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OCCUPATIONAL HEALTH AND SAFETY (MARITIME INDUSTRY) REGULATIONS 1995 - SCHEDULE Forms

(subregulation 2 (2))

Form 1         Provisional improvement notice

(regulation 6)

OCCUPATIONAL HEALTH AND SAFETY (MARITIME INDUSTRY) REGULATIONS

Provisional improvement notice

To the person in command of (insert name of prescribed ship or prescribed unit)

I, (insert name of the health and safety representative issuing the notice) , selected as the health and safety representative under section 41 of the Occupational Health and Safety (Maritime Industry) Act 1993 for (insert name of the prescribed ship or prescribed unit) , after consultation in accordance with subsection 57 (1) of the Act, believe that the following contravention of the Act or Regulations is occurring, or has occurred and is likely to occur again:

The contravention is (give a brief description)

 

The contravention is occurring at (specify location)

 

The reasons for my opinion are as follows:

(give reasons briefly)

 

In accordance with paragraph 58 (2) (c) of the Act, action necessary to prevent the contravention, or the likely contravention, of the provision or provisions referred to above must be taken before (insert the date of a day that is:

 

 ( page 2 of Form 1 )

          (a)     not less than 7 days after the day when the notice is issued; and

          (b)     reasonable in the opinion of the health and safety representative) .

 

In the meantime, the following action should be taken in accordance with subsection 58 (3) of the Act:

(give a brief description)

 

Dated

 

(signature)

Health and safety representative

 

Notes:

1.            Under subsection 59 (1) of the Act, a person to whom a provisional improvement notice is given may, within 7 days, request the Inspectorate or an inspector to conduct an investigation into the subject matter of the notice.

2.             Under subsection 59 (2) of the Act, the operation of a provisional improvement notice is suspended if a request is made for an investigation into the subject matter of the notice.  The suspension remains in effect until an inspector makes a determination that confirms, varies or cancels the notice.

3.            Subsection 60 (1) of the Act requires the person in command to whom a provisional improvement notice is given:

                   •      to notify each employee who is affected by the notice of the fact that the notice has been issued; and

                   •      to display a copy of the notice at or near each workplace at which work that is the subject of the notice is being performed.

( page 3 of Form 1 )

4.             Under subsection 60 (2) of the Act, a provisional improvement notice ceases to have effect if:

                   •      it is cancelled by the health and safety representative or an inspector; or

                   •      the person in command, or a person who is given a copy of the notice under subsection 58 (5), takes the action specified in the notice or, if no action is specified, takes the action that is necessary to prevent the contravention, or likely contravention, with which the notice is concerned.

5.             Section 61 of the Act requires the person in command:

                   •      to ensure, as far as practicable, that a provisional improvement notice is complied with; and

                   •      to inform the health and safety representative who issued the notice of the action taken to comply with the notice.

6.             Under subsection 100 (2) of the Act, if an inspector has confirmed, varied or cancelled a provisional improvement notice the following persons may request Fair Work Australia in writing to review the decision of the inspector:

                   •      the operator affected by the inspector's decision;

                   •      the person in command;

                   •      the person to whom the notice was given by the person in command under subsection 58 (5) of the Act;

                   •      the health and safety representative for the designated work group that includes an employee who is affected by the decision or an involved union for the designated work group;

                   •      if there is no designated work group of that kind -- an involved union in relation to the affected employee;

                   •      the owner of any plant, substance or thing to which the decision relates.

Form 2         Notice of removal of plant or sample

(paragraph 8 (a))

OCCUPATIONAL HEALTH AND SAFETY (MARITIME INDUSTRY) REGULATIONS

Notice of removal of plant or sample

To the person in command of (insert name of prescribed ship or prescribed unit)

and (insert name of health and safety representative for the prescribed ship or prescribed unit)

I, (insert name of inspector) , an inspector appointed under section 84 of the Occupational Health and Safety (Maritime Industry) Act 1993 , in the course of conducting an investigation under section 87 of the Act, have taken possession of:

(insert description of  item  removed)

from (insert name of the prescribed ship or prescribed unit ) located at ( insert location of ship or unit)

The reason for this action is:

(give explanation of why removal of item was necessary)

 

Signed: (signature of inspector)

Dated: (insert date)

 

Notes:

1 .            Subsection 91 (3) of the Act requires the person in command of the prescribed ship or prescribed unit to display this notice in a prominent place on the ship or unit from which the item was removed.

