December Mars Reports

Although SWZ Maritime's December issue will not appear until 18 December, you can already read the latest, complete Mars Reports on SWZonline.

Marine Accident Reporting Scheme (Mars) Report No. 277

Unsafe Cargo + Unsafe Anchorage = Lost Ship: Mars 201560

Edited from Hong Kong SAR Marine Department Report, published 16 March 2015

A bulk carrier was to load a cargo of nickel ore from barges into five holds. During loading, which took approximately three weeks, intermittent rainfall caused interruptions in loading. The ore on the barges had to be covered over with tarpaulins and the holds on the vessel had to be closed. The crew of the vessel carried out a “can test” of the ore on each barge before transfer to the vessel. If the test failed, an “oven drying test” was done to determine the moisture content of the ore. If the moisture content was found to exceed the Transportable Moisture Limit (TML was 34.80 per cent), the cargo in the barge would normally be rejected.

However, records indicate that on at least two occasions, cargo was accepted with moisture contents of 35.54 per cent and 37 per cent respectively. Once the loading was completed, the holds were trimmed and pressed by means of cargo grabs; each cargo hold was about half-full. Calculations showed the vessel’s intact stability met the requirements of the International Code on Intact Stability, 2008.

About a week after departure, the master had to divert due to a typhoon, eventually dropping anchor at a port of refuge that offered protection from wind and seas from the north. The vessel was yawing and rolling heavily and dredging its anchor at the anchorage due to strong winds and heavy sea, now coming from the southeast. The following day, the vessel encountered a strong wave causing it to heel to port about 20°. The vessel returned somewhat upright, but was still listing about 10° to port. Within two hours, the list to port increased to 45° and then 90°. Soon afterward, the vessel capsized and sank.

Vessel at 45˚.

All crew successfully abandoned the vessel before sinking and were rescued without injuries. More than 600 tonnes of oil leaked into the sea and took more than three months to clean up. The investigation into the accident revealed several contributory factors including the following:

• Nickel ore was loaded despite a moisture content that exceeded its TML, contrary to the requirements of the International Maritime Solid Bulk Cargoes Code.
• Several of the shipboard safety procedures for loading and carriage of nickel ore were not followed.
• Due to the heavy rolling at anchorage there was liquefaction of the ore cargo.
• The master’s selected refuge anchorage was not appropriate as the location could only shelter from northerly wind and waves. The vessel experienced strong south-easterly wind and waves when the typhoon, as predicted, passed south and southwest of the vessel’s anchorage.

Typhoon track and refuge anchorage.

The investigation also revealed the following safety issues:

• The moisture content certificate of the nickel ore was issued by the shipper instead of the local administration or independent organisation (or authorised organisation).
• The crew was not trained and therefore not competent to carry out the oven drying test to verify the moisture content of the cargo before loading.

Editor's note: Although “can tests” can be used by crew to validate suspicions that the moisture content of the ore may be above the certified TML (for example, cargo that appears wet and/or splatters when loaded may raise suspicions that the moisture content of the ore may be above the certified TML), the oven drying test should be done in a laboratory. The Intercargo guide for transporting nickel ore, published in 2012, states: ‘Where there is doubt concerning any cargo declaration information, or suspicion that the cargo has been misrepresented, independent cargo testing to determine the FMP, TML and actual moisture content of the cargo to be loaded should be carried out.’ The guide can be found here.

‘Time Out’: Mars 201561

A port superintendent sent this Mars report with the title “A picture speaks a thousand words”. He states that in his job over the years he has witnessed many cases of a ship’s crew failing to recognise the potential hazards around them while carrying out their work.

In this case, the gangway support wire had come out from its sheave and become jammed and a crew member was attempting to remove it. Thankfully, he did take some precautions, like wearing a life vest, helmet, and gloves, but failed to realise that during the process of clearing the stuck gangway wire, the gangway could have moved or lowered onto him.

