M1973

Initial report

“As a first officer I used to take the yacht on and off anchor regularly, whilst I was getting the fenders ready near to the anchor station the captain asked me, in the exact words “can you pick up the anchor” the engineer was next to me who saw that I was busy with fenders and said that he would lift it for me instead. Once the anchor was up the engineer called to the bridge to notify the captain. He wasn’t on the bridge; nobody was for that matter.

There had been a complete miscommunication between me and the captain. In his mind he asked me to drive the yacht off the anchor and in my mind, he asked me to operate the windlass and lift the anchor. Luckily he arrived back into the bridge quickly and we had a good conversation about how we are going to avoid that in the future.”

CHIRP comment

This incident highlights several factors that eroded safety practices on board. The primary cause was miscommunication because of the captain’s imprecise language. Furthermore, the First Officer did not confirm through closed-loop communication what the Captain was asking (eg “so you want me to operate the windlass?”) and because there was no plan or brief given, no-one was sure of their or others’ roles.

For safety critical tasks it is best practice to use key words from an agreed taxonomy and use closed-loop communication (repeating back what you think you’ve been told) to reduce the risks of misunderstanding.

Another reason that the incident occurred was the relaxed safety culture on board: there appeared to be a lack of planning and no safety brief was given. The first officer did not question why they were being asked to do something normally assigned to a deckhand. Was the informal swapping of roles something that occurred frequently on board?

Human factors and other issues identified in this report

Communication –  Use key words during safety critical tasks to reduce miscommunication.

Complacency – The lack of plan or a brief before weighing anchor indicates complacency.

Teamwork – Assignment of key roles and responsibilities should be clear to everyone.

Culture – The informal information exchange and tasking suggests a weak safety culture.

Report Ends…………