Hong Kong Merchant Shipping published lessons learned from a fatal fall accident that happened on board during the testing of a shipboard derrick.
The incident
A Hong Kong registered general dry cargo ship berthed at the port of Changshu, China for cargo discharge and other miscellaneous tasks, including crew change and the repair work of the crane and derrick.
The duty officer noticed that a contractor carried out a derrick load test on board without informing crew members. The Bosun summoned four ABs and a deck cadet (the testing crew) to assist the contractor in testing the derrick when he received the notice from the duty officer.
When testing the derrick, the AB accidentally fell onto the cargo hold bottom through the tween deck opening next to him while he was assisting to untangle the idle gear from the hanging wire. Afterwards, the AB was sent to a local hospital for emergency medical treatment, but he was declared dead on the same day.
Probable cause
The investigation revealed that the main contributory factors of the accident were that:
- the management company had not ensured the safe operation of the vessel by failing to establish a retesting procedure of the derrick in identifying safety precautions and duties of the testing team which comprised the contractor and crew members;
- the contractor was not competent enough in testing the derrick;
- the crew members were not well prepared to assist the contractor in repairing and retesting the derrick;
- the toolbox talk was not carried out thoroughly to ensure that the retesting work plan, safety precautions and the hazards involved were clearly understood by the testing crew;
- the in-depth pre-work inspection was probably not done satisfactorily at the work site before commencing the work;
- the site supervision to the testing crew was inadequate to prevent the fatal accident from happening
Lessons learned
In order to avoid the recurrence of similar accidents during operation in the future, the following should be taken into consideration when arranging the shore repairing:
- To ensure that a standard retesting procedure of lifting appliances is available and followed on board;
- To ensure compliance with the shipboard Safety Management System (SMS) requirements in performing key operations including lifting and working at height;
- To ensure the accomplishment of preparation work including the establishment of a safe work plan and procedure, the availability of special tools and the formulation of acceptance standards for the job to be done by contractors;
- To carry out a cautious pre-work inspection for identification and evaluation of the inherent risks particularly in the environment of non-routine work and take effective control measures;
- To ensure that crew members in toolbox talk fully understand the work plan, safety precautions, and hazards involved before commencing work;
- To ensure that site supervision of all key operations is carried out by experienced officers; and
- To ensure the competence of contractor(s) for the work on board