The UK Marine Accident Investigation Branch (MAIB) has published a report into the deaths of three stevedores in a cargo hold access space on board the bulk carrier Berge Mawson. The incident took place at Bunyu Island anchorage, Indonesia on 27 June 2022.
What happened?
On 27 June 2022, three unconscious stevedores were recovered from a cargo hold access space on board the Isle of Man registered bulk carrier Berge Mawson at Bunyu Island Anchorage, Indonesia. Despite prompt medical attention by ship and port staff, the three men died.
Berge Mawson was loading a bulk cargo of coal from barges using a floating crane. The coal in cargo hold No.7 was being levelled by a bulldozer, when loading was paused and all hatches were closed due to heavy rain. Once the rain had stopped, a stevedore made several attempts to gain access to the bulldozer. Unsupervised, the stevedore mistakenly descended into cargo hold No.8 access space where he collapsed. As Berge Mawsons crew were collecting rescue equipment, two stevedores also collapsed in cargo hold No.8 access space as they attempted to rescue their stricken colleague.
The MAIB investigation concluded that:
- The stevedores died because they entered an enclosed space that had a noxious atmosphere that could not sustain life.
- Atmosphere testing of cargo spaces was not routinely carried out before stevedores entered the compartments.
- The stevedores were not adequately supervised on board Berge Mawson.
- Access ways to cargo spaces were not locked closed when not in use.
- The stevedores were unable to understand safety labels and warnings and cargo space identification.
- The agreed Ship-Shore Safety Checklist had limited validity after the commencement of cargo operations.
- The terminal had not trained the stevedores in line with international guidelines on safe cargo work on board bulk carriers.
- An industry-led initiative that requires bulk terminals to implement safety training and management systems could improve stevedore safety on board vessels.
Recommendations
A recommendation has been made to the Maritime and Coastguard Agency to review and revise the Code of Safe Working Practices for Merchant Seafarers to ensure that emergency drill scenarios for enclosed space rescues include the possible presence of shoreside staff or third parties. Recommendations have also been made to Bunyu Port Organizing Unit, PT Bintang Kartika Segara and PT Tanjung Mas to follow the guidelines set out in the IMSBC Code, BLU Code and BLU Manual to provide stevedores with training and PPE to enable them to work safely on board bulk carriers. A recommendation has been made to Berge Bulk Maritime Pte. Ltd maintain clear and precise guidance for masters and ships crews on cargo operations and ensure that specific duties for shore personnel are considered and the control of access is robustly applied. Recommendations have been made to Intercargo, InterManager and RightShip to develop a minimum operational safety standard for stevedores conducting cargo operations on board their members vessels to include and encourage their members to introduce the minimum operational safety standard for stevedores.
Read the full PDF report: Berge Mawson - Report And Annexes
