The incident

On 30 September 2017, shortly after midnight, the Australian Border Force cutter Roebuck Bay (ABFC Roebuck Bay) grounded on Henry Reef in the Great Barrier Reef, Queensland.

The cutter was on a passage from Saibai Island in the Torres Strait Islands archipelago bound for Lizard Island, located about 71 NM south-east of Cape Melville.

The cutter sustained substantial damage to the keel, stabiliser fins and propellers, with hull breaches in way of the storage void and tank compartment spaces.

There were no reported injuries or oil pollution. The cutter was subsequently towed off the reef, stabilised and towed to Cairns, arriving on 5 October 2017.



The ATSB investigation found that:

  • ABFC Roebuck Bay’s route plan was amended during the passage planning process resulting in the route being inadvertently plotted across Henry Reef.
  • The cutter’s ECDIS identified the reef as a danger to the planned route, but the ship’s deck officers did not identify the danger, either visually or using the ECDIS.
  • The effectiveness of the officers’ visual check was likely influenced by a misinterpretation of chart symbology and possible obscuration of the reef's chart symbol and label.
  • The officers’ expected that the ECDIS would not save a route plotted across a chart danger, and had a misunderstanding of the ECDIS safety checking functions.
  • The cutter’s officers did not possess an adequate level of knowledge to operate the ECDIS as the primary means of navigation.
  • The type‑specific ECDIS familiarisation training, as undertaken by ABF deck officers, was not effective in preparing the cutter’s officers for the operational use of the ECDIS.
  • There was also no consistent provision of ECDIS annual continuation familiarisation training, as required by ABF procedures.
  • The ECDIS on board most ABF cutters, including ABFC Roebuck Bay, operated on a non-type-approved naval software version, although the class certified them as using type-approved ECDIS as the primary means of navigation.
  • The cutters’ ECDIS were also not up‑dated to the latest International Hydrographic Organization (IHO) standards at the time of the grounding.
  • The ATSB also identified a risk associated with the hydrographic use of point feature objects to represent physical features of relatively significant spatial extent on an electronic navigational chart. The ATSB found that this could increase the risk of the hazard posed by such features being misinterpreted by mariners and potentially reduce the effectiveness of the ECDIS safety checking functions.

As a result of the investigation, the ATSB considers the use of point features in electronic navigational charts to represent areas of relatively significant size on the earth’s surface is likely to increase the risk of the hazard posed by such features being misinterpreted and potentially reduce the effectiveness of ECDIS safety checking functions,

...said ATSB Chief Commissioner, Greg Hood.


Actions taken

The ABF have advised the ATSB of several measures aimed at improving fleet knowledge of ECDIS functions and features:

  • There is an increased focus on passage planning, watchkeeping and use of ECDIS during the annual maritime operational compliance audits of vessels.
  • These audits will now include training and information sessions and watchkeeper assessments.
  • The training package and requirements for ECDIS annual familiarisation training has been updated.
  • Task books have also been implemented for each role to reduce the effects of incorrect information being communicated by trickle-down training.
  • Specific training documentation for the navigation officer’s role has also been improved.

The ABF is also engaged in ongoing work with the ECDIS manufacturer to improve ECDIS type‑specific familiarisation training.

The ABF also advised that a review of navigation related procedures and work instructions was undertaken and completed. This resulted in several work instructions being updated and re-issued with the lessons learned from the investigation incorporated into the instructions.

The ABF undertook a program of software and hardware upgrades to update all cutters to the IHO’s S-52 Presentation Library 4.0. This was completed in September 2018.

AMSA have reminded all Recognised Organisations of the requirement that an ECDIS is only compliant when installed and operated in accordance with the type-approval issued.

The Australian Hydrographic Office has identified about 2,200 point features on 243 Australian Electronic Navigational Charts potentially affected by the identified point feature safety issue. Commencing in December 2018, these point features were updated by encoding an obstruction area around the existing underwater, awash rock, obstruction or isolated danger symbols.

In addition, the AHO has published an online supplement to the Seafarers Handbook for Australian Waters that will be fully incorporated as a new chapter into the new edition of the handbook (Edition 5), due for publication in 2019. The supplement addresses the dangerous effects of overscaled ECDIS displays near features such as isolated danger symbols.


Lessons learned

  • The safe and effective use of ECDIS as the primary means of navigation depends on the mariner being thoroughly familiar with the operation, functionality, capabilities and limitations of the specific equipment in use on board their vessel.

ECDIS type-specific training needs to be designed, delivered and undertaken so operators have the required knowledge to confidently operate ECDIS as intended by the manufacturer,

...Mr. Hood noted.

  • ECDIS type-specific familiarisation should be designed, delivered and undertaken so as to ensure the transfer of knowledge required to confidently operate the ECDIS as the manufacturer intended it to be operated.
  • ECDIS, as a complex software based system, is subject to constant change and improvement. In order for mariners to always have the best possible advantage in conducting safe navigation, ECDIS needs to be maintained so as to be compatible with the latest applicable standards mandated by the appropriate organisations.
  • While the use of ECDIS and ENCs as an essential tool for navigation provides many safety benefits, navigation with ECDIS is fundamentally different from navigation with paper charts. The implementation of ECDIS and the replacement of paper charts has introduced certain risks to the conduct of marine navigation, as highlighted in this investigation.
  • While the challenges faced by regulators, manufacturers, hydrographic offices and other concerned parties in resolving these risks is acknowledged, the ultimate goal must be to eliminate significant risks or at least reduce them to an acceptable level in terms of navigational safety.

Like all on-board equipment, ECDIS needs to be maintained and compatible with the latest applicable standards,

...Mr Hood said.

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