Accident Investigation Report 14/2015
Investigation report into marine accident including what happened, safety lessons and recommendations made:
At 0654 on 9 March 2014, the master of Sea Breeze, a Barbados registered general cargo ship, contacted Falmouth Coast guard to report that the ship’s engine room was flooding. A ballast pump in the vessel’s engine room was being maintained when water began to enter the space. The crew were unable to stem the flow and the engine room was evacuated. The crew did not deal effectively with the emergency as they had not been trained. Salvors were able to bring the flooding under control and the vessel was initially anchored in St Austell bay at 2100 on 10 March before being moved to a berth in Fowey. The MAIB investigation identified a very poor standard of engineering being carried out on a ship in materially poor condition.
The key safety issues identified were:
The master, who was the officer on watch at the time, was not aware that the work was taking place and no permit to work had been issued.
A risk assessment had not been completed prior to work commencing, basic contingency preparations were not taken and good engineering practice was not applied.
No on board training or drills had been completed, hampering the crew’s ability to respond effectively to the flooding.
The crew saw no value in safety management and this was symptomatic of a wider absence of any safety culture both on board and within Shipmar.
The sea water inlet valve actuator could jam intermittently, giving the impression that the valve was closed when it was not. The actuator had been poorly repaired in the past leaving the worm and quadrant gearing in an unserviceable condition.
The report has made a recommendation to the managers of Sea Breeze, Shipmar Co Ltd, which is designed to improve the application of its safety management system across the company and its fleet (2015/136).
Recommendations have also been made to Lloyd’s Register to: improve its guidance to surveyors on the conduct of ships side valve surveys (2015/137); and to propose to the International Association of Classification Societies that its requirements should be amended to include a function test of the actuator mechanism of ship’s side valves during special surveys (2015/138)