SWZ Maritime's October issue, to appear 23 October, features a selection of the Mars Report No. 275. Read the full report online now, on SWZonline.
Mars Report No. 275
Haphazard Storage Creates Fire Hazard: Mars 201548
An oil/chemical tanker was berthed at a shipyard for routine dry docking. Prior to entering dry dock, seven pallets of paints and thinners for coating the cargo tanks were received on board from the shipyard. These were stowed on the starboard side of “A” deck, between the engine room casing and the accommodation. The products were stored on wooden pallets covered with plastic wrapping, with the thinner cans stored on top of the paint cans in cardboard packages. About seven days later, at lunch break, a fire broke out among the paint and thinner cans. The fire alarm was sounded and the master ordered ship staff to assemble on the quay side. All appropriate authorities were informed immediately. Simultaneously, shipyard firemen were preparing the hoses to fight the fire. Within an hour, the fire was totally extinguished but boundary cooling was continued for some time afterwards.
The fire may have been caused by spontaneous combustion.
Although two separate investigations failed to determine the origin of the fire, it was suggested that the paint and/or thinner cans may have leaked due to expansion and contraction resulting from exposure to the elements. Vapour escaping from the cans was then contained within the plastic wrapping and the fire may have been caused by spontaneous combustion.
The pallets were stowed in direct sunlight and ambient temperature on the day of the incident was 25°C. The investigation found no evidence of smoking in the area (which was prohibited). There was no hot work done in the vicinity nor were incompatible items stored nearby.
Lessons Learned
- In future dockings, managers/master shall not permit shipyard to store bulk quantity of paint and thinners on board the ship. Shipyard shall be instructed to bring on board sufficient paint drums for the day’s work.
- Store paints and thinners in their original container, protected from direct sunlight in dry, cool and well ventilated space, away from incompatible materials.
Minor Spill Reported: Mars 201549
A laden tanker encountered heavy weather during a Pacific Ocean passage. Pre-arrival checks of the discharge ports were completed including pressure testing of all three cargo lines.
Once arrived at the lightering area, the lightering vessel was berthed alongside the tanker and the cargo hoses connected. At one point during cargo transfer operations, drops of oil were seen leaking from the dresser coupling of cargo line number two. Cargo operations were stopped and clean-up operations carried out. Oil was contained in a catch-all below the dresser coupling area (total quantity spilled was less than one litre). The dresser coupling from the leaking area was tightened and the cargo line was isolated and drained. The discharging operation continued with the two remaining lines without any further incident.
After investigation, the company suspected that isolated flexing of the dresser coupling may have occurred during the heavy weather passage. This was not apparent during testing. A hazard occurrence report was produced as per the company’s SMS requirements and closed out by management. An oil spill drill was carried out including simulation of reporting procedures to all parties concerned.
Editor’s note: Even though the spill was very minor, the company reporting procedure was activated and all parties were informed – even Mars! This is a sign that the company’s safety culture is alive and well. Mars needs your reports too – let us know what happens, so others can learn the same lessons you learned.
Do Not Be Drawn in by a Drawstring: Mars 201550
Edited from International Marine Contractors Association (IMCA) Safety Flash 04-15
On an offshore platform, a construction team was fitting pipe supports; part of this task involved drilling holes through the deck plate with a magnetic drill. Owing to the poor weather conditions, the crew was wearing parka-style storm jackets with a drawstring closure. At one point, the drawstring and toggle on one worker’s clothing was observed to be hanging close to the revolving spindle of the magnetic drill. One of the work party members noticed this unsafe condition and realised there was potential for the drawstring to be drawn into the tool causing injury to the operator. He immediately stopped the job and the hazard was highlighted and corrected.
Dangling lanyards pose a potential snagging hazard.
The entire work party removed the drawstrings from their jackets and the hazard and intervention was shared with the rest of the crew. The intervention was further discussed at start of shift meetings. It was apparent that these lanyards could and had become snagged when climbing ladders and had got caught on plant and equipment etc. It was agreed that the drawstrings were impractical as their use on this type of jacket would restrict both leg movement and body positioning.
Incinerator Ends Sea Career: Mars 201551
The second engineer distributed the day’s work to the engine room staff, verbally instructing the junior wiper to burn the garbage in the incinerator. He was familiar with the job, having done the task for the last seven months. A little while later, the fourth engineer went up to the incinerator room to check the safety parameters of the equipment. He found all systems in satisfactory condition and so he returned to the control room. The junior wiper was standing outside the incinerator room waiting for the combustion temperature to reduce prior to loading the second garbage pack. About thirty minutes later, the junior wiper rushed to the master’s office; he had sustained very deep burns to his left palm.
