Derailment of On Board Hatch-Lid Gantry Crane – Investigation Report

On 22 July 2011, the hatch-lid gantry crane on board the dry cargo vessel Blue Note derailed while it was carrying a single hatch-lid to its stowed position in preparation for discharging cargo. The derailment caused the chief officer, who had been riding on one of the crane’s wheel units, to be thrown overboard; an able seaman, who had been riding on another wheel unit, to be left hanging by his hands over the 8.4m deep hold; and the second officer, who was operating the crane, to fall to the deck of the control platform. All three crewmen were lucky to escape with only minor injuries.

At 0600 on 21 July 2011, Blue Note arrived in Londonderry to discharge its cargo of soda ash. The two movable bulkheads in the hold were positioned right aft so the ship was in its single hold configuration. At 1025, with the discharge well underway, a new chief officer joined the ship for a short handover with the outgoing chief officer, who was due to leave the following day. This was the new chief officer’s first contract with Reederei-Meyering GmbH, however he had previously worked on six other ships with hatch-lid gantry crane arrangements similar to those on Blue Note.

The day was spent with the two chief officers working through their handover while cargo operations continued. At 1825 the stevedores suspended discharge operations for the day, and the outgoing chief officer was watched by his relief as he used the gantry crane to close the hatch-lids. The outgoing chief officer used this opportunity to explain the operation of the crane and guided his relief through the control system, the lifting mechanism and the lifting procedure. He informed the new chief officer that the crane’s maintenance was recorded in a 3-monthly deck maintenance checklist and that one wire had been changed several weeks earlier.

As was normal procedure on board Blue Note, the outgoing chief officer directed the hatch closure while riding on the starboard, forward wheel unit of the gantry crane. This position was directly below the third officer, who was operating the crane from the upper control platform. An able seaman (AB) stood on the port side, forward wheel unit.

At 0800 the following day, the outgoing chief officer watched his relief open hatch-lids 3, 4 and 5 in preparation for the resumption of the cargo discharge. The lids were stacked in the designated storage position at the forward end of the ship. The relief chief officer followed his predecessor’s practice of riding on the starboard, forward wheel unit, with an AB on the port wheel unit and the third officer at the controls. Discharge of the cargo resumed at 0900. By 1000 the three men had also opened hatch-lids 6 and 7; this time without any supervision from the outgoing chief officer.

At 1300 the stevedores stopped for their lunch break. Being conscious that the soda ash cargo could cake if exposed to moisture, the chief officer, third officer and AB set about replacing the hatch-lids on the forward part of the hold. When this was done, they began to open up the after part of the hold in anticipation of the stevedores continuing with the discharge. Hatch-lids 11 then 9 and then 10 were removed and stacked in their designated stowage position, aft of the hold and just forward of the superstructure.

At approximately 1420 the crane was positioned above hatch-lid number 8. The normal lifting procedure was followed: the AB signalled to the chief officer that the port hooks were engaged and, satisfied that the starboard hooks were engaged, the chief officer signalled to the third officer to continue lifting. The third officer then raised the lid and began to drive the crane aft towards the position of the stacked lids.

The crane had travelled approximately 10 metres when the port side of the lid fell from the lifting hooks. The hatch-lid pivoted momentarily on the starboard hooks before the additional weight bent the starboard lifting sockets and the lid crashed into the starboard legs of the crane and came to rest on the bottom of the hold (Figure 1). The crane derailed and three of the four wheels were detached. The chief officer was thrown overboard and into the water between the quayside and the ship; the AB was left hanging by his hands over the cargo hold; and the third officer fell onto his knees at the control station. All three men suffered minor injuries and were able to get themselves to safety without assistance.

Most witnesses to the accident thought that the crane gantry was travelling along the rails when the hatch-lid fell. However, some thought that the crane might have stopped to check that the hatch-lid had been lifted sufficiently high to clear the other stacked lids before approaching them.

The MAIB investigation found the most likely cause of the accident was that the port side lifting hooks of the gantry crane were not correctly engaged with the hatch-lid’s sockets during an operation to move the lid aft to its open stowage position. This led to the port hooks becoming disengaged as the lid was being moved, causing it to fall and pivot about the starboard lifting hooks. The hatch-lid struck the starboard legs of the gantry crane, causing it to derail while the port side continued to fall, finally coming to rest at the bottom of the cargo hold.

Safety issues which contributed to the accident included:

  • The design of the crane made it difficult for ships’ staff to verify if the lifting hooks were correctly engaged in the lifting sockets provided on the hatch-lids.
  • There was no manufacturer’s instruction manual for the crane on board Blue Note.
  • Upkeep of the crane was not a specific part of the ship’s planned maintenance system.
  • There were no records held on board of maintenance or repairs to the crane.
  • There was no risk assessment covering the operation of the crane and movement of the hatch-lids. As a consequence, ship’s staff had adopted poorly considered working procedures that focused on expediency rather than safety.

Source: MAIB

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