202316 When is a supervisor not a supervisor?

24 Mar 2023 MARS

Routine maintenance on a fuel oil pump for the auxiliary boiler was scheduled while the vessel was at anchor. A toolbox meeting was held to discuss the work and the risks and the appropriate permits to work were checked, including cold work and pressure pipeline work permits. The Second Engineer was to be the work supervisor.

The maintenance work began after lunch. The Second Engineer was dismantling the pump’s filter cover, while also acting as the work supervisor. The pump had been isolated by closing the inlet and outlet valves – but the vent cock fitted on the system had not been opened, so the system was still under pressure.

As the pump’s filter cover came loose, hot fuel and gases under pressure escaped from the pump. The Second Engineer and three other engine crew who were involved with the work suffered burns on their faces, neck and hands from the hot oil, even though they were wearing PPE (safety hats, gloves and eye protection). After the accident the outlet and inlet valves to the pump were checked and found to be closing efficiently. There were no signs of leakages into the system.

The four injured crew were given first aid on the vessel, and two of them were subsequently transferred to the local hospital for further treatment and examination. After 11 days of hospitalisation and medical treatment both crew were fit to travel and were safely repatriated.

Lessons learned

  • Checking the boxes of a ‘permit to work’ form is not going to protect you from the known hazards. Working according to the precautions on the permit will protect you.
  • A supervisor who is taking part in the work itself (instead of acting only as a supervisor) is less likely to be able to control the work and assess the risks.