Office of the Rail Safety Regulator Rail Safety Act 2007 Notification of Occurrence All fields marked with a * are mandatory for completed form to be submitted. In accordance with Section 74 of the Rail Safety Act 2007 and the Rail Safety (General) Regulations 2008, Rail Transport Operators must report to the Regulator all notifiable occurrences that happen on, or in relation to, the Rail Transport Operators railway premises or railway operations. Reports can be made by completing the fields below using the national Occurrence Notification Standard (ON-S1) and Occurrence Classification Guidelines (OC-G1) as guides. (The reference numbers shown below refer to ON-S1).   Incident No: * TCR: *     Notifying Organisation (2.1.1): * Other Organisations Involved: * Infrastructure Manager (2.1.2): * Rolling Stock Operator(s) (2.1.3): * Line Section (2.1.8): *Kilometrage (2.1.9): * Location Description: * Time of Occurrence: *(24 Hour Clock) Date of Occurrence: *Day, Month, Year Occurrence Category: Category A * Category B *     Occurrence Classification (2.1.13) in reference to Occurrence Classification Guidelines, (OC-G1) June 2008 * Description of Occurrence (2.1.14) * Cause / Contributing factors (2.1.15) * Likely Involvement of external Parties? (2.1.16) Tick yes if occurrence was likely to have been caused by actions of external parties such as trespassers, vandals etc. Yes: No: Property Damage / Consequences (2.2.6) Property Damaged Damage Type * * 2. PERSONAL / SPECIFIC DETAILS Personal Consequence (2.2.1):        Personal Consequences                                               Personal Details Person Type (1.7) Fatality (1.10.2) Serious Injury (1.10.2) Minor Injury (1.10.3) Given / Surname (if available) Age (2.2.5) Gender (2.2.4) Address (if available) Passenger Public Railway Staff Contractor Volunteer Trespasser Passenger Public Railway Staff Contractor Volunteer Trespasser Passenger Public Railway Staff Contractor Volunteer Trespasser Passenger Public Railway Staff Contractor Volunteer Trespasser Passenger Public Railway Staff Contractor Volunteer Trespasser Drug and Alcohol Testing of Rail Safety Workers (2.2.7) Name Time of Test (2.2.10) Test Type (2.2.2) Employee Type (1.7.1) Job Description Reason for Test (2.2.9) Test Results (2.2.11)   Specific Data Items Comments/Description Train Type (2.3.2) (select one) Urban Passenger Freight Non - Urban Passenger Hi- Rail Heritage Track Machine Tram Other Train Identification (i.e. Train number) (2.3.3) Traction Type (2.3.4) (select one) Diesel Electric Steam Diesel Hydraulic Other Electric     Rolling Stock Number/Class (2.3.5)   Level Crossing Details Comments/Description Level Crossing Identification/Name (2.3.7) Level Crossing Control (2.3.8) (select one) Active - Lights Only Passive - Give Way Signs Active - Lights Boom Gates None Passive - Stop Signs Other Road Vehicle Type (2.3.9) (select one) Light Passenger Vehicle Motorcycle Heavy Freight Vehicle Bicycle Dangerous Goods Vehicle Other Bus     Additional Information & Details Comments/Description SPAD / P.A. Over Run (2.3.10)  Metres Signal Number (2.3.12) Perway Switch Points No. (2.3.13) Dangerous Goods Type (2.3.14)   Additional Comments: (if required)           Name of Reporting Person Position Contact Telephone No. Contact E-mail Date * * *

Notifiable Occurrences Reporting Requirements
Notification of Occurrence form to download and print and complete
Notification of Occurrence form to download and print and complete

Notes for completing the Notification of Occurrences Form

Each occurrence must be submitted on a separate form (unless an alternative arrangement has been made with the Office of the Rail Safety Regulator). 

Notifying Organisation:
The organisational code (issued by the Office for the Rail Safety Regulator) for the reporting rail organisation.

Incident No:
The unique code used by the reporting rail organisation to identify the Occurrence within their own recording system.

TCR:
Train Control Report Number/Code. The unique code issued by a train control authority to identify the Occurrence.

Notifying Organisation:
Enter the full name of the accredited rail organisation reporting the Occurrence.

Other Organisations Involved:
If applicable, enter the names of other rail organisations involved in the incident that are NOT the infrastructure manager or rolling stock operator. This information is entered in the fields specifically requesting the ‘Infrastructure Manager’ and ‘Rolling Stock Operator(s)’ information.

Location, Line Identifier, Date and Time of Occurrence
Each field must be completed.

Description of Occurrence
The reporting organisation must ensure that adequate information is provided to clearly describe the circumstances and outcomes of the occurrence, based on the information available at the time of notification.
(Further information outlining the description requirements for each type of occurrence can be located in Section 3 of the ON-S1.)

Cause/Contributing Factors
A description of any factors that may have contributed to the occurrence or any other qualifying information which is available at the time of notification.
For example, the cause of a derailment may have been a broken rail. The cause of a fatality or injury may be a suspected suicide.

Casualty
Types as follows:

Property Damage/Consequence
Where property damage has occurred, a description of the property type (rolling stock, railway infrastructure or other property) and the type of damage sustained is required.

For further information on the reporting requirements for notifiable occurrences please refer to the Occurrence Notification Standard One (ON-S1).

FORWARD COMPLETED FORMS
within 72 hours of the occurrence to:

Email: dtei.railsafety@sa.gov.au
Fax:    (08) 83432718
Post:   Attention: Office of the Rail Safety Regulator
GPO Box 1533
Adelaide
SA 5001