Lessons Learned: Tipping of Loose Steel Plates Cause Crew Fatality

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Transport Malta reports an incident where the tipping of loose steel plates caused crew injury on a chemical tanker.

What happened

On 21 November 2023, while the motor tanker Amur Star was en route to Immingham, United Kingdom, the electrician found the second engineer unconscious, trapped by steel plates in the steering gear compartment. The electrician raised the alarm, and together  with other crew members, he freed the second engineer and attempted to resuscitate him. The master sought medical help from the German authorities, and although two medical teams boarded the vessel by helicopter, they were unable to revive the second engineer.

The safety investigation concluded that the second engineer was alone in the steering gear compartment. A stack of heavy steel plates that was stored vertically and free from its lashings, tipped over on him, possibly as a result of the natural movement of the vessel in a seaway. The MSIU has issued two recommendations to the Company and the flag State Administration, designed to address the safe stowage of heavy steel plates, and raise awareness on this particular hazard.

Safety actions taken 

The company took a number of safety actions including:

  • initiated its own internal investigation into the accident on board the vessel;
  • issued a Circular Fleet Alert on 27 November 2023 to all its managed vessels;
  • reviewed its safety management procedures to make them more robust and incorporate the findings of this accident. Company audit and inspection checklists have been included for the inspection of steel plate storage arrangements on board;
  • appointed Fathom Marine Consultants, UK, to create a training video regarding the accident;
  • the area around the steel plates has been marked as hazardous;
  • a notice has been posted to caution crew members that work necessitating the use of steel plates, had to be notified to the chief engineer beforehand;
  • a poster for the handling, stowage and securing of steel plates and pipes has been prepared and circulated among the fleet vessels;
  • non-essential steel plates have been landed ashore;
  • extra-reinforcement was welded around the steel plates to restrict them from tripping over, even if the lashings is released;
  • initiated the process for the purchasing of a steel plate stowage rack for all fleet vessels;
  • launched a campaign on all fleet vessels for the verification of steel plates securing arrangements on board.

Recommendations

Taking into consideration the safety actions taken, the company is recommended to:

15/2024_R1 circulate the finding of this investigation to its managed and owned
fleet.

The flag State Administration is recommended to:

15/2024_R2 issue an information notice to ship owners and ship managers, highlighting the importance of safe stowage and securing of steel plates, ensure the availability of the necessary tools and means to handle steel plates safely, and to transfer any unnecessary heavy steel plates ashore.

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Source: Transport Malta