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An assessment finding is a non-compliance or a recommendation made by the safety assessor in an assessment report. The Transport Agency considers these findings and then determines what action, if any, is required. However, it’s expected that all matters identified in the report will be resolved through normal continuous improvement processes. 

Take particular note of each finding as you may already have a process in place that addresses the issue, which the safety assessor wasn’t made aware of. Some findings may be able to be closed relatively quickly, by:

  • providing further information
  • presenting existing information in a different way, or
  • documenting practices that already exist but aren’t written down.

Remedial actions

When systemic or potentially significant safety improvements can be made as a result of the findings of the assessment, a notice requiring you to make improvements (remedial action) may be issued under section 42 of the Act(external link). The purpose is to compel licence holders to take remedial steps, as opposed to relying on them voluntarily addressing such matters.

A remedial action may also be issued to address a common theme across a number of non-compliances or safety improvement recommendations.

If the Transport Agency determines that remedial action is necessary, you’ll be informed in writing of the proposed decision. You’ll have the opportunity to make submissions regarding any proposed remedial action before a final decision is made.

Once a final decision is made your licence manager will confirm the due date for responses to any remedial actions (and associated non-compliances and recommendations), along with due dates for any other findings arising from the assessment report that did not require remedial action. You will still have the right to appeal under section 68 of the Act(external link), if appropriate.

Due dates

Keep an eye on the due dates for responding to remedial actions and assessment findings as these are extremely important. You should provide a formal response with associated evidence as early as possible to ensure the due date is met. The due dates assigned to your rail organisation are final cut off points, not targets. If you know in advance these cannot be met for a genuine reason, please contact your licence manager.

Taking the appropriate action to close the findings in good time demonstrates that you prioritise safety and compliance. Further compliance action will be considered where remedial actions and assessment findings cannot be satisfactorily addressed. This could include a review of your risk profile and lead to a more frequent assessment schedule.

Managing your findings

If you have a number of findings to work through, it may help to record them in a table as a summary review. This would be in addition to the detailed evidence you send in to your licence manager. On its own a summary table such as this will not suffice to address most findings of a systemic safety nature. However, if you do it this way, it can be helpful to attach a copy for your licence manager when you send in the evidence.

Example railways assessment findings

Finding

Topic

Evidence provided

How evidence meets requirements

NC1 19/02

Safety case

Safety case version 3.2

Revised safety case takes into account assessor’s comments

Safety case

Safety case variation form

Documents the changes made to the safety case

NC2 19/02

Risk management

Risk register and risk matrix

Shows that the risk for all rail excursions is managed SFAIRP

NC3 19/02

Staff training

Training matrix

Amended to show training certifications and expiry/due dates

NC4 19/02

Internal audit

Internal Audit Dec 2018

Audit of processes, procedures and documentation. Includes actions, responsibilities and closure dates

Providing evidence

If you need to do something differently or add an element to an activity, document the decision-making process and include that with your evidence. In some situations a variation may also be required to your safety case. If this is required please also submit an application for a safety case variation form [DOCX, 79 KB], making clear that it relates to a response to an assessment finding or remedial action.

Any uncertainty or barriers in responding to remedial actions or other assessment findings should be discussed with your licence manager as soon as you are aware. It’s too late once the due date is going to be missed to expect an extension simply because you have not taken any appropriate action.

When updating documents and/or processes, include the updated copies marked with the changes, identify what you’ve changed and state which finding the document is addressing. If you send through a whole document without specifying the section or aspect which relates to the finding, it may not be approved/closed. The more specific and clear you can be, the faster your findings can be closed.

At the completion of the time allowed for remedial action, the safety assessor will provide a report to the Transport Agency on whether the remedial action required has been satisfactorily completed. This may require further on-site activity and the viewing of documentation or information.

Following consideration of the remedial action report, the Transport Agency will consider whether the remedial action is completed or whether further action is required, including whether an extension of time under section 44 of the Act(external link) is warranted, or whether alternate compliance action is appropriate.

You must provide responses with supporting evidence to close all remedial actions, non-compliances and recommendations within the agreed timeframes. Remember, a remedial action is a statutory notice under the Act. You must achieve it by the due date or your operations may be suspended. Further regulatory requirements, such as a Safety improvement plan, may also be imposed on you.

Safety improvement plans

If a rail licence holder fails to take the appropriate remedial action as required by the Transport Agency after a safety assessment, the Transport Agency may require that they prepare and submit a safety improvement plan for approval. Once the plan is approved, the licence holder must implement the plan and not amend it without further approval from the Transport Agency.

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