The superintendent stopped the work and ensured that concrete blocks were placed on the wharf so that the weight of the gangway could be landed on them. The wire clearing process was then resumed in relative safety.

The crew member failed to realise the gangway could lower onto him.

Editor’s note: In this instance, the person initiating the “stop work” request was a port official. The lesson here is, even if you are not part of the team involved in the work, if you see a danger you should make it known.

Anchors Away: Mars 201562

Edited from USCG Marine Safety Alert 5-15

Recently, a freight ship was underway in 15 foot seas when the forepeak flood alarms activated. The crew investigated and discovered the starboard anchor had slipped ten to fifteen links, causing it to strike and puncture the hull. As a result, seawater flooded the bow thruster and emergency fire pump compartment. The casualty resulted in excess of $1 million in vessel damage and a month’s lost revenues while the vessel was out of service undergoing repair.

During the repair period, it was discovered that the anchor windlass brake pad had worn down to 2-3 mm thickness. With only this amount of pad, the fully applied brake could not achieve its designed holding power. The crew should have recognised the excessive wear to the brake pads and that these required replacement.

It was also discovered that the anchor involved in the incident was a replacement, and had different specifications to the original anchor. The replacement anchor’s relative position in the hawse pipe was not the same as the original, because the shank length and connecting linkages were different. The size difference prevented the riding pawl from properly engaging the anchor chain.

As an added safety device, a wire sling had been used to secure the anchor while at sea. The wire sling was threaded through a chain link and secured to the vessel with a pelican hook. When the sling broke and the brake failed, the anchor’s weight and the ship’s movement then caused it to drop before the riding pawl could properly engage. The sling failure was likely caused by the corrosion of the inner wire strands; the inner wire strands being exposed to the elements because of the sharp bend in the wire. Although the wire sling was inspected regularly, those performing the inspections were not instructed on how to examine and determine its serviceability.

The sling failure was likely caused by the corrosion of the inner wire strands.

Lessons Learned

• All preventative maintenance programmes should be up to date and include specific language on anchor windlass equipment, particularly emphasising when brake assemblies must be renewed or adjusted.
• When key vessel components, such as anchors, are to be replaced, a proper review should be undertaken and all possible variables considered.
• Persons involved with vessel maintenance and repair should have the technical resources available to them in order to assist in determining serviceability or replacement of shipboard equipment.

Editor’s note: Inspection of wire rope is not an easy task and cannot be properly done without opening the lay with a spike and examining the inner core. Even this step is not foolproof, and wire rope degradation within the core can be hard to spot. Crew should adopt the “precautionary principle” when using and examining wire rope – that is, if unsure, replace with new.

Fatal Fall Overboard: Mars 201563

Edited from official report published by the Dutch Safety Board, May 2014

After unloading containers from a general cargo vessel, crew prepared the decks and holds for a new cargo. One task was to move the hatch covers forward; a crew member operated the ship’s crane to move the hatch while two other crew guided the hatch with securing lines on each side. The crew member guiding the hatch on the starboard side was blocked by the vessel’s heavy lift spreader stored on deck, so he had to climb the spreader in order to continue his pace forward.

At some point while on the spreader, he lost his balance and fell overboard between the ship and the dock. An officer nearby heard the splash and rushed to the scene. With the help of other crew, the officer was able to recover the fallen crew onto the quay, but the victim was unconscious. The victim was taken to hospital, but died of his injuries later that day.

The crew member lost his balance while on the spreader.

It is not known how the crew member lost his balance, but after the accident it was found that his shoes and coveralls were in very poor condition. At the time of the accident, the victim was not wearing a safety harness, life vest or helmet.

Work boots in poor condition.

Lessons Learned

• Personal protective equipment such as boots should always be in good order for proper support, protection and traction.
• When working on deck a safety helmet should always be worn.
• The crew considered moving the hatch covers a routine job. As such, they did not discuss arrangements and possible risks prior to moving the hatch cover on the morning of the accident.
• The spreader had an uneven surface and was without fall protection. It was probably slippery due to the morning dew; it had no anti-slip paint applied as it was not intended to be walked upon.

