MARS Report No. 237 Online

by | Aug 21, 2012 | News

anchor

One of the regular sections of SWZ Maritime is MARS Reports, from the Marine Accident Reporting Scheme. As we receive more of these reports than we can publish in our magazine, we post the other ones online. The page has now been updated with new reports. Read them here.

MARS Reports cover all kinds of maritime incidents such as (near) collisions and groundings to accidents with tools, falling objects injuring crew and accidents with rescue boats. SWZ Maritime strongly believes relaying these incidents may help prevent new accidents from happening.

Collision and Oil Spill in TSS: MARS 201232

Our VLCC was on a loaded voyage and was transiting a busy strait by night, drawing 19.9 metres even keel. During the crucial passage, the bridge was manned by the Master, 3/O and a helmsman. The vessel was on harbour manoeuvring mode under bridge control, displaying the appropriate signals to indicate her ’constrained by draught’ status.
At about 2100 hrs, after reaching her waypoint, the vessel altered course to 070ºT and was proceeding along the designated east-bound deep water route, close to the separation zone of the TSS. A number of vessels were proceeding in both directions within the appropriate lanes.
Once on the new heading, the Master observed a container feeder vessel crossing from the west-bound lane into the separation zone and straying into the east-bound deep water route, against the traffic flow.
The Master stopped the engine and then went full astern to reduce speed. At the same time the appropriate sound signal under Rule 34 (d) was sounded on the whistle (air horn) to convey doubt as to other vessel’s intentions and illegal manoeuvre.
With our vessel’s engine still going astern, the rogue vessel crossed about half a mile ahead. Immediately after crossing, she inexplicably began to alter course hard to starboard and turn back towards our vessel.
Reacting quickly, our Master, whilst maintaining the full astern propulsion, ordered the rudder hard to port and repeated the Rule 34 (d) sound signal, but the container vessel continued to alter her course to starboard and, on a NW’ly heading, was heading directly for our tanker’s bow. With our ship still making headway, the container vessel’s port quarter came into contact with our vessel’s bow. The collision resulted in multiple indentations on our vessel’s bow area and a breach in the container vessel’s port bunker tank, resulting in an oil spill.

Result of Investigation

  1. Work and rest period records indicated that the ship’s staff was adequately rested. The Master had exceeded the optimum work and rest hour guidelines, but not to a significant degree. In view of the searoom limitations and extreme traffic density, the Master’s lengthy period on the bridge was considered appropriate and did not contribute to the incident.
  2. Alcohol tests were conducted on all staff on duty shortly after the incident and the results were satisfactory i.e. negative. (The vessel is alcohol free).
  3. The Master has been in rank for the past three years and had transited the area a number of times as Master.
  4. Although the vessel’s bridge was manned by the Master, 3/O and a helmsman, an additional officer and lookout were required as per company’s procedures for the area being transited.
  5. The engine room was adequately manned at the time of the incident.
  6. The manoeuvres implemented by our Master were considered to be the most appropriate under the circumstances, but due to the wrong actions by the other vessel, contact could not be avoided.

Immediate Actions Taken

  1. VTS was informed about the rogue container vessel as soon as it was evident that she was crossing the separation zone.
  2. Immediately after the collision, Vessel Traffic Service (VTS) and all concerned parties were informed.
  3. Both vessels complied with VTS orders and anchored in a designated area for investigations by port authorities.
  4. All the ship’s tanks / compartments were sounded and monitored for any ingress of water or possibility of pollution.
  5. At anchorage, all spaces in the affected area were inspected internally by ship’s staff and a class surveyor.
  6. P&I club representatives, surveyors and superintendents boarded the vessel in the morning.
  7. Once all the investigations were completed, a condition of class required permanent repairs on the return voyage and permission was obtained for our VLCC to resume her passage to the discharge port.

Root Cause / Contributory Factors

  1. Violation of COLREGS Rules 5 (Lookout), 8 (Action to avoid collision), 10 (Traffic separation schemes), 17 (Action by stand on-vessel) and 18 (Responsibilities between vessels) by rogue container vessel.
  2. Residual headway of own vessel despite the emergency full astern manoeuvre.

Corrective Actions

  1. A navigational audit was carried out by the attending marine superintendent and all the staff were re-briefed on the company’s procedures for safe navigation.
  2. The superintendent also assessed the Master and found him capable/ competent to complete the voyage and continue sailing on the vessel.
  3. A flag state investigator visited the vessel at the discharge port to carry out an investigation and to review navigational procedures.
  4. On the return west-bound ballast voyage, permanent repairs were carried out to the satisfaction of class.

Preventative Actions

  1. An urgent circular was circulated to the fleet on the accident, highlighting the importance of maintaining the appropriate watch levels and complying with the work and rest hours guidelines when navigating in restricted waters and areas of dense traffic.
  2. The importance of proper passage planning and ensuring that loaded VLCCs adjust speed so as to transit critical areas during daylight hours was also reiterated in the same circular.
  3. The incident will be addressed at the next Officers’ seminar and form part of pre-boarding briefing for all Masters / Chief Engineers.

Hand Injury from Falling Lid: MARS 201234

The crew on board a tanker was engaged in lifting some light loads out of the pump room stores hatch. The lid was raised to its open position and secured at only one of the two hinges, using a mild steel (MS) bolt. The crew then began the task of lifting out the loads by attaching a tackle to a dedicated padeye on the underside of the open lid. Suddenly, the open hatch lid dropped unexpectedly on to the coaming, inflicting severe crush, cut and fracture injuries on the right hand of a deck rating. The injured person was given first aid onboard and was further treated ashore before repatriation.


