Executive summary
On Monday 6 August 2001 at about 0730, a lifeboat and rescue boat launching drill was conducted on board the passenger and freight ferry "Aratere". At about 0750, during the recovery of the port lifeboat, the forward hook of the synchronous release equipment opened spontaneously when the lifeboat was about one metre above the water. The bow of the lifeboat fell back into the water. None of the 8 occupants were injured and the lifeboat sustained no damage.
Safety issues identified included:
• the design of the equipment, which allowed the closure of the operating levers while the release mechanism was not properly engaged
• the limited visibility from inside the lifeboat of critical parts of the release equipment, which did not allow the boat crew to adequately check that the release mechanism was properly engaged
• the limited opportunities for maintenance and training, leading to a lack of appreciation by the ship’s crew of the proper operation of the release mechanism
• the difficulty of operating the cumbersome and complicated equipment while attempting to recover a lifeboat from a seaway
• the fitting of replacement critical parts that were not made or approved by the manufacturer of the release mechanism
• the lack of appreciation by the ship’s crew of warning signs in previous events which, if acted upon, would have increased the crew’s knowledge of the equipment.
Safety recommendations were made to the managing director of Tranz Rail, the Spanish maritime administration, Inspeccion General Maritima, Pesbo S.A., the International Association of Classification Societies and the Director of Maritime Safety to address the safety issues
Related Recommendations
Advise all recipients of its synchronous lifeboat release equipment of the type supplied to the Aratere, of this incident and of the potential for the equipment to be incorrectly engaged when recovering a lifeboat.
Advise all member Classification Societies of this incident in order that where synchronous [lifeboat] release equipment of the same type is fitted on ships classed by them, their surveyors and all relevant ship operators are made aware of the potential for improper engagement of the equipment.
Introduce a policy that when replacement parts are required for any life-saving appliances or safety equipment, only parts made or approved by the manufacturer are used
Submit a copy of Commission’s report 01-211, together with the Maritime Safety Authority final report into the same incident, to the Maritime Safety Committee of IMO to support the work and initiatives now being conducted by both the Marine Accident Investigation Branch and the Maritime and Coastguard Agency of the United Kingdom, regarding the safety of lifeboats and lifeboat drills. Any review conducted by IMO should consider reported accidents worldwide, with particular emphasis on lifeboat/rescue boat launch and recovery systems.
Require Pesbo S.A. to provide a modification for existing synchronous lifeboat release equipment to address the deficiencies identified in this report.
Require Pesbo S.A. to re-design its future synchronous lifeboat release equipment so that it fully complies with the provisions of the LSA Code, and is able to be engaged and checked before the lifeboat is attached to the davit falls.
When available, provide all recipients of its synchronous lifeboat release equipment of the type supplied to the Aratere with a modification to prevent incorrect engagement of the equipment.