A walkaround audit conducted aboard a vessel revealed two critical safety deficiencies in the engine room, as reported by the International Marine Contractors Association (IMCA). The audit identified improper application of Lock Out/Tag Out (LOTO) procedures and unauthorized modifications to electrical systems, both of which pose significant risks to personnel and equipment.
What Happened
During an onboard engine room audit, two unsafe practices were identified. Electrical equipment connected to the main switchboard was switched off for repairs to the hydraulic pipeline of the anchor handling system, but no LOTO was applied.
Although the emergency stop was activated from the bridge, the electrical isolation point was not secured with a LOTO device. A hydraulic valve was physically closed and tagged out, but the mechanical isolation was incomplete as the valve lockout device was not applied.
Furthermore, the audit identified unauthorized and undocumented disconnections and bypassing of critical electrical systems. These modifications were not logged, and proper reinstatement procedures had not been followed after likely temporary changes made during Dynamic Positioning (DP) trials.
Why It Happened
In both LOTO-related cases, the responsible personnel failed to follow the full isolation procedures. A key contributing factor was the unavailability of suitable LOTO devices for the electrical isolation points, despite prior instructions to ensure adequate onboard inventory. The control of work and isolation process was not effectively implemented or monitored. In the case of unauthorized electrical disconnections, causes included:
- Lack of documentation for temporary modifications.
- Failure to assign responsibility for system reinstatement.
- Poor communication between shifts and teams.
- Absence of verification checks post-DP trials.
Actions Taken
No specific corrective actions were detailed in the report. However, reference was made to prior fleet-wide instructions about ensuring the availability of LOTO devices onboard, indicating a procedural gap in compliance or enforcement.
Lessons Learned
- Merely switching off equipment or closing a valve does not ensure complete isolation. Without proper LOTO, systems can be unintentionally reactivated due to error or malfunction.
- LOTO procedures must be applied in every maintenance or repair activity involving hazardous energy, regardless of perceived risk.
- Regularly verify the availability and suitability of LOTO devices onboard for all required isolation points.
- Temporary system modifications, especially during DP trials, must be formally documented, approved, and reinstated promptly after testing.
- Reinforce clear communication during handovers, ensuring all personnel are briefed on system changes and restoration responsibilities.
- Conduct post-maintenance checks to confirm full system reinstatement before resuming operations.
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Source: IMCA