View of pump room hatch in shut position

Root Cause / Contributory Factors

  1. Inappropriate operation – the lid was fitted with a padeye of approved strength on the underside to be used for the lifting and handling of loads inside the pump room, but only with the lid properly secured in the fully closed position. In this incident, the crew not only failed to properly secure the lid in the open position, but wrongly used this fitting to lift loads out of the hatch with the lid held in the open position.
  2. A single, non-standard pin (MS bolt without a check-nut) was used to secure the hatch lid in the open position. It is suspected that the bolt was not passed all the way through the lugs of the hold-back arrangement of the lid.
  3. The crew failed to carry out a proper risk assessment, possibly because of the light loads (bundles of staging aluminum pipes) being handled.


Improperly secured open lid

Corrective / Preventative Actions

  1. The incident was discussed at a special safety meeting.
  2. All hatch lids were fitted with securing pins as per original specifications and these were permanently attached with keeper chains.
  3. All hatch lid securing arrangements were painted yellow and a prominent warning stencilled on them to ensure that the lid is properly secured when in the open position;
  4. The padeye on the underside of the hatch lid was similarly marked, specifying it is to be used only when the lid is properly secured in the fully closed position.


Dedicated padeye on underside of hatch lid intended for use only when lid is secured in closed position

Lessons Learnt

  1. Lifting loads must always be considered a risky task, regardless of the weights being handled, and must be preceded / controlled by proper risk assessments, work planning and supervision.
  2. Engine and pump room hatch lids can be very substantial in construction, and very heavy. Securing arrangements, especially in the open position, must be carefully inspected and properly used; even if the lid is to be kept open only briefly.
  3. Work teams must be enabled and encouraged to identify and break a developing ‘error chain’.


Non-standard bolt was used in place of a safer ‘drop-nose’ pin

Anchor Cable Rendered in Severe Gale:  MARS 201235

Our vessel let go her starboard anchor at an exposed roadstead at night in a near gale (30-33 knot wind), awaiting delivery on a new charter. The next morning, the wind increased to a severe gale, with gusts of 40-45 knots, and waves 3-4 metres high. After a day with the cable paid out to this scope, the attending superintendent suggested the paying out of a few links in order to ‘freshen the nip’ of the cable at stress points (e.g. gypsy whelps, guide roller, chain stopper and hawse pipe etc.). The Master agreed and this operation was successfully executed by the anchor team under the supervision of the C/O at about 0900 hrs, after which the crew re-tightened the brake and re-engaged the bow chain stopper. At about 1315 hrs, the Bosun, who was working on the forecastle deck, heard a loud noise and noticed the chain stopper lifting and the anchor brake rendering slowly under heavy tension. He immediately tightened the brake further and reported the event to the duty officer, who, in turn, informed the Master and superintendent.

Results of Investigation

  1. Chain stopper support brackets were found deformed.
  2. Securing pin of chain stopper bar found displaced and deformed.
  3. Stopper bar also found deformed and not aligning with guillotine recess.

Root Cause / Contributory Factors

  1. Prevailing severe weather conditions.
  2. Possible insufficient tightening of the brake after adjusting scope.
  3. Ineffective design of the securing arrangement on the chain stopper bar – comprising oval holes only on the counterweight side, which permitted large play in the engaged position, allowing the cable to slip from under the stopper bar.

Immediate Corrective Actions

  1. Near miss report sent to office.
  2. Chain stopper support brackets and stopper pin temporarily faired.
  3. Anchor watch and deck crew instructed to continuously monitor status of anchor cable to ensure avoidance of overstressing.

Further Planned Corrective / Preventive Actions

  1. Incident to be discussed at next safety meeting.
  2. Chain stopper to be modified to include additional securing pin arrangement on the ‘gravity’ side of stopper bar.
  3. Securing pins to be renewed with stronger material.
  4. Pin’s securing points/holes to be changed from oval to round.
  5. Consider fitting additional chain stopper device designed to engage on a vertically-oriented link of the cable (e.g. devil’s claw).

Editor’s note: The engaging of a ‘guillotine’ type bow stopper whilst at anchor is not advised, as this may prevent the emergency  release of the anchor cable. As a good practice, the brake mechanism should be properly maintained and adjusted so that it begins to render at its designed safe holding power.

Acknowledgement

Through the kind intermediary of The Nautical Institute we gratefully acknowledge sponsorship provided by:
American Bureau of Shipping, AR Brink & Associates, Britannia P&I Club, Cargill, Class NK, Consult ISM, DNV, Gard, International Institute of Marine Surveying, Lairdside Maritime Centre, London Offshore Consultants, Lloyd’s Register-Fairplay Safety at Sea International, MOL Tankship Management (Europe) Ltd, Noble Denton, North of England P&I Club, Port of Tyne, Sail Training International, Shipowners Club, The Marine Society and Sea Cadets, The Swedish Club, UK Hydrographic Office, UK P&I Club

Submit a MARS Report

More reports are needed to keep the scheme interesting and informative. All reports are read only by the MARS-coordinator and are treated in the strictest confidence. To submit a report please use the MARS report form (MARS@nautinst.org)