(page 2 of Form 2)

2.             Under subsection 100 (2) of the Act, any of the following persons may request Fair Work Australia in writing to review the inspector's decision:

                   •      the operator affected by the inspector's decision;

                   •      the health and safety representative for a designated work group that includes an employee affected by the decision or the involved union for the designated work group;

                   •      if there is no designated work group -- an involved union in relation to the employee;

                   •      the owner of any plant, substance or thing to which the inspector's decision relates.

Form 3         Do not disturb notice

(paragraph 8 (b))

OCCUPATIONAL HEALTH AND SAFETY (MARITIME INDUSTRY) REGULATIONS

Do not disturb notice

To the person in command of (insert name of the prescribed ship or prescribed unit )

I, (insert name of inspector) , an inspector appointed under section 84 of the Occupational Health and Safety (Maritime Industry) Act 1993 , direct that:

(insert name of the prescribed ship or prescribed unit, or part of the ship or unit, or of the plant, substance or thing, that is affected)

is not to be disturbed during the period from                                      hours

to                                          hours on                                     (date).

The reasons for issuing this notice are:

( give reasons briefly )

Signed: (signature of inspector)

Dated: (insert date)

 

(see notes over )

(page 2 of Form 3 )

Notes:

1.            Subsection 92 (4) of the Act requires the person in command of the prescribed ship or prescribed unit to display this notice in a prominent place on the ship or unit.

2.             Under subsection 92 (6) of the Act, if the operator of the prescribed ship or prescribed unit does not ensure that the notice is complied with, the operator may be liable for a fine not exceeding $25,000 (if the operator is an individual), or not exceeding $125,000 (if the operator is a body corporate).

3.             Under subsection 100 (2) of the Act, any of the following persons may request Fair Work Australia in writing to review the inspector's decision to issue a prohibition notice:

                   •      the operator affected by the inspector's decision;

                   •      the health and safety representative for a designated work group that includes an employee affected by the decision or the involved union for the designated work group;

                   •      if there is no designated work group -- an involved union in relation to the employee;

                   •      the owner of any plant, substance or thing to which the inspector's decision relates.

Form 4         Prohibition notice

(paragraph 8 (c))

OCCUPATIONAL HEALTH AND SAFETY (MARITIME INDUSTRY) REGULATIONS

Prohibition notice

To the person in charge of (insert name of prescribed ship or prescribed unit )

I, (insert name of inspector) , an inspector appointed under section 84 of the Occupational Health and Safety (Maritime Industry) Act 1993 , am of the opinion that activity being undertaken on (insert name of prescribed ship or prescribed unit) is of a kind that immediately threatens the health and safety of a person.

I therefore PROHIBIT the following activity or activities:

(specify  prohibited activity or activities)

*Action that may be taken that will be adequate to remove the threat to health and safety of the person is:

(if insufficient space, use additional page or pages)

 

Signed:  (signature of inspector)

 

Date:  (insert date)

 

[*  Omit if inapplicable]

 

(see notes over )

 (page 2 of Form 4)

Notes:

1.             Section 96 of the Act requires the person in command of the prescribed ship or prescribed unit to give a copy of this notice to the health and safety representative on the ship or unit and to display a copy of this notice in a prominent place on the ship or unit.

2.             Under subsection 93 (5) of the Act, if the operator of the prescribed ship or prescribed unit does not ensure that the notice is complied with, the operator may be liable to a fine not exceeding $25,000 (if the operator is an individual), or not exceeding $125,000 (if the operator is a body corporate).

3.             This notice ceases to have effect when the inspector notifies the person in command that the inspector is satisfied that the operator has taken adequate action to remove the threat to health and safety.

4.             Under subsection 100 (2) of the Act, any of the following persons may request Fair Work Australia to review the inspector's decision to issue a prohibition notice:

                   •             the operator affected by the inspector's decision;

                   •      the health and safety representative for a designated work group that includes an employee affected by the decision or the involved union for the designated work group;

                   •      if there is no designated work group -- an involved union in relation to the employee;

                   •      the owner of any plant, substance or thing to which the inspector's decision relates.

