20 LMM V I S I O N ISSUE 19 | Q4 2024 III. Personal Factor: ●● Lack of situational awareness and risk perception IV. Job Factors: ●● Inadequate supervision of the tugboat’s movement ●● Inadequate assessment of the soft touch potential damage ●● Improper decision regarding the timely reporting of a potential damage to ship’s hull ●● Inadequate information handling between Master and Officer in charge of aft mooring gang Team Engagement & discussion topics ●● Why must the tugboat always use the designated push points (strong points) for pushing? ●● What the Officer in charge must do if observes that the tug is not pushing at the designated push points of the hull? ●● What are the Company’s procedures for reporting incidents, hazardous occurrences and near misses? Incident Description While the vessel was in ballast condition and en route from Reunion towards Persian Gulf, during a routine (e-PMS) inspection of AFT STBD Cofferdam space from the vessel’s crew, a dent was observed in the vessel’s hull in way of frames No.36-40. The vessel was not engaged in any operation or activity at the time of the finding, while the preliminary assessment of the damage, along with previously conducted inspections and attendances, suggests that the dent has occurred sometime in the recent past, and most probably during vessel’s berthing or un-berthing maneuver. The finding was then reported to DPA, as per Company’s procedures for reporting Incidents and hazardous occurrences and the relevant procedure for structural defect had been initiated. Root Causes I. Substandard Actions: ●● Incorrect position of the tugboats while pushing during berthing maneuver ●● Failure to warn the Master and eventually the Pilot and the tugboat about the incorrect position ●● Inadequate communication II. Substandard Conditions: ●● The berthing maneuver took place at night ●● Location of damage is outside vessel’s parallel body and can be observed externally with vessel only in ballast condition from seaside. Lessons learned Tugboats shall push vessel only at designated push points. If not, intervene without delay! Any other touch or contact not at strong points by tugboat to be investigated and reported to the office without exceptions. INCIDENT REPORT Aft Starboard side hull slight dent Hull damage -side shell plating STBD Cofferdam -side shell structure
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