The Australian Transport Security Bureau (ATSB) has revealed Report MO-2025-004 into an unplanned strain launch which resulted in burn accidents to a few crew members, studies an IMCA Security flash.
What occurred?
An engineering crew was conducting upkeep on the principle deck steam valve for the heating system of an oil tanker. After the system was remoted, the crew eliminated the valve bonnet, and residual scorching condensate was all of a sudden launched, leading to burn accidents to a few crew members. After receiving first assist on board, the crew members have been transported to shore for medical therapy.
What went incorrect?
Investigation discovered the crew had not allowed enough time for the steam system to chill earlier than beginning work on the cargo heating system principal deck steam valve.
The investigation additionally discovered a everlasting modification to the steam drain line had been carried out on board this vessel with out documentation.
The ATSB famous that this undocumented change, which was not included right into a danger evaluation or formally reviewed, doubtless launched a system vulnerability that undermined the effectiveness of the steam system isolation.
Furthermore, the ATSB discovered the modification was not recognized throughout routine technical inspections or a number of firm superintendent visits to the ship.
What did they do subsequent?
Because the incident, the drain line on this vessel was returned to its authentic design configuration.
A fleetwide marketing campaign was began to determine any unauthorised modifications to shipboard piping techniques.
Crew have been inspired to keep in mind that modifications ought to be undertaken solely after acceptable session and at all times in accordance with a proper Administration of Change course of.
Classes to study
The place modifications are to be made to a system, these have to be recorded and the processes to determine the dangers ought to to be adopted to make sure there are not any unintended penalties.
Enable adequate time for cooling when coping with techniques involving fluids at very excessive temperatures.
Keep in mind to incorporate visible affirmation that one thing is remoted – examine, double examine, examine once more.
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Supply: IMCA
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