Pasha Bulker 243 - Independent investigation into the grounding of ...

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4 SAFETY ACTIONS 4.1 Safety action by Newcastle Port Corporation The ATSB has been advised that the following safety actions have been taken by Newcastle Port Corporation as a result of the grounding of Pasha Bulker on 8 June 2007 and related events. • Recommending that masters of ships arriving off Newcastle anchor not less than three miles from the shore. • Providing masters of ships at Newcastle anchorage with regular weather broadcasts when a Bureau of Meteorology weather warning is in place. • Enhanced monitoring of ships off Newcastle with Automatic Identification System equipment. • Increased monitoring of the draughts of ships entering port with the aim of ensuring they are appropriately ballasted. • Procedural checks of the audio recording equipment at the Vessel Traffic Information Centre. 4.2 Safety action by Port Waratah Coal Services The ATSB has been advised that the following safety actions that have been taken by Port Waratah Coal Services (PWCS) as a result of the grounding of Pasha Bulker on 8 June 2007 and related events. In submission PWCS stated: The following are details of PWCS initiatives to assist Vessel Master/Owners and Operators to understand Vessel Suitability List: • Modification of the PWCS Coal Terminals Information Handbook to expand the vessel suitability criteria selection; • Modification of the PWCS Coal Terminal Handbook to reinforce vessel port entry requirements; • In conjunction with NPC, issued a general notice to industry on port entry requirements and ongoing radio communication with each vessel prior to entry; • Commenced bi-annual workshops with vessel agents and local industry representatives to review/discuss improvement initiatives; • Ongoing dialogue/communications with all vessel owners/operators and masters on vessel performance including any safety issues; and • Bi-annual meetings with senior management of large vessel owner groups to discuss safety performance and how to work together. Examples include NYK, Mitsui, K Line and Shinwa. - 61 -
4.3 ATSB recommendations MR20080009 The safety management system on board Pasha Bulker did not provide the master with specific guidance about safely putting to sea in adverse weather. Neither the master’s standing orders nor the passage plan form prescribed in the safety management system contained any guidance with regard to bridge resource or team management or encouraged its use. The Australian Transport Safety Bureau recommends that Fukujin Kisen Company take action to address this safety issue. MR20080010 Newcastle Vessel Traffic Information Centre’s advisory role was not properly understood by the masters of a number of the ships in the Newcastle anchorage on 7 June 2007. The Australian Transport Safety Bureau recommends that Newcastle Port Corporation take action to address this safety issue. MR20080011 Newcastle Port Corporation’s incident control system was activated at about 0830 on 8 June 2007, suggesting that the corporation was not sufficiently responsive to the increasing seriousness of the situation that developed off the port from the evening of 7 June. As a result, the Australian Maritime Safety Authority was not notified until about 0900 on 8 June. The Australian Transport Safety Bureau recommends that Newcastle Port Corporation take action to address this safety issue. MR20080012 Newcastle Vessel Traffic Information Centre’s offers of assistance to Pasha Bulker’s master were made at a late stage in extreme weather conditions when it was unlikely that any practical assistance could be provided. The Australian Transport Safety Bureau recommends that Newcastle Port Corporation take action to address this safety issue. MR20080013 Newcastle Vessel Traffic Information Centre requested the masters of four ships to leave the anchorage at a very late stage, when the weather conditions were extreme and just before Pasha Bulker grounded. The masters of several ships, including Pasha Bulker, had expected the centre to provide them with similar guidance earlier, when weather conditions warranted, enabling them to safely clear the coast. The Australian Transport Safety Bureau recommends that Newcastle Port Corporation take action to address this safety issue. MR20080014 On 8 June 2007, Newcastle Vessel Traffic Information Centre’s advice was limited to the masters of only those ships that were dragging their anchors. Some masters - 62 -
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ATSB TRANSPORT SAFETY INVESTIGATION
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CONTENTS DOCUMENT RETRIEVAL INFORMA
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DOCUMENT RETRIEVAL INFORMATION Repo
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THE AUSTRALIAN TRANSPORT SAFETY BUR
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TERMINOLOGY USED IN THIS REPORT Occ
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EXECUTIVE SUMMARY At 0742 1 on 23 M
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A number of masters had deployed in
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1 FACTUAL INFORMATION 1.1 Pasha Bul
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een to Newcastle many times. The th
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Figure 3: Section of navigational c
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particular, with their extended fet
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At 0742, Pasha Bulker’s starboard
Page 26 and 27: oarding ground for its scheduled be
Page 28 and 29: By 0600, only 27 ships remained and
Page 30 and 31: Figure 6: Section of VTIC radar scr
Page 32 and 33: Figure 8: Section of navigational c
Page 34 and 35: mates suggested to the master that
Page 36 and 37: Figure 10: An aerial view of Pasha
Page 38 and 39: Figure 11: A visualisation of Pasha
Page 40 and 41: 2 ANALYSIS 2.1 Evidence From 9 to 1
Page 42 and 43: anchor dragged. The decision was ba
Page 44 and 45: enough and ascertain the effect of
Page 46 and 47: No one on the bridge, at any time,
Page 48 and 49: 2.2.3 The critical decisions A numb
Page 50 and 51: severe weather at the time, it is l
Page 52 and 53: While a number of masters probably
Page 54 and 55: and continued for about 12 hours wi
Page 56 and 57: the angle increases, the holding po
Page 58 and 59: For a bulk carrier, the tension in
Page 60 and 61: It is good practice for bulk carrie
Page 62 and 63: Along with its safety functions, NP
Page 64 and 65: decided to remain anchored in adver
Page 66 and 67: ‘afraid’ because the ‘wind wa
Page 68 and 69: In early 2004, when the ship queue
Page 70 and 71: While the coal producers pay demurr
Page 72 and 73: 3 FINDINGS 3.1 Context On 23 May 20
Page 74 and 75: minimum considered to be acceptable
Page 78 and 79: assumed, incorrectly, that the appr
Page 80 and 81: MS20080018 A number of masters at N
Page 82 and 83: APPENDIX A: EVENTS AND CONDITIONS -
Page 84 and 85: APPENDIX B: SHIP INFORMATION Pasha
Page 86 and 87: APPENDIX C: SOURCES AND SUBMISSIONS
Page 88 and 89: Seamanship International Limited, B
Page 90 and 91: APPENDIX D: METEOROLOGICAL INFORMAT
Page 92 and 93: Table 4: Swell condition Descriptio
Page 94 and 95: APPENDIX E: SURVEY INFORMATION AND
Page 96 and 97: Question 4: When the weather worsen
Page 98 and 99: Factors considered in deciding to l
Page 100 and 101: Question 11: Where can you get the
Page 102 and 103: Comparison 2a One of the 42 masters
Page 104 and 105: APPENDIX F: MEDIA RELEASE ATSB rele
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