Confidential Human Factors
Incident Reporting Programme
The Charity
Aviation
Maritime
M1900
Initial Report
While the vessel was at an anchorage, the Chief Engineer was doing maintenance work in the forecastle deck, building-up the starboard mooring chock by welding.
During this activity, he suffered an eye injury when a metal fragment was embedded in his eye. Three days later, the injured Chief Engineer reported the incident to the master, complaining about eye pain and irritation. Fortunately the vessel was near a port and he was transferred ashore for medical treatment. An eye specialist removed the particle and he was able to return on board fit for duty.
The incident occurred during the day and during regular working hours, and the chief engineer was adequately rested before the work activity commenced. The job was carried out as planned, and the relevant work permits and RA had been carried out.
The weather was a gentle breeze with a slight sea state. However, according to the vessel’s reports, sudden wind gusts and updraughts started during the work activity.
From the Chief Engineer’s statement, he was wearing eye protection when he started the job. However, as the work was carried out in a restricted place, the goggles were removed later.
CHIRP Comment
The forecastle is particularly prone to wind updrafts, and eye protection should never be removed until the job is completed.
It is well-known that many types of eye protection can mist up with moisture, blurring the worker’s vision. Some poor-quality goggles can be poorly fitting which makes them uncomfortable to wear, so the temptation to remove the goggles can be compelling. If this happens, stop the work, clean the goggles or adjust them, but never remove them while the work is still taking place.
We only have one pair of eyes, and every effort must be made to protect them.
Common thoughts – I do not need them; it will only take a second; no problem, I’ll be ok; the goggles are uncomfortable; I’ll use my sunglasses. Sounds familiar?
Key Issues relating to this report
Situational awareness- The location of the work can be challenging given the updrafts, which can be hazardous due to flying particles when grinding and welding. Whilst there may be little or no wind when the work commences, this can change quickly as the vessel moves to the tide and the wind affects the work location.
The grinding tool also presents a serious hazard and must always be protected; the grinding disk shown in the report does not have a cover installed and should not have been used.
Alerting- The chief engineer was carrying out the work and was not challenged. Was the company culture robust enough to challenge/alert the chief engineer that the grinding disk was unsafe and should not be used and that goggles must always be worn to prevent debris from impacting the eyes and face?
Complacency- The chief engineer is usually an experienced officer. Was this overconfidence causal to the injury? The chief engineer took three days to report that his eye was in pain. Delays in getting to an eye specialist can often have severe consequences.