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[TSB of Canada] MARINE INVESTIGATION REPORT - Person overboard and subsequent loss of life While Reading Draft  
administrator 19-06-05 16:50  

Vessels are expected to take accident preventive measures such as evaluation of risks, wearing personal protective gears, etc. prior to risky operations such as hot work, cargo work in enclosed space, high place work, etc.

However, such measures are sometimes not taken properly for operations which are frequent or not classified as dangerous such as installation of pilot ladder or reading drafts, etc. Also, some operations are actually conducted with risks exposed as the responsible personnel for safety management can not always monitor in advance.

We hereby share the accident investigation report for your reference.

According to the report, the crew did not wear personal protective gear, without being paired up, proper ladder was not in use. Measures for dangerous operation procedures were not taken although overside work was performed.

To prevent such accidents, it is necessary for vessel's safety manager or responsible personnel for the operation to evaluate the risks once again even though they are routine works to make sure there is no potential risk for the operation.

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