Flood Tide Breaks Mooring Lines: Mars 201564

Edited from official Canadian NTSB report MAB-14-21

A small products tanker docked at terminal to load a cargo of tallow. The pilot had given the master the local pilot information card that warned of three to five knot tidal currents in the river waterway. The card also warned of the importance of skilled line tending when moored in the river, stating: ‘equal tension or equal weight on all ropes at all times; mooring winch brakes shall have a holding near the strength of the line’.

The next day after loading, and in order to refuel, the vessel was shifted about three miles downriver during slack water. This was accomplished by the same pilot from the previous day and the transit was uneventful. At the new berth, ten mooring lines were used as illustrated.

The ten mooring lines used.

Because of draught considerations, the vessel was docked such that the ship’s bow extended 30 feet beyond the east end of the wharf. After docking, a crew member conducting a patrol noticed dust and smoke coming from the brakes of the mooring line drums on the bow. The alert was given and the bridge team tried using the ship’s bow thrusters to push the vessel toward the dock, but to no avail.

As the vessel’s bow was pushed into the river, the three mooring lines that were on bitts parted (both forward springs and one aft spring).

The remaining mooring lines were on winches; the winch brakes began slipping and the lines quickly ran free off the drums and fell into the water. Within about ten minutes of the initial warning, the ship was adrift in the river. Anchors were dropped, but they only slowed the drift. A few minutes later the vessel struck a bridge, which sustained approximately $ 2.5 million in damage, while damages to the vessel were estimated at $ 1 million.

Lessons Learned

• All mooring lines should be equally tensioned so as to share the load.
• Never underestimate the force a current can exert on the vessel and carefully evaluate the vessel’s mooring situation with respect to possible current interactions.
• Mooring winch brakes should always be in top condition and properly adjusted.
• Given the vessel’s bow was exposed to the flood tide current, several bow lines should have been on bitts as opposed to on mooring winches.

The vessel struck a bridge.

Beached Instead of Berthed: Mars 201565

Our tanker arrived in port and was to go to berth at the southern extremity of the port. The manoeuvre required swinging the vessel 180 degrees and then backing astern to berth port-side to. Another tanker was moored just to the north of the intended berth which restricted the manoeuvring room somewhat. The berthing plan was discussed between the pilot and the master, but the pilot had not mentioned the restricted room due to the other berthed tanker.

Although there was a flood tide and the westerly wind was blowing at 15 knots, a tug was not considered necessary. Once turned successfully, the pilot began backing the vessel; running astern with main engine and bow thruster, the wind and the flooding tide were slightly on the vessel’s port side.

The vessel’s planned berth with flood tide and wind indicated.

When our vessel was approximately 15-20 metres from the berth, an aft spring line was sent ashore by heaving line and secured. The forward mooring station lowered the headlines to the mooring boat, but they could not be made secure in good time. The vessel was now swinging to starboard even though the bow thruster was full to port.

Since the headlines were not secured at the designated bollards, and in an attempt to reduce the vessel’s swing to starboard, the headlines were sent for securing at the designated bollards for the springs, but still to no effect.

Realising the vessel was approaching shallow water, the bridge team ordered the port anchor dropped, but the headlines were now obstructing the anchor’s release. By the time the anchor was finally released, the vessel was already aground; the vessel’s position almost perpendicular to the berth. A tug was promptly called and with the rising tide the vessel was quickly re-floated and properly berthed.

Lessons Learned

• The angle of approach to the berth was more open than ‘usual’ due to another tanker alongside the adjacent berth. This placed the vessel in a more vulnerable position, especially considering the effect of the wind and current.
• When manoeuvring a vessel in a confined waterway where the margin for error is small, a tug is always a good investment.

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

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 and send it to mars@nautinst.org.