Application for Internal Review/Stay of a Reviewable Decision

APPLICATION FOR INTERNAL REVIEW

Transport (Safety Schemes Compliance and Enforcement) Act 2014

Applications for internal review may be sent to the Safety Director via facsimile (03 9655 6611) followed by a signed original addressed to the Safety Director

PO Box 2797, Melbourne, Victoria 3001.

PRELIMINARY INFORMATION

Eligible person declaration:

This section must be completed by an ‘eligible person’who is applying to the Safety Director for reviewof a decision made under the Transport (Safety Schemes Compliance and Enforcement) Act 2014(Vic) (TSSCEA) that is listed in this form.

I ......

(first name)(surname)

of ......

(address)

Status/title/employer (if applicable):......

Telephone Number:...... (business hours)

...... (non-business hours)

Email:...... …………………

aman ‘eligible person’, in accordance with section 99 of the TSSCEA:

Tick the appropriate box in the table below

Tick / Provision under which reviewable decision is made / Eligible person in relation to reviewable decision
Section 33 (forfeiture of seized things) / The person entitled to the thing.
Section 50 (service of improvement notice) / The person on whom the improvement notice is served.
A rail transport operator or an operator of a bus service whose interests are affected by the decision.
Section 59 (extension of time for compliance with improvement notice) / The person on whom the improvement notice is served.
A rail transport operator or an operator of a bus service whose interests are affected by the decision.
Section 54 (amendment of improvement notice) / The person served with the improvement notice that is being amended.
A rail transport operator or an operator of a bus service whose interests are affected by the decision.
Section 56 (clearance certificate to the effect that all or any specified requirements of improvement notice have been complied with) / The person on whom the improvement notice was served.
A rail transport operator or an operator of a bus service whose interests are affected by the decision.
Section 60 (service of prohibition notice) / The person on whom the prohibition notice is served.
A rail transport operator or an operator of a bus service whose interests are affected by the decision.
Section 64 (amendment of prohibition notice) / The person served the prohibition notice that is being amended.
A rail transport operator or an operator of a bus service whose interests are affected by the decision.
Section 66 (certificate that prohibition notice matters have been remedied) / The person served the prohibition notice.
A rail transport operator or an operator of a bus service whose interests are affected by the decision.
Section 71 (service of non-disturbance notice) / The person on whom a non-disturbance notice is served.
A rail transport operator or an operator of a bus service whose interests are affected by the decision.
Section 74 (service of subsequent non-disturbance notice) / The person on whom a subsequent non-disturbance notice is served.
A rail transport operator or an operator of a bus service whose interests are affected by the decision.
Section 90 (direction to take specified action following safety report) / The rail transport operator or operator of a bus service given the direction.
Section 91(2) (direction to stop, alter or not to commence work) / The person given a direction to stop, alter or not commence work.
A rail transport operator whose interests are affected by the decision.
Section 91(3) (direction to stop, alter or not to commence the railway operations) / The rail transport operator given the direction.
A utility whose interests are affected by the decision.

Details of reviewable decision:

Irequest the Safety Director conduct an internal review of the decision:

a)concerning the forfeiture of ………………………………………………………………………….; (list item forfeited)

b)to serve me with Improvement Notice Number ……………………..…………………….……..;

c)to extend the time for compliance with Improvement Notice Number
…………………………..;………………………………………………………………….…..…….;

d)to amend Improvement Notice Number ………………………………….………………..……..;

e)to serve me with a Certificate Number ………………………….. in regard to compliance with requirements in Improvement Notice Number……………………………………………..……..;

f)to serve me with Prohibition Notice Number ……………………………………………………..;

g)to amend Prohibition Notice Number …………………………………………..………..………..;

h)to serve me with Certificate Number ………………………….. in regard to matters being remedied concerning Prohibition Notice Number …………………………..……..………..…….

i)to serve me with Non-Disturbance Notice Number ………………….………..……………..;

j)to direct me to take specified action following a safety report: …………………………………………………………………………………..….(describe action);

k)to direct me to stop, later or not to commence work: ………………………………………………………………………….…….….(describe direction);

l)to direct me to stop, alter or not to commence railway operations: …………………………………………………………………….….……….….(describe direction).

The decision was made on ………/…………/……….. at ……………:…………….. by

……………………………….……………………………………………………………….…………..………

Grounds for internal review:

Supporting reasons:

APPLICATION TO STAY THE DECISION

Transport (Safety Schemes Compliance and Enforcement) Act 2014

Even though the eligible person has applied for an internal review, the application does not affect the operation of the decision and TSV may take steps to implement the decision immediately. However, the Safety Director may stop the implementation of the decision if the applicant applies to have the decision ‘stayed’. This means all steps to implement the decision must stop until the outcome of the internal review application is decided.

Are you applying to stay the decision while the outcome of the internal review is determined?

Yes No

TSV must be satisfied there will be minimal risk to transport operations or the safety of any persons as a result of granting the stay.Please specifythe reasons for making the application as well as the interim measures to reduce safety risk to be put in place while the reviewable decision is being reviewed. Please also attach any supporting information. All relevant information must be included in the application.

Reasons for requesting the stay:

Details of interim measures to reduce safety risk:

To apply for a 'stay' or suspension of the decision while it is being reviewed you must contact us as follows:

During business hours (8.30 am - 5.00 pm Monday to Friday excluding public holidays), contact the relevant modal branch by calling 1800 223 022.
Outside business hours contact the Duty Officer on 1800 301 151.

Completed applications to stay the decision must be sent to the Safety Director via facsimile (03 9655 6611) followed by a signed original addressed to the Safety Director at PO Box 2797, Melbourne, Victoria 3001.

SP135/F04A