The widower of a firefighter who died battling a bushfire near Albany believes a failure by authorities to warn crews about a wind change led to his wife's death.
Mother of three Wendy Bearfoot died and several other firefighters were injured last October after their trucks were trapped in the fire's path and engulfed in flames.
Mrs Bearfoot died three weeks later in hospital. A report released yesterday said full weather forecasts, including a warning of a "significant wind change", were not given to firefighters.
"Within about four minutes, firefighters were trapped in a burn-over," the Department of Fire and Emergency Services report said.
The investigation found the City of Albany did not pass on the forecast to crews and no one else in the incident management team, which included the then-Department of Environment and Conservation and the Department of Fire and Emergency Services, noticed the omission.
The three organisations jointly managed the fire but none wanted to take control and they were based in separate locations.
"The likelihood of this tragic incident occurring may have been reduced had there been greater involvement of all three agencies in the incident management team," the report found.
The crews stranded in the fire-storm had no in-cab radiant heat shields to protect them, were not wearing all their protective gear and lacked burn-over training.
The review made 10 recommendations, including ensuring all fire managers were trained to interpret weather forecasts, all vehicles entering a fire ground be fitted with radiant heat shields and have one accessible fire blanket for each person and that future fires are managed by a joint team based at one site.
Mrs Bearfoot's widower Garry said he was furious about the failures and believed authorities were not acting quickly enough to give firefighters the equipment they needed to protect them in future blazes.
At a State Budget estimates hearing last month, Environment Minister Albert Jacob said two out of 10 "improvement notices" issued by WorkSafe after the fire were yet to be put in place.
The notices called for safeguards for firefighters in the event of a "burn-over or entrapment", including heat shields and water spray protection.
Albany mayor Dennis Wellington said the city was acting on the report's recommendations.