5.             Under subsection 100 (3) of the Act, any of the following persons may request Fair Work Australia to review the inspector's decision that adequate action has been taken to remove the threat to health and safety:

                   •      the health and safety representative for a designated workgroup that includes an employee affected by the decision or the involved union for the work group;

                   •      if there is not a designated work group -- an involved union in relation to the affected employee.

Form 5        Improvement notice

(paragraph 8 (d))

OCCUPATIONAL HEALTH AND SAFETY (MARITIME INDUSTRY) REGULATIONS

Improvement notice

To the person in command of (insert name of prescribed ship or prescribed unit)

I, (insert name of inspector) , an inspector appointed under section 84 of the Occupational Health and Safety (Maritime Industry) Act 1993 , am satisfied that (insert name of person responsible for the contravention) is contravening, or has contravened, or is likely to contravene, section                                            of the Act or regulation       of the Occupational Health and Safety ( Maritime Industry) Regulations on (insert name of prescribed ship or prescribed unit) .

 

The reasons for my opinion are:

(give a brief description of contravention)

 

You are required to take action within (insert number) days of the date of this notice to prevent any further contravention or likely contravention of that section or regulation.

*The following action must be taken by the person in command within the period specified above:

(if insufficient space, use additional page  or pages)

 

Signed: (signature of inspector )

 

Date: (insert date)

 

[*  Omit if inapplicable]

(page 2 of Form 5 )

Return this portion of the notice (when the required improvement has been completed) to:

Name:

Position:

Address:

Telephone:

Improvement Notice No.                                 has been complied with.

Signed:

___________________________________________________________

This notice was delivered to: (insert name)

in the office/position of: (insert office/position)

at: (insert time)  hours on: (insert date)

(See notes over)

 

( page 3 of Form 5 )

Notes:

1.             Subsection 99 (1) of the Act requires the person in command of the prescribed ship or prescribed unit to give a copy of this notice to the health and safety representative on the ship or unit and to display a copy of this notice in a prominent place on the ship or unit.

2.             If this notice relates to any plant, substance or thing that is owned by a person other than the operator, subsection 99 (2) of the Act requires the inspector to give a copy of this notice to the owner.

3.             Under subsection 98 (5) of the Act, if the person in command of the prescribed ship or prescribed unit does not ensure that this notice is complied with, the person in command may be liable to a fine not exceeding $10,000.

4.             Under subsection 100 (2) of the Act, any of the following persons may request Fair Work Australia to review the inspector's decision:

      •      the health and safety representative for a designated work group that includes an employee affected by the decision or the involved union for the designated work group;

      •      if there is no designated work group -- an involved union in relation to the employee.

Form 6         Incident alert

(subregulation 12 (4))

 

INCIDENT ALERT

SHIP DETAILS

Ship's name

IMO number

Flag

Call sign

Satcom number

 

Master

Gross tonnage

 

No. of persons on board

Class society

Propulsion

IOPP certificate date of issue

o   Container  o Tanker     o   Bulk Carrier    o Tug o   OSV                  o   Other

Operator's name and address

Responsible Officer (ISM designated person)

Contact number

Agents and P&I Club

 

INCIDENT DETAILS

 

Voyage

From

 

To

Ship's Location

(eg port, at sea, lat, long)

 

Location on ship where

incident occurred

 

Date & time

of incident    /     /                           am/pm

No. of persons

involved

Nature of Incident

 

o Collision

o MARPOL ship defects

o Grounding

o Serious personal injury

o Fire

o Death

o Structural failure

o Disappearance

o Flooding

o Loss

o Machinery failure

o Presumed lost

o Cargo gear

o Close quarters situation

o Pilotage

o Births

o Dangerous goods

o Other (specify)

 

DESCRIPTION OF INCIDENT/DAMAGE

Note: If incident occurred under Pilotage, include name of pilot

 

 

 

 

 

 

 

OTHER RELEVANT INFORMATION

 

 

 

 

 

 

 

 

 

 

 

Form 7         Incident report

(subregulation 13 (4))

 

Incident report

Note: This form must be forwarded within 72 hours of the incident by the ISM Code Designated Person or equivalent to:

General Manager, Ship & Personnel Safety Services, AMSA

GPO Box 2181 Canberra ACT 2601 Australia

Fax: +61 2 6279 5966

E-mai l: Reports@amsa.gov.au

For further information please call 1800 021 098

Ship's name

 

IMO number

Flag

Call sign

Satcom number

Master

 

