Atsb transport Safety Report Marine Occurrence Investigation
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ATSB Transport Safety Report Marine Occurrence Investigation 300-MO-2013-007 Final – 9 May 2014 Fall from the pilot ladder on the bulk carrier Atlantic Princess Whyalla, South Australia, 3 July 2013
Released in accordance with section 25 of the Transport Safety Investigation Act 2003 Publishing information Published by: Australian Transport Safety Bureau Postal address: PO Box 967, Civic Square ACT 2608 Office: 62 Northbourne Avenue Canberra, Australian Capital Territory 2601 Telephone: 1800 020 616, from overseas +61 2 6257 4150 (24 hours) Accident and incident notification: 1800 011 034 (24 hours) Facsimile: 02 6247 3117, from overseas +61 2 6247 3117 Email: atsbinfo@atsb.gov.au Internet: www.atsb.gov.au © Commonwealth of Australia 2014 
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Safety summary What happened On 3 July 2013, a company representative was boarding the bulk carrier Atlantic Princess via the ship’s pilot ladder when he fell and landed on the deck of the pilot launch below. At the time, the ship was at anchor off Whyalla, South Australia, loading iron ore from an offshore transhipment barge. The injured man was provided with immediate first aid and transported to the local hospital. However, he died later that day as a result of his injuries.
The ATSB found that while Atlantic Princess’s pilot ladder had been rigged in accordance with the relevant international requirements, no further risk assessment was carried out for the personnel transfer. The investigation also found that the company’s safety management system provided no guidance relating to actions that should be taken when less experienced personnel were to use a pilot ladder to board or disembark the ship. In addition, there were no facilities on board the transhipment barge that could be used to provide a safe means of access between the barge and the ship for personnel transfers with the barge operator’s procedures prohibiting such transfers. The investigation also identified safety issues relating to the content and implementation of the pilot launch operator’s safety management system. What's been done as a result The ship’s managers have issued a fleet safety circular noting that helicopters should be used for transfers of persons other than pilots wherever possible. When this is not possible, they are required to use a safety harness while climbing a pilot ladder. These requirements are to be advised to the ship’s agent in advance. The pilot launch operator’s safety management system has been audited and the company is working to improve the system and its implementation. The company’s personnel transfer procedures have also been updated.
This accident highlights the fact that while pilots may be competent in the use of pilot ladders, it should not be assumed that other personnel are proficient in climbing or descending a pilot ladder, or fit to do so. Contents The occurrence 1 Context 5 Port of Whyalla 5 Iron ore transhipment operations 5 Atlantic Princess 5 Switcher 6 The fall 7 Safety analysis 8 Safe means of access 8 Shipboard procedures 9 Launch procedures 9 Findings 12 Contributing factors 12 Other factors that increase risk 12
Risk assessment 13 Safe means of access 14 Safety management system compliance 14 Safety management system guidance 15
Occurrence details 17 Atlantic Princess details 17
Sources of information 18 References 18 Submissions 18 Australian Transport Safety Bureau 19 Purpose of safety investigations 19 Developing safety action 19 Directory: media media -> Applications to Drill media -> Unicef voices of Youth Chat Theme: Children and aids nigeria and Zimbabwe 13 October 2006 Background media -> Tsunami Terror Alert: Voices of Youth media -> Biblical Eschatology Presentation by: D. Paul Beck May 4, 2016 Ground Rules media -> Guide to completing the collection using the Omnibus system media -> The milk carton kids media -> Events Date and Location media -> The Gilded Age: The First Generation of Historians by H. Wayne Morgan University of Oklahoma, April 18, 1997 media -> Analysis of Law in the United Kingdom pertaining to Cross-Border Disaster Relief Prepared by: For the 30 June 2010 Foreword media -> Cuba fieldcourse 2010 Download 0.89 Mb. Share with your friends:
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