Confidential Human Factors
Incident Reporting Programme
The Charity
Aviation
Maritime
M2168
Initial Report
At 2200hrs, a tender was returning from a crew pickup carrying three individuals. The tender began to reduce its speed as it approached the main vessel. Unfortunately, the helmsman failed to notice that the tender had veered off course from the tracks typically navigated during daylight hours. In the darkness, the tender collided with a sizable, unmarked rock and ran aground approximately 100 meters from the yacht.
Subsequently, the incident was reported to the bridge via radio communication. A second tender was swiftly deployed, and a rescue team was dispatched to assess the extent of water ingress and damage to the vessel. The passengers on board were immediately checked for injuries, with one individual found to have suffered a sprained leg. A trained crewmember aboard the tender then administered oxygen to the injured passenger.
The tender itself sustained superficial damage to its hull and propulsion system. The reporter informed CHIRP that a passage plan had been established for daytime navigation; there was no specific plan for navigating these known hazards during night-time hours. The waters were characterised by shallow depths and a high density of other small vessels at anchor, contributing to the challenging conditions.
CHIRP Comment
CHIRP has reported a similar incident in SYFB 01, M2083, where there was insufficient assessment of the risks during a night-time passage.
More attention should have been given to monitoring the track of the vessel. The tender entered an unfamiliar hazardous area by veering off the course used during daylight hours.
The passage plan evaluation must be revised to consider additional hazards. The management company must ensure that the tender operating procedures are clear for the type of passage to be undertaken and that new dangers are included in the passage plan. In particular, a thorough handover of the duties for the crew carrying out nighttime pickups. The crew must be suitably rested to remain alert to additional dangers, such as the loss of unlit visual cues for the passage, e.g. the unlit rock. It is strongly recommended that waypoints are included in the passage plan, which a deck officer verifies. Crucially, to have more time to assess other dangers which might be present in a crowded anchorage, slowing down the transits by reducing speed should be considered.
Key Issues relating to this report
Situational Awareness- During the pick-up of passengers and the crew back to the Yacht, situational awareness was lost. There was likely an assumption that the driver knew where they were going, and there was no challenge or input from the other crew to check on the route. This creates a single point of failure! Some positional signposts available during the day can be lost at night, making the transit back to the yacht challenging. Slowing down the transit speed will allow more time to assess the situation, and damage will be lessened in the event of collision or allision.
Distractions- It can be very easy to become distracted when new crew are joining. It’s natural to want to catch up on news and events. It should be part of the tender boat training that the driver must not be distracted and focus solely on driving the boat. Signage indicating that the driver is not to be distracted should be considered. A run-through on the route and a buddy system for checking that it is being followed should be part of the procedures for driving the tender.
Alerting- There appears to have been minimal or no contact or assistance from the Yacht to alert the tender when it veered off course. When setting off from the pick-up point, an initial course with waypoints should be part of the passage plan. Is your passage plan signed off for day and night-time navigations? What equipment do you have to direct your tender back to your yacht?