Gross tonnage

Propulsion

Class society

 

Operator's name and address

 

Agents and P&I Club

 

Date & time of incident

Ship's location (eg port, at sea, lat, long)

 

PART 1 - To be completed if reporting under Marine Orders Part 32

Person-in-charge

 

Employer of person-in-charge

 

Incident

 

   Injury 

If injury, complete parts 4 - 8

   Gear failure 

If gear failure, complete parts 5 - 8

   Dangerous Goods

If dangerous goods, complete parts 5 - 8

PART 2 - To be completed if reporting under sections 268, 269 and 417 of the Navigation Act 1912 (other than births) and regulation 4 of the Navigation (Marine Casualty) Regulations

Voyage

To

 

From

 

Incident description

 

 

  Grounding

  Foundering

  Stranding

  Collision

  Capsize

  Flooding

  Fire

  Explosion

  Machinery failure

  Structural failure

  Close quarters

  Disappearance

  Loss

  Presumed lost

  Injury

  Death

  Dangerous
      occurrence

 

  Other (specify)

 

 

Place of incident

 

 

  Machinery spaces

  Accommodation block

  Galley

  Deck/cargo spaces

  Gangway/pilot ladder

  Wharf

  Other (specify)

 

 

Crew numbers

Passenger numbers

Cargo

 

PART 3 - To be completed if reporting under section 417 of the
Navigation Act 1912 - Births

Child's name

 

Gender

M / F

Date of birth

Place

 

Mother's full name

 

 

Town & country of birth

 

Australian resident Yes/ No

Father's full name

 

 

Town & country of birth

 

Australian resident Yes/ No

Note: Part 4 relates to personal injury.  If more than one person is affected complete Part 4 on a separate form for each person.

 

PART 4 - To be completed if reporting under section 107 of the Occupational Health and Safety (Maritime Industry) Act 1993

Name of affected person

 

 

 

Date of birth

 

Gender  M / F

PIN

Home address

 

 

 

Australian resident 

Yes / No

Town & country of birth

 

 

Capacity

 

 

 

  Crew 

  Contractor

   Waterside worker

  Supplier

  Watchkeeper

  Other (specify) ..........................................

 

 

show watch period: from ............... to .................Time since last rest period: ............

Logbook entry date

 

Rank

 

Hours of duty

     Time on:

 

 

Time off:

Hours before duty

Affected area

 

 

 

  Head (1)

  Eyes (1)

  Trunk (3)

  Arms (4)

  Hands (4)

  Legs (5)

  Internal (7)

  Back (3)

  Neck (2)

  Fingers (4)

  Feet (5)

  Toes (5)

  Other (specify)

 

 

 

Type of injury

 

 

 

  Drowning (150)

  Crushing (100)

  Laceration (060/080)

 

  Burns & scalds (120)

  Hernia (450)

  Fracture (020/010)

 

  Electric shock (150)

  Amputation (070)

  Foreign Body (110/090)

  Abrasion (090)

  Bruising (100)

  Asphyxia (110/150/140)

  Strain & sprain (040)

  None

 

 

  Other (specify)

 

 

 

Result of incident

 

 

 

  Death

  Serious Injury

  Minor Injury

 

  Near miss

  Temporary disability

  Partial disability

 

  Permanent disability

  Disappearance

  Time off work

 

  None

  Other (specify)

 

 

 

Incident factors

 

  Machinery and (mainly) fixed plant (1)

 

  Mobile plant and transport (2)

 

  Powered equipment, tools and appliances (3)

 

  Non-powered hand tools, appliances and equipment (4)

 

  Chemicals and chemical products (5)

 

  Materials and substances (6)

 

  Environmental agencies (7)

 

  Animal, human and biological agencies (8)

 

  Other and unspecified agencies (9)

 

Cause of injury/illness

 

Date left ship

Expected period

of incapacity

Treatment given on board ship

 

 

 

 

 

PART 5 - Explanation and Description

State cause and give names and addresses of any witnesses

Attach additional pages if necessary

 

 

 

 

 

 

 

PART 6 - Incident Narrative

Attach additional pages if necessary

 

 

 

 

 

 

 

PART 7 - Action taken to prevent similar occurrences

 

 

 

 

 

 

 

PART 8 - Details of person completing report

 

Name

 

Position

Contact number

Signature

/      /




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