Summary

The 16 m landing barge Keppel Trader sailed from Darwin, Northern Territory in the early hours of the morning on 6 August 1995, bound for the port of Wyndham in Western Australia. On board were the Master and one deckhand.

On its deck, the barge was carrying a cargo of materials and equipment to enable it to be put on to a low-loader at Wyndham and transported overland to Lake Argyle. There it was contracted for thirteen weeks, to move equipment and stores during work on the Ord River hydro electric scheme.

The voyage plan was for the vessel to hug the coast, from Darwin to a position near Port Keats where, if necessary, it would anchor and wait for suitable weather conditions before making the crossing of the south-eastern corner of the Joseph Bonaparte Gulf at the mouth of the Victoria River. Strong south-easterly winds were forecast.

At about 0400 on 7 August, the vessel was south of Cape Hay when the Master handed the watch over to the deckhand instructing him to follow a course approximately one mile off the coast. The Master then turned in for a few hours sleep.

At some time before 0700, the Master was awakened by the motion of the vessel and found that it was in rough seas and approximately six miles off the coast, west of Pearce Point. The wind was blowing from the south-east at 25-30 knots and an estimated 3.5 m sea was running. He decided to run with the weather for a while, but after a further twenty minutes turned on to a reciprocal course and headed back into the weather towards the lee of the coastline.

The vessel made no headway into the weather. After a while, the deckhand went down the engine room hatch, situated on the main deck, to carry out engine checks. He had been gone for about five minutes when the barge suddenly developed a loll. The Master left the wheelhouse and when he reached the deck, the barge appeared to be sinking by the stern. A few seconds later it rolled to port and capsized, settling in a stable, upside down, attitude. Both men were thrown into the water.

The Master twice managed to swim to the exhausted deckhand, who drifted away from the vessel, and twice dragged him back to the upturned barge. After several unsuccessful attempts to get the apparently lifeless deckhand up the sloping bow door, the Master, exhausted, let go of him and the deckhand drifted away.

By that afternoon, the owner of the barge, having not been able to make either radio or satellite phone contact with the vessel, flew his own aircraft down the vessel's intended route but did not find the barge. On the morning of 8 August, when Keppel Trader still had not arrived at Wyndham and there had been no communication with the vessel, the owner advised the Marine Branch of the Northern Territory Department of Transport and Works, which contacted the Maritime Rescue Coordination Centre, and a search and rescue (SAR) operation was initiated.

The Master was rescued late that afternoon by an army helicopter, after spending some 34 hours on the upturned hull and in the water.

Two weeks later Keppel Trader was towed back to Darwin having been salvaged and righted.

Although Keppel Trader is under survey by the Marine Branch of the Northern Territory Department of Transport and Works, it was on an inter-State voyage and thus came under the provisions of the Navigation (Marine Casualty) Regulations.

Conclusions

These conclusions identify the different factors contributing to the circumstances and the causes of the incident and should not be read as apportioning liability or blame to any particular organisation or individual.

The Inspector concludes that Keppel Trader capsized due to the ingress of seas shipped into the engine room after the hatch in the weather deck was left open while the deckhand was carrying out engine checks. The following factors are considered to have contributed directly to the incident.

1. Keppel Trader was loaded at Darwin in such a manner that the vessel's stability did not meet the criteria of the USL Code Section 8, Sub section C.16 (for landing barges). The effect of the free-surface formed in the engine room bilge was exacerbated by this reduced stability which existed before the flooding began.
2. No stability calculations were undertaken before sailing from Darwin and the investigation revealed a lack of understanding of the principles of stability as applied in the Trim and Stability booklet.
3. The weather deck hatch was not marked `To be kept closed at sea' and the practice had arisen of always using this hatch, in spite of the emphasised warning contained in the Trim and Stability booklet.
4. The internal hatch, which should have been used for access to the engine room under the prevailing conditions, had been stacked with cartons of soft drinks when the vessel was stored with provisions, indicative of the fact that this hatch had fallen into disuse, even in heavy weather.
5. It is considered that the long-standing defects in the wheelhouse panel temperature gauges contributed to the incident, in as much as the Master felt compelled to check the engine temperatures on the local gauges at a time when the vessel was in difficulties.
6. Keppel Trader was proceeding on an inter-State voyage and as such came under the provisions of the Navigation Act 1912. No exemption under section 421 from certain provisions of the Act was obtained, or applied for in writing, from the Australian Maritime Safety Authority prior to Keppel Trader sailing from Darwin.
7. In the opinion of the Inspector, the manning of the vessel was inappropriate for a voyage of the duration of that being undertaken and Keppel Trader should have carried two qualified bridge watchkeepers.
8. The Inspector considers that insufficient attention was paid to the weather forecasts issued by the Bureau of Meteorology, both before the start of the voyage and after departure from Darwin, in particular the strong wind warning which was current for three days before the vessel's departure.