The vessel was diverted to an anchorage and the junior wiper disembarked for medical treatment. All five fingers of his left hand were badly burnt and after assessment by doctors, four fingers were amputated. The junior wiper had to return to his home country for further reconstructive treatment. To all intents and purposes, his seagoing career was over.
The company conducted an investigation and found the following:
- It appears the junior wiper, because of his small stature, had always used a bench to better access the incinerator door. Furthermore, in this case he may have tried to push an oversized garbage bag down the incinerator sluice with a long handled poker. To do this, the junior wiper had to hold down the incinerator door micro switch (to simulate a closed door) and press “start sluice action, all while trying to push the bag down.”
Lessons Learned
- Proper training and supervision are critical with operations such as incineration.
- Incineration on this ship is best undertaken by two persons.
- Ship-specific Job Hazard Analysis should be done for incineration, as for all vessel activities.
- Under normal conditions, safety devices such as micro switches should never be “tricked”.
Editor’s note: According to the company, ship’s personnel interviewed during the investigation indicated that the use of a bench to access the incinerator was not a safe practice. Yet, this practice had been tolerated for many months and was never identified as a nonconformity or unsafe practice during the course of work or during safety meetings. This indicates some important latent unsafe conditions contributing to this accident: a less than adequate safety culture and poor safety leadership.
Small Slip with Unfortunate Consequences: Mars 201552
An oiler was on his usual rounds when the internal telephone system sounded. He quickly proceeded towards the engine control room to answer the call. As he stepped on the insulation mat in front of the main air compressor breaker panel, the mat slipped under his foot and he fell. After examination, it was determined that his shoulder had become dislocated. The company investigated the incident and has since removed the mat from service as the underside was worn and not gripping properly. All other mats have been checked for their grip and wear.
A hazard in plain view.
Editor’s note: A very mundane accident that brings to light hazards that are right under our nose. Although the oiler should not have been so hasty in his movements, the mat was still inadequate for service. This teaches us that we should always have our “safety eyes” on – being continuously on the lookout for hazards in plain view. Readers may remember a similar case of “hazards in plain view” – the steel plates from Mars Report 201423. Readers can view all past Mars reports online.
Fall Protection Device Improperly Attached: Mars 201553
Edited from Marine Safety Forum – Safety Flash 15-12
The starboard side lifeboat was being hoisted back on board after being deployed. As it reached the upper deck, it was noticed that the Fall Protection Device (FPD) was not properly secured; it was only attached to the davit lifting lug without passing through the lifeboat check release mechanism.
Lessons Learned
- Attention to detail when attaching an FPD is critical.
- Crew should be properly trained in FPD procedures and refresher training given regularly.
The Fall Protection Device (FPD) needs to be properly secured.
Steam Cleaning and Flammable Atmosphere Do Not Mix: Mars 201554
Edited from IMO sub-committee III 1/WP.3
A chemical tanker in ballast was en route and the crew were preparing the tanks for loading. The crew had just completed washing of one of the tanks, which had previously carried benzene. The next steps were to strip the tank, ventilate it for a few hours, and then carry out tests to determine the cleanliness of the tank.
A crew member decided to carry out steam cleaning before ventilating the tank. A steam hose was inserted into the tank, steam pressure was increased and a cargo pump was started to remove any water collecting in the tank. A few minutes later there was an explosion and fire. Unable to contain the fire, the crew abandoned ship and were later rescued. However, one crew member went missing and was presumed deceased.
The investigation found that the explosion was the result of the ignition of the tank atmosphere, which contained benzene gas that was within the flammable limit. The source of the ignition was most likely an electrostatic discharge from the end of the steam hose coming into contact with the tank side or other structure. The steaming of the tank, which was performed immediately after washing and before ventilation, also likely gave rise to an electrostatically charged mist.
Lessons Learned
Prior to tank cleaning, a pre-cleaning meeting should be held to ensure that crew members understand their duties and the proper procedures to be followed. Any deviation from the procedures must be reported immediately.
After carrying a flammable cargo, always assume that the atmosphere within a tank is flammable.
Be aware of the extreme danger of using steam injection to clean flammable cargo tanks due to the risk of static electricity.
Benzene is a significant fire and explosion hazard based on its physical properties, including its flash point, vapour pressure, and boiling point. It can quite readily form explosive mixtures in air as a result of its high vapour pressure. Preventive measures against the accumulation of static electricity should always be employed.
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, DNV, Gard, IHS Fairplay Safety at Sea International, International Institute of Marine Surveying, Lairdside Maritime Centre, London Offshore Consultants, MOL Tankship Management (Europe) Ltd, Noble Denton, North of England P&I Club, Sail Training International, Shipowners Club, The Marine Society and Sea Cadets, The Swedish Club, UK Hydrographic Office, West of England P&I Club
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