Confidential Human Factors
Incident Reporting Programme
The Charity
Aviation
Maritime
M2173
Initial Report
Whilst in drydock, the vessel underwent a change of Flag. As part of that change, all lifebuoys needed to be re-marked with the new port of registry. As the day’s first job, the Chief Officer instructed the deck crew to collect all the lifebuoys. An AB attempted to retrieve the port side man overboard (MOB) lifebuoy. Holding onto the line which connects the lifebuoy to the smoke float, he released the pin. Failing to anticipate the weight of the buoy, the line slipped from his grip, and the buoy fell, contacting the corner of the dock quayside before falling to the dock bottom.
The combined weight of 7.6 kg fell 22m to the dock bottom below. At the time, dock personnel were working on the dock bottom but, fortunately, not close to the point of impact. An immediate halt was called to all work in the dock bottom and onboard the vessel. All personnel left the dock bottom whilst the smoke float discharged its contents.
CHIRP Comment
Seafarers are used to being at sea, but drydock operations require another level of risk management.
Had this incident, had the float hit a person as it fell, it would have caused a severe injury or fatality. The undesired event occurred despite a risk assessment and a toolbox meeting, which should have mitigated this risk.
The risk assessment and the toolbox meeting only captured some risk factors. An inexperienced crewmember was used to do the job, increasing the risk of the lifebuoy falling. Removing a man overboard lifebuoy is risky, especially in a dry dock where dry dock workers often have to undertake tasks below the bridge wings.
A useful IMCA video on the hazards of dropped items can be found here: 0 Saipem DROPS – choice not chance – IMCA (imca-int.com)
Key Issues relating to this report
Capability – Assigned work in dry docks must be allocated based on the knowledge and experience of the individual crew member. A buddy system should be used for those new to dry dockings. When you are assigned to a vessel that will dry-dock, how well are you briefed on dry-dock safety? Does your company have a specific section on drydock safety in the safety management system? Is there a company training video highlighting all the hazards? Are you aware of it?
Teamwork – All drydocks are unfamiliar and dangerous places, and collaboration is required to ensure everyone looks out for each other. When jobs are being assigned, calculate the resources based on the risks of doing the work.
Pressure – Do not let outside factors interfere with safety performance. The work will get done, and it must be done safely. This should be a daily mantra for those on board.