Accident to shore worker while disembarking passenger vessel Oldenburg with 1 fatality

Location: Ilfracombe Harbour, England

Accident Investigation Report 3/2016

Investigation report into marine accident including what happened and safety lessons:

MAIB investigation report 3-2016: Oldenburg

Oldenburg Photograph of Oldenburg courtesy of Lundy Company Limited


A shore worker was fatally injured when he became trapped between the hull of the passenger vessel Oldenburg and a vertical fender as he attempted to disembark through a main deck shell door and along the ship side belting.

The man had been employed by the Lundy Company Limited, as a shore-based rope handler for 2 seasons and had gone on board the vessel to socialise with the crew before its departure from Ilfracombe.

Oldenburg was alongside a berth which was close to the harbour entrance and, after he had boarded, the vessel’s gangway had been withdrawn due to the vessel’s movement in the prevailing moderate swell.

The main deck shell door had been left open and unguarded and, in attempting to get ashore, the man went through the door and along external belting towards a platform and steps on the quayside. The vessel’s crew were unaware that he intended to return ashore at that time or by that route.

Following the accident the crew went to the man’s aid but, due to his injuries, they were unable to recover him back onto the vessel and he was lowered into the water to facilitate his retrieval by lifeboat. Tragically, he died of his injuries shortly after arriving at a local hospital.

The vessel’s owner undertook an investigation and fitted barriers and signage to the vessel’s shell door openings to prevent unauthorised use and has also introduced a procedure for monitoring visitors to the vessel.

Safety Issues

  • The deceased used an unapproved means of access when attempting to disembark from the vessel.
  • The vessel’s Safety Management System did not include a procedure for the control and supervision of visitors – make sure there are procedures in place for the supervision and control of visitors to your vessel.
  • The health and safety induction training given to the deceased, who was a shore-based worker, had not included shipboard access, although he had regularly gone on board during his employment with the company.


In view of the actions taken by the owners following the accident, no recommendations have been made

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