The incident

On 21 May 2018, the MSIU was informed that the Maltese registered bulk carrier 'Seastar Endeavour' had lost a crew member at sea a day before, when the ship was navigating the North Sea Deep Water Route.

The vessel was heading to Gdansk, Poland, carrying 30,003 tonnes of sodium feldspar.

During the third mate’s 0800 to 1200 navigational watch, the master reminded him to check Life Saving Appliances (LSA) and Fire Fighting Equipment (FFE) in accordance with the ship’s daily work-plan.

At 2000, it was noticed that the third mate failed to report for his navigational watch. Numerous calls to his cabin remained unanswered.

The general alarm was raised and the crew members, led by the chief mate, started a search.

By the time the search was completed at 2040, the third mate was still missing. Immediately, a Mayday message was broadcasted on the VHF radio.

The master set the vessel at full speed on reciprocal course to the position where the third mate was believed to have fallen overboard.

At 2050, the master contacted the Company and MRCC Netherlands to notify them of the situation.

No crew member had witnessed the accident. An extensive search was carried out by the Netherlands MRCC and Seastar Endeavour’s crew.

However, the search was unsuccessful and the crew member was never recovered. The search and rescue operations were subsequently suspended by the MRCC.

The safety investigation determined that in all probability, the crew member was lost overboard during maintenance work on the vessel’s rescue boat.

Probable cause of the fall overboard

Notwithstanding the absence of witnesses, the MSIU considered it very likely that the third mate had accidently fallen into the sea. The safety investigation, however, was unable to establish precisely what had caused his fall. Four scenarios were considered as possible causes of the man overboard:

  • the third mate tripped and fell overboard while moving about inside the rescue boat;
  • felt dizzy when he stood up, following a prolonged period of sitting down inside the rescue boat;
  • felt dizzy in view of the prescribed medication; or
  • due to natural causes.


  1. The likely position of the man overboard position was either the rescue boat or the area around the boat;
  2. Neither a toolbox talk nor a formal risk assessment had been carried out on board;
  3. The crew member was not wearing a fall preventer device;
  4. There were no other crew members overseeing the task in the area;
  5. The risk of falling over board was either not envisaged or the third mate was expected to work on the inside of the rescue boat but without actually accessing it (perhaps with the use of a ladder);
  6. It was highly probable that once immersed in the cold water, hypothermia would have set in within minutes.


Actions taken

The Company prepared and introduced a new procedure on working in areas outside of the safety railing (rescue boat, life boat and life raft) in the Company’s Health and Safety Manual.

As a minimum, the following precautions are being implemented across the fleet:

1. All work conducted outside the perimeter of the safety rails is to be discussed during the daily work planning meeting. A formal risk assessment has to be conducted, taking into account the following safety controls:

  • work must be carried out during daylight hours and in favourable weather condition;
  • personnel conducting the work must be positioned as far as possible from the outer board;
  • decks must be free from any grease or other oily substance;
  • use of flotation aid, fall arresters, or safety harnesses is now compulsory;
  • constant or periodic visual supervision or VHF reporting routine must be established, if deemed necessary; and
  • end of task shall be reported to the safety officer;

2. Safety rounds are being carried out to confirm that all worksites are secured and tools are stored away at the end of the working day; and

3. Manning agencies are being requested by the Company to check and analyse medical certificates against seafarers’ previous ailments and fitness for sea duties prior to their engagement on board vessels.


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