Annual Self Assessment Report (ASAR)

NSW Bus Operator Accreditation
Annual Self Assessment Report (ASAR)
Important information
This Self-Assessment must be completed and signed by:
1. Accreditation held by an individual -The person whose name the accreditation is held in;
2. Accreditation held by a group or partnership - Any one of the people whose name the accreditation is held in;
3. Accreditation held by an incorporated association or corporation - A designated manager or director (as nominated in the
accreditation).
Operators must advise Roads and Maritime Services (RMS) of any aspect of their operation which does not comply with the conditions
of the Accreditation as set out in the Bus Operator Accreditation Package. If you declare that you are not compliant in any area, RMS
may provide information to assist you in meeting the relevant requirements.
If you fail to declare a non-compliance and a subsequent investigation determines that you are not compliant, serious penalties in
relation to your accreditation, including suspension, cancellation or prosecution may apply.
Notice to Accredited Bus Operators
1. It is an offence under clause 90 of the Passenger Transport Regulation 2007 if an operator fails to submit the ASAR audit by the due
date. Maximum penalty $550.00.
2. It is an offence under section 54 of the Passenger Transport Act 1990 to provide RMS with any information you know to be false or
misleading. Maximum penalty $2200.
Part A - Accreditation Details (complete your
accreditation details)
1. Your details
Name accreditation held in
2.
Accreditation type
Regular Passenger Service
Number of buses approved
to operate
Number of buses operated
at time of ASAR
Accreditation number
Long Distance Tourist or Charter
Number of buses approved
to operate
Number of buses operated
at time of ASAR
Trading name
Please list the registration numbers of all buses operated
under this accreditation (Please use separate sheet if
required)
Postal address
Postcode
Depot address
3.
Do you hold any other accreditation?
Telephone number
Postcode
Mobile number
Yes if yes give details below
No
Provide name and accreditation details
Fax number
Email address
Public Passenger Services
Level 4, 16 - 18 Wentworth Street Parramatta NSW 2150
Locked Bag 5085, Parramatta NSW 2124
www.transport.nsw.gov.au 1800 227 774 T 02 9689 8888 F 02 9689 8813 E licensing@transport.nsw.gov.au
Catalogue No. 45071727 Form No. 1673 (04/2013) ABN 76 236 371 088
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NSW Bus Operator Accreditation Annual Self Assessment Report (ASAR)
Part B - Incorporated Association or Corporation
Details (this section to be completed if Accreditation is
held by an incorporated association or corporation only)
1.
Has a Designated Manager or Director changed in the
previous 12 months?
Yes if yes give details below
No
Previous Designated Manager/Director
5.
Has there been previously or is there currently any
bankruptcy, insolvency or winding up proceedings brought
against the nominated director/s or manager/s of the
association/corporation, of which the RMS has not yet been
informed?
Yes
No
if yes give details below
New Designated Manager/Director
2.
3.
Position in the Association/Corporation
Since the association/corporation was first accredited are
there any charges or pending charges against the
association/corporation for any criminal or corporate
offences or has the association/corporation been found
guilty or convicted by a court in NSW or elsewhere of any
criminal or corporate offences of which RMS has not yet
been informed?
Yes
No
if yes give details below
Since the association/corporation was first accredited has
there been previously or is there currently any bankruptcy,
insolvency or winding-up proceedings brought against the
association/corporation, of which RMS has not yet been
informed?
Yes
No
if yes give details below
6.
Is the association/corporation associated with any other
entity which has been subject to bankruptcy, insolvency or
winding-up proceedings within the previous 12 months?
Part C - Individual(s) Details (To be completed if the
Accreditation is held by one or more individuals)
1.
2.
Yes
No
Since you were first accredited are there any charges or
pending charges against you for any criminal or corporate
offence/s or have you been found guilty or convicted by a
court in NSW or elsewhere of any criminal or corporate
offences of which RMS has not yet been informed?
Yes
No
Since you were first accredited has there been previously or
is there currently any bankruptcy, insolvency or winding up
proceedings brought against you, of which RMS has not yet
been informed?
Yes
No
if yes give details below
if yes give details below
if yes give details below
4.
Are there any charges or pending charges against a
nominated director/s or manager/s of the association/
corporation for any criminal or corporate offence/s or has
the nominated director/s or manager/s of the association/
corporation been found guilty or convicted by a court in
NSW or elsewhere of any criminal or corporate offences of
which RMS has not yet been informed?
Yes
No
if yes give details below
3.
Have you been a director of a company which has been
subject to bankruptcy, insolvency or winding-up proceedings
within the previous 12 months?
Yes
No
if yes give details below
Catalogue No. 45071727 Form No. 1673 (04/2013) ABN 76 236 371 088
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NSW Bus Operator Accreditation Annual Self Assessment Report (ASAR)
Part D - ASAR Operator Accreditation Check
1. Do you currently have in place the following:
a) Management Information System (MIS) including the
following
Third Party Property Insurance Policy with a minimum of
$5 million cover per bus
Yes
No
Fleet Register
Yes
No
Complaints Register
Yes
No
b) Records of drivers including the following:
Drivers name and residential address
Yes
No
Driver Authority and licence numbers and expiry dates
Yes
No
Dates and times during which drivers drove
Yes
No
c) A system to ensure that all drivers are appropriately
authorised and licensed
Yes
No
2. Drug and Alcohol Testing
a) Does your risk register identify random drug and alcohol
testing?
Yes
No
b)
Do you have a system in place to ensure that RMS is
notified of any “positive” Drug and Alcohol test conducted?
