is there evidence of pollution by a third party

  Yes

  No

• Type of pollution

  Select Debris Hydrocarbon Detergents Other

  • Debris
  • Hydrocarbon
  • Detergents
  • Other

• Additional information obtained

• Appropriate information must be obtained and reported to DER

• Did it cause any damage to property

  Yes

  No

• Did it cause any internal property damage

Property

• Customer name

• Customer contact number

• Number, Street, Suburb

• Description of damage

• Estimated value of damage

• Was a loss adjuster engaged

  Yes

  No

• Loss Adjuster

  Select Main Insurance Assessors, Laurie Butler, 0411 186 730 Richstar Holdings, Brian Sowden, 0418 952 220 Encompass Construction Risk Services, Douglas Bicknell, 0419 929 095 Western Assessors, John Riley, 0418 959 611 LAC, Chris Cook, 0418 924 015

  • Main Insurance Assessors, Laurie Butler, 0411 186 730
  • Richstar Holdings, Brian Sowden, 0418 952 220
  • Encompass Construction Risk Services, Douglas Bicknell, 0419 929 095
  • Western Assessors, John Riley, 0418 959 611
  • LAC, Chris Cook, 0418 924 015

• Does the customer have insurance

  Yes

  No

  Unknown

• Building Insurance

• Contents Insurance

• Remedial action taken

• Did it cause any external property damage

Property

• Customer name

• Customer contact number

• Name, Street, Suburb

• Description of damage

• Estimated value of damage

• Was a loss adjuster engaged

  Yes

  No

• Loss Adjuster

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Does the customer have insurance

  Yes

  No

  Unknown

• Building Insurance

• Contents Insurance

• Remedial action taken

• Is this an "OTHER" Incident?

  Yes

  No

• Has DFES reported incident where our infrastructure is at risk due to fire

  Yes

  No

• Details of infrastructure

Asset

• Street, Suburb

• Asset type

• Describe affect on the system

• Potential customer impact

• Is this an accidental chemical release to the watercourse incident

  Yes

  No

• Provide additional details

• Is this an aquatic or wildlife death incident

  Yes

  No

• Provide additional details

• This is any marine fauna deaths that is adjacent or near our drain (e.g at ocean outfall)

• Is this a staining of receiving watercourse from construction incident

  Yes

  No

• Provide additional details

• Is this a Non-emission event/non-compliance with environmental conditions Incident?

  Yes

  No

• Additional details

NOTIFICATIONS

• INTERNAL PARTIES

  Yes

  No

• Perth Regional Manager, PRA

• Service Delivery Manager, PRA

• Environmental Advisor, PRA

• Finance and Administration, PRA

• General Manager, MCSG

• Manager, Environment and Aboriginal Affairs

• Communications Branch

• Security

• Drinking Water Quality Branch

• CIMC

• Operations Centre

• EXTERNAL PARTIES

  Yes

  No

• Department of Environment and Regulation

• Enter name of person and time of contact

• Department of Health

• Enter name of person and time of contact

• Local Government Authority

• Select Authority

  Select Armadale Bassendean Bayswater Belmont Cambridge Canning Claremont Cockburn Cottesloe East Fremantle Fremantle Gosnells Joondalup Kalamunda Kwinana Mandurah Melville Mosman Mundaring Murray Nedlands Peppermint Grove Perth Rockingham South Perth Stirling Subiaco Swan Victoria Park Vincent Wanneroo

  • Armadale
  • Bassendean
  • Bayswater
  • Belmont
  • Cambridge
  • Canning
  • Claremont
  • Cockburn
  • Cottesloe
  • East Fremantle
  • Fremantle
  • Gosnells
  • Joondalup
  • Kalamunda
  • Kwinana
  • Mandurah
  • Melville
  • Mosman
  • Mundaring
  • Murray
  • Nedlands
  • Peppermint Grove
  • Perth
  • Rockingham
  • South Perth
  • Stirling
  • Subiaco
  • Swan
  • Victoria Park
  • Vincent
  • Wanneroo

• Enter name of person and time of contact

• Swan River Trust

• Enter name of person and time of contact

• Community Group

• Enter Group name, name of person and time of contact

• Department of Fire and Emergency Services

• Enter name of person and time of contact

• Other

• Enter Department, name of person and time of contact

• SMS notification text sent

  Yes

  No

MEDIA

• Is there media interest

  Yes

  No

  Likely

• Contact must be made with Communications Branch

• Provide details (e.g channel 7 on site taking photos)

CATEGORISATION

• Minor Incident - WILL NOT cause harm or loss to a third party, environmental harm, generate media interest, endanger public health or safety

• Significant / Moderate Incident - WILL cause damage or affect the function of infrastructure, environmental harm, significant local media interest, safety or health hazard, risk to regulatory compliance, damage to corporate reputation, damage or loss to a third party.

• Major Incident - WILL cause extensive damage to infrastructure or property (>$100k), simultaneous significant incidents in more than one business unit, medium to long environmental harm, high level of media or stakeholder interest, serious death or injury, enduring damage to reputation, unacceptable financial loss or corporate fraud.

• Severity of this incident

  Select Minor Moderate / Significant Major

  • Minor
  • Moderate / Significant
  • Major

DER REPORTING

• Is a section 72 required

  Yes

  No

  Unknown

• Name of responsible person to complete

• Section 72 must be submitted with 24 hours from time of incident excluding weekends (e.g incident occurs 4.00pm Friday document due 4.00pm on the following Monday)

• Required to be submitted on

  Date

• If this timeframe can not be met an extension must be applied for and communications must be sent to the Correspondense Coordinator and Environmental Advisor.

• Was an extension of time requested for the section 72 submission

  Yes

  No

• Name of contact from Department of Environment and Regulations

• New agreed time frame for submission of section 72

  Date

FURTHER INVESTIGATION

• Do you believe a hot debrief is required?

  Yes

  No

  Unknown

• Service Delivery Manager must be notified