2003X01 Fatal Mooring Accident

Fatal Mooring Accident
Australian TSB Official Report

The following incident is part of Report 180 by the Australian Transport Safety Bureau into a fatal mooring accident. It is available on the ATSB Web Site www.atsb.gov.au
The incident

Taharoa Express berthed at the Parker Point ore jetty at 0024 on 10 July 2002, to load a cargo of iron ore for Japan. The vessel was secured port side to the jetty, heading west, by four headlines, two forward breastlines, two forward springs, two aft springs and six sternlines to quick release hooks on the mooring dolphins. After completing the loading of 129,959 tonnes of iron ore at 0109 on 11 July, Taharoa Express immediately started unberthing on a falling tide.

Ashore, an operations supervisor at the remote console and two process operators, one forward and one aft, assisted with unberthing the vessel. From the console, the operations supervisor could see the vessel's lines aft but, as he was unable to see the forward lines, the process operator was standing by to inform him when those lines had been released. The wind was from the south at about 10 knots and the tide was ebbing at about 0.3 knots towards the northeast. Two tugs, secured to the vessel, were pushing square at idling revolutions and the only other vessel in the vicinity, an incoming ship, was about two miles away.

The pilot instructed the master to slack all headlines and sternlines. He then ordered the operations supervisor ashore to release the headlines. On the ship, the forward mooring crew was under the supervision of the mate who relayed the order from the pilot to slacken the breastlines to the bosun. The mate then moved aft to supervise two crew who were preparing to recover the forward springs. After the headlines had been recovered on board, the bosun engaged the winch for the breastlines, then released the brake. A seaman was told to look over the bulwark and to inform the bosun when the breastlines had been released. About a minute later, the pilot ordered the operations supervisor to release the sternlines. From the bridge wing, the pilot was able to see that the breastlines forward were slack. At about 0126, while the tugs were still pushing at minimum revolutions to hold the vessel up to the jetty, the pilot ordered the operations supervisor to let go the breastlines. The process operator, watching the forward lines, informed the operations supervisor that the hook for one of the breastlines had failed to release, but that the line itself was slack enough for him to go down to the dolphin to release the line manually. The supervisor relayed this information to the pilot on board. However, by the time the operator reached the dolphin, there was considerable tension in the line.

When the operator reported that the line was taut, the supervisor asked the pilot to have it slackened. Instead, the line became tighter and tighter. The operator heard the rope crack with tension and noticed that the hook seemed to be moving.

On the ship, the seaman, looking over the bulwark, shouted to the bosun, in their own language, 'Bosun, wait!'. At this point, the hook released the tensioned breastline. The line whipped back towards the ship, striking the seaman who had been looking over the bulwark. The seaman collapsed on the deck with severe head injuries. The injured seaman was taken to the hospital at Karratha and the vessel's departure was delayed until the next tide. When the pilot asked the bosun what had happened, the bosun's response was that he had been slacking the breastlines at all times and that the seaman had been standing on a bulwark stiffener to watch the ropes.

The injured seaman's condition was so critical that he was transferred to a hospital in Perth, but he died the next day.

Contributing factors

The seaman who was killed was standing almost directly over the fairlead roller for the breastline that struck him.

Chapter 19, section 4 of the International Labour Organization (ILO) publication 'Accident prevention on board ship at sea and in port' advises that;

· All seafarers involved in mooring and unmooring operations of any kind should be informed of the hazards of engaging in such operations.
· A competent person should be in charge of mooring operations and ascertain that there are no persons in a dangerous position before any heaving or letting go operation is commenced.

· Ropes and wires are frequently under strain during mooring operations and seafarers should always stand in a place of safety from whiplash should ropes or wires break.

The seaman was not under direct supervision of the mate during the moments leading to the accident. The mate's position on deck and the bosun's position at the controls of the mooring winch meant that the mate, and possibly the bosun, did not have the seaman directly in their line of sight.

Conclusions

The following factors are considered to have contributed to the incident:

The seaman was standing almost directly over the fairlead roller for the mooring rope and was not warned that he should have been in a safer position;
It is likely that the bosun, thinking that the breastlines had been released, operated the winch to recover the lines, resulting in tightening of the line that was still attached to the mooring hook.
In addition, although tests on the hook were not conclusive, one or more of the following possibly occurred;

The initial attempt to release the hook partially altered the position of the release system resulting in a release of the hook under tension;
Dirt or rust had prevented the mooring hook from being correctly reset;
The mooring hook was not correctly reset.
It is possible that modifications to the remote release mechanism might also have been a factor in the hook releasing.
Similar incidents

ATSB reports Numbers. 40 (Searoad Mersey) and 58 (Pacific Commander) examine similar incidents of a fatality and an injury to a crew member during mooring operations and emphasise the danger to personnel working in close proximity to mooring ropes. The Searoad Mersey incident was also reported in MARS 19 in May 1994. A fatal mooring accident was also reported in MARS 200333 in July 2003.