Yes
No
c) Have you conducted any Drug and Alcohol testing in the last
12 months?
Yes
No If No go to Question 3
d) Have any positive results been received?
Yes
No
If yes:
How many?
Did you notify RMS of any positive tests within 48 hours?
Yes
No
If No go to Question 3
3. Do all buses operated under this accreditation comply with
the requirements for registration, vehicle safety and
roadworthiness?
Yes
No
d) Runaway bus procedures as set out in the Bus Operator
Accreditation Package
Yes
No
4. Are your bus maintenance and repairs carried out by a
Motor Vehicle Repair Industry Authority (MVRIA) licensed
mechanic?
e) Safety Management System (SMS) compliant with the
published guidelines
Yes
5.
No
Do you operate buses which must be fitted with Vehicle
Monitoring Devices (VMDs)?
No
Yes
f) A Drug and Alcohol Program compliant with the published
guidelines
Yes
No
g) Records maintained in English for the prescribed time
frames
Yes
No
h) A Vehicle Maintenance Plan consistent with manufacturer's
maintenance guidelines
Yes
No
i) A Vehicle Defect and Repair System
Yes
No
Yes
No If No go to Question 6
If yes:
Are the VMDs operated in accordance with RMS and
Transport for NSW requirements?
Yes
No
6. Are any of your buses required to have a speed limiter
device installed as per the Road Rules 2008?
Yes
No If No go to Question 7
If yes:
Are all speed limiters working in accordance with the
Road Rules 2008?
Yes
No
continued page 4
Catalogue No. 45071727 Form No. 1673 (04/2013) ABN 76 236 371 088
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NSW Bus Operator Accreditation Annual Self Assessment Report (ASAR)
7. Have you notified the Office of Transport Safety
Investigations (OTSI) and RMS of any incidents within the
last 12 months?
Yes
No If No go to Question 8
If yes:
How many incidents have you reported?
How many reports required a follow up 72 hour Report to
OTSI?
8. If you answered 'no' to questions 1, 3 or 4 in Part D you
must provide details to RMS as to why you are not
complying.
Part F - Privacy Statement
Roads and Maritime Services (RMS) collects and holds your
personal information for the purposes of determining whether or
not you continue to meet the requirements for accreditation as a
bus operator under the Passenger Transport Act 1990 and
Passenger Transport Regulation 2007. You are required to
provide this information to demonstrate that you continue to
satisfy the purposes of accreditation otherwise RMS may vary,
suspend or cancel your accreditation. Failure to provide this
information may also be a contravention of the Regulations.
RMS may retain and use this information for driver licensing,
road transport or road safety purposes. If required RMS may
provide your personal information to the Australian Taxation
Office, the Department of Immigration and Citizenship, the
Office of Transport Safety (OTSI), the National Heavy Vehicle
Regulator, and/or Transport for NSW.
RMS may obtain information from Australian law enforcement
agencies and from RMS' other driver licensing and/or vehicle
registers required to be kept under the Road Transport Law to
verify or check your criminal history and/or driving record.
You have a right to request access to the information collected
by contacting the appropriate RMS office, the contact details
are at the end of this form.
Part G - Declaration
1.
Part E - Defect Notices
Have you been issued in the last 12 months with any defect
notices and/or any grounded/major grounded defect notices
(issued by either NSW Police, RMS or Transport for NSW)?
Yes
No
if yes give details below
Details (Copies of Major and Major Grounded RMS defects
to be provided)
I hereby declare Parts A - G inclusive on this form have been
read by me and understood. The answers given to the
questions in this self assessment are, to the best of my
knowledge, true, correct and accurate in every detail. I have
listed all details of charges pending, convictions or proven
offences against myself or the association/corporation for
which I hold representataion.
I understand failure to comply with all the relevant Acts and
Regulations governing the operation of public passenger
services, the obligations of accredited bus operators outlined in
the Bus Operators Accreditation Package Section 2 and any
additional requirements which may be imposed by RMS from
time to time may result in the immediate cancellation,
suspension or variation of the accreditation.
I consent to the disclosure, by RMS, of information needed to
verify the details I have given in this self assessment, including
a check and release of any criminal convictions or charges
recorded against my name and kept by any enforcement
agency in any country.
I acknowledge any information obtained as part of this process
may be required by Australian Police Services for law
enforcement purposes including the investigation of any
outstanding criminal offences. Further, I give authority for RMS
to obtain details of any matters, which may be relevant to this
self assessment, or during the currency of the accreditation,
relevant to the suspension, cancellation or for any audit or
review of the accreditation.
Signature
Name (print)
By email:
Sydney region:
02 9689 8813
Public Passenger Services
Locked Bag 5085,
Parramatta NSW 2124
Level 4,
16 - 18 Wentworth Street
Parramatta NSW 2150
Date
/ /
day month year
Part H - Lodgement Details (This completed form can be returned to your closest office)
By fax:
By mail:
By hand:
Scan this form and email to licensing@transport.nsw.gov.au
Wollongong region:
Newcastle region:
Fax: 02 8265 6633 Fax: 02 4929 6288
Catalogue No. 45071727 Form No. 1673 (04/2013) ABN 76 236 371 088
Transport for NSW
PO Box 5215
Wollongong NSW 2520
Level 5
280 Keira Street
Wollongong NSW 2500
Transport for NSW
PO Box 871
Newcastle NSW 2300
Ground Floor
239 King Street
Newcastle NSW 2300
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