The MAIB has published its report in the fatal incident aboard the pelagic fishing vessel Sunbeam FR 478 at Fraserburgh
The Marine Accident Investigation Branch has published its report in the fatal incident aboard the mfv Sunbeam FR 478 at Fraserburgh Harbour on 14 August 2018 which resulted in the sad loss of one life.
On 14 August 2018, a second engineer on board the pelagic trawler Sunbeam was asphyxiated and died in one of the vessel’s refrigerated saltwater tanks. Sunbeam was in Fraserburgh and the refrigerated saltwater tanks had been emptied of water in preparation for cleaning. Entry into Sunbeam’s refrigerated saltwater tanks, which were enclosed spaces, was routine business for the crew, both when operating the tanks at sea and during maintenance in harbour. On this occasion, the atmosphere could not support life because Freon gas had leaked into the tank, displacing the air.
Hazards associated with enclosed spaces can include flooding, heat, toxic gasses, flammable gases and oxygen deprivation. It is vital that enclosed spaces are recognised, and safety precautions are put in place before personnel enter them. These include proper ventilation, atmosphere monitoring and a rescue plan.
Risk assessments help to identify hazards and lead to method statements for the safe control of work. Without control of the maintenance work being undertaken on board Sunbeam, the second engineer was working alone, and in an enclosed space. Lone working presents significant hazards if you get into difficulty, and it is completely unacceptable in enclosed spaces.
Sunbeam’s refrigeration plants were not well maintained and were not being operated as designed. Repairs to corroded and leaking tubes in the starboard refrigeration plant’s evaporator had been ineffective, resulting in the leak of Freon.
This report makes recommendations to the Maritime and Coastguard Agency to: implement measures for the safe conduct of enclosed space entry on board fishing vessels by extending the application of the Merchant Shipping (Entry into Dangerous Spaces) Regulations 1988 to include fishing vessels (2020/137) and make corresponding updates to the relevant codes of practice; and, review its Letters of Delegation to its Recognised Organisations with respect to the survey of machinery items (2020/138).
Since the accident, the International Labour Organization’s Fishing Convention 188 has come into force and an industry voluntary Fishing Safety Management Code has been developed to assist owners in complying with the Convention. A safety recommendation has, therefore, been made to the owners of Sunbeam to implement a safety management system on board, in accordance with the Fishing Safety Management Code (2020/139). The Scottish Pelagic Fishermen’s Association has also been recommended to encourage its members to maintain safety management systems compliant with the Fishing Safety Management Code (2020/140).
Accident Investigation Report 19/2020
Investigation report into marine accident including what happened, safety lessons learned, action taken and recommendations: