Accident Investigation Report 27/2015
Investigation report into marine accident including what happened, safety lessons and recommendations made:
This reports the MAIB’s investigation into the fall of a ship’s chief officer from a cargo hatch top to the deck below on 18 June 2014. The chief officer suffered fractures to both legs. The ship, Norjan, had been loading high value motor yachts and their owners had employed a specialist company to supervise the operation. The company’s representative and the ship’s crew did not properly plan, supervise or carry out the loading operation. Subsequently, no consideration was given to the possibility of falling from the cargo hatch top to the deck, 2.4 metres below.
The chief officer fell from the hatch cover to the main deck 2.4m below because he stumbled and lost his balance while working close to the unfenced edge of Norjan’s hatch covers and was injured because there was nothing in place to arrest his fall.
Working on the hatch covers was a day to day activity; without edge protection, the risk of falling off the hatch covers was ever present.
The crew and the loadmaster gave insufficient regard to the risks posed when working on the hatch covers; their perception was that the risk of falling off the hatch covers could be controlled by remaining alert to the hazard and taking care when working close to the edges.
The lifting operation on board Norjan was not properly planned, appropriately supervised or carried out in a safe manner.
The roles and responsibilities of the loadmaster and the ship’s cargo officer were unclear to the crew. A detailed loading plan and a crew briefing would have avoided any confusion and might have resulted in the operation being conducted in a safer manner.
The vessel did not carry the type of ready use portable safety barriers prescribed in its risk assessments; had it done so the likelihood of the crew fencing off the exposed edges of the hatch covers; and therefore preventing the accident, would have increased.
Recommendations to ensure that the safety lessons identified in this report are addressed at a company level have been made to Norjan’s managers, Reederei Erwin Strahlmann GmbH & Co. KG (2015/160, 2015/161 and 2015/162) and to global boat transfer and marine freight service providers, Peters & May Ltd (2015/163).