Accident Investigation Report 9/2015
Investigation report into marine accident including what happened, safety lessons and recommendations made:
On 9 April 2014 a lifeboat on the refrigerated cargo vessel Nagato Reefer fell from its davit while being secured, following an abandon ship drill. A crewman was injured and the lifeboat was damaged as a result of the accident.
The abandon ship drill had taken place as part of a ‘more detailed’ Port State Control Inspection which was undertaken when an initial inspection identified a number of deficiencies. These included: a low level of crew competence; inadequate maintenance of safety equipment and a systemic failure of the safety management system.
The MAIB investigation found that the accident occurred when the lifeboat’s forward lifting hook opened while the boat was being secured as it had not been correctly reset when lifted from the water.
Recommendations have been made to the vessel’s manager to improve the safety culture throughout its fleet and within its shore based management.
The key safety issues identified were:
- Low level of crew competence, inadequate maintenance of safety equipment and a failure of internal communications.
- There was an inadequate safety culture on board and within the management company:
- The crew had not been effectively trained in the maintenance and use of the vessel’s emergency lifesaving equipment and, as a result, it was not serviceable.
- Records of SOLAS safety drills and other statutory requirements had been falsified.
- The site of the accident had been interfered with by the crew before the MAIB investigators attended the scene.
Recommendation 2015/124 was made to the vessel’s manager aimed at ensuring its crews are properly trained in emergency preparedness, the maintenance and operation of their safety equipment, and that the importance of maintaining accurate records required by international statutes is observed throughout its fleet.