In addition, the Inspector considers that:

1. It would have been prudent to have alerted the Northern Territory Police to the loss of contact with the barge after the owner had overflown the vessel's intended route on the afternoon of Monday 7 August, and it had not been sighted.
2. The Master made commendable efforts to save the deckhand following the capsize and the Inspector considers he did everything possible under the circumstances.

Summary

On the morning of 10 July 1995, the Australian operated 37,557 tonnes deadweight bulk carrier Iron Baron arrived and anchored off the entrance to the River Tamar, Northern Tasmania. The ship was bound for the TEMCO terminal at Bell Bay, where it was to discharge 23,896 tonnes of manganese ore. The Master was advised that the Pilot would board at 1930.

When the crew went to stations to weigh anchor at 1900, the wind was from the north-north-west at 20 to 25 knots. The anchor was aweigh at 1913 and, after turning the vessel around, the Master manoeuvred the ship, at minimum manoeuvring pitch on the propeller, towards the pilot boarding position. So as to maintain a lee on the port side for the pilot launch, he adjusted the heading from south-south-west to south-west.

The Pilot boarded at 1933 and as soon as the launch was clear of the ship's side, the Master, aware that he had overshot the boarding position, ordered the wheel hard to port and the telegraph dead slow ahead, to bring the ship around on to the leads.

After an exchange of information with the Master, the Pilot ordered full ahead, to increase the rate of swing, and went to the port bridgewing, to check the lie of the leads. Using binoculars, he saw that the ship was too far to the south and likely to run aground on the eastern end of Hebe Reef. He therefore ordered hard to starboard, hoping to clear the northern edge of the reef. However, after turning through about 40, the ship grounded at a speed of about five knots, in a position 1.8 cables (333 metres) north of Hebe Reef beacon.

Attempts were made to refloat the ship, initially by going full astern and later with the aid of a tug, but these were unsuccessful. With the tide ebbing and the weather deteriorating, the movement of the ship became violent and progressive damage to the bottom plating became evident, with a number of tanks being ruptured.

When fuel oil was seen in the water, the Master mustered the crew and ordered the disembarkation of some of them, eventually ordering the disembarkation of the remainder at about 0645 on 11 July. Iron Baron was eventually refloated by salvors on 16 July. After extensive inspection of the vessel, both internally and externally by divers, and discussions with the Launceston Port Authority, the decision was made that Iron Baron should be scuttled. The vessel was towed to the position 39 37S 149 25E, 60 miles east-northeast of Flinders Island, where it was scuttled in 4000 metres of water on 30 July 1995.

Conclusions

These conclusions identify the different factors contributing to the incident and should not be read as apportioning blame or liability to any particular individual or organisation.

It is considered that by the time the Pilot arrived on the bridge and assumed control of the conduct of the vessel the grounding could not be avoided.

The following factors are considered to have contributed to Iron Baron grounding on Hebe Reef:

1. A full passage plan, detailing safe clearing distances and bearings to be used while picking up the Pilot, had not been prepared, and proper management of the bridge resources had not been considered.
2. Due consideration was not paid to the effects of the strong northerly wind and south flowing flood tide when manoeuvring to pick up the Pilot.
3. The vessel's progress was not monitored by plotting positions on the chart.
4. Although navigating by radar, no safety distances or bearings were drawn on the reflector plotter.
5. The Mate did not monitor the Master's actions, nor did he check the vessel's position by radar.
6. In relying upon the radar for information on the vessel's position, the Master
   a) was initially under the impression that Iron Baron was a mile further from the pilot boarding point than would have been the case.
   b) appears to have made no allowance for the fact that the beacon is located on the south side of the reef, that the shallows extend 2.5 cables north-east of the beacon and that the vessel's bow, 150 metres forward of the bridge, reduced the indicated distance off the reef by almost one cable.
7. The Master and the Deck Officers had not been given specific directions that passage planning was to include pilotage sections.
8. Although the Master was appropriately qualified, he had not been provided with all available training for the safe handling of ships before being appointed to his first command.

Summary

On Saturday 17 June 1995, the Australian bulk carrier Iron Prince collided with the fishing vessel Pisces to the west of Cape Nelson, Victoria at 0644 Australian Eastern Standard Time. The weather at the time was clouded sky with passing showers and gale force winds with a heavy sea and swell.

Iron Prince was on passage from Hay Point, Queensland, to Whyalla, South Australia, with a cargo of coal. The bridge watchkeepers did not see the fishing vessel in sufficient time to take full avoiding action.

Pisces, engaged in gill net shark fishing, was lying at anchor in proximity to the western end of its streamed nets. No lookout was being kept, the crew being asleep and, as the anchor light had failed, the lights being shown provided less chance of the vessel being seen by ships approaching from well abaft the beam.

After the collision, Iron Prince turned about and escorted Pisces, which had sustained damage but was still able to proceed safely, to Portland harbour.

No one was injured in the incident and there was no pollution.

Conclusions

These conclusions identify the different factors contributing to the incident and should not be read as apportioning blame or liability to any particular organisation or individual.

1. The manning on the bridge of Iron Prince was appropriate and the visual lookout alert. However, the lights being shown by Pisces were not seen in sufficient time for full avoiding action to be taken.
2. The lights being shown by Pisces on the night of 16/17 June 1995, were not those prescribed in the regulations for a vessel at anchor and greatly reduced the chances of early detection by a vessel approaching from astern or on the quarter.
3. There was no lookout being kept aboard Pisces.
4. The minimum safe manning requirement for Pisces, as detailed in the Uniform Shipping Laws Code and the State of Victoria marine regulations, makes the maintaining of a lookout at all times impractical.
5. The electrical supply, as required by regulation, aboard Pisces, was inadequate to provide sustained power to the deck lights when the engine was stopped.
6. The timber construction of Pisces made the vessel's detection by radar unlikely in the prevailing heavy sea conditions.
7. The Master of Iron Prince, in making contact with Pisces, in advising the authorities of the collision and in escorting Pisces to Portland, acted appropriately after the incident.

Summary

The Danish owned vessel Svendborg Guardian sailed from Townsville at about 2000 on 23 June 1995, on its regular service between Townsville and the port of Kiunga, on the Fly River, Papua New Guinea.

The ship had been engaged on this service since 1988 and habitually followed a route inside the Great Barrier Reef between Townsville and Cairns, and then by the Grafton Passage, through the Coral Sea to the Fly River.

At about 0400 on 24 June, the ship failed to make a course alteration off Brook Islands and maintained a straight course to run aground south of Murdering Point, Queensland at about 0600.

Immediate attempts to refloat the vessel were unsuccessful as the tide started to fall. The ship was towed off the ground by the tug Otto Tasman at about 1830 on 24 June. The vessel was subsequently towed to Cairns for inspection.

No significant damage was found, and the ship resumed its voyage to Kiunga on the afternoon of 26 June.

Conclusions

These conclusions identify the different factors contributing to the accident and should not be read as apportioning liability or blame to any particular organisation or individual.

Svendborg Guardian grounded as a result of a number of factors which combined to contribute to the grounding:

1. There was nobody on the bridge for a period of almost five hours with the ship effectively out of control.
2. The bridge was unmanned because the Second Mate left the bridge at shortly after 0105 and failed to return because he fell asleep.
3. The Second Mate was suffering from extreme fatigue as a result of poor-quality sleep from 18 June to 23 June and his decision not to sleep after the ship left Townsville. This decision, prompted by his desire to watch a rugby league match rather than ensure he was as fit as possible to take his watch, displayed inexperience and irresponsibility.
4. There was no look-out stationed on the bridge, and the ship was not equipped with any other system to alert the Master and crew in the event of the officer of the watch being incapacitated or otherwise not able to perform his/her duties.
5. The absence of a look-out made the accident inevitable once the Second Mate had fallen and remained asleep, because there was nobody to rouse the Second Mate, call the Mate or summon the Master.
6. The Master, Mate and Second Mate were all fatigued to a significant degree.
7. The Master in command on 24 June had ordered that a seaman should act as look-out during the hours of darkness. This instruction was not complied with possibly due to a misunderstanding and a lack of effective communications in the form of written notification, and because of the entrenched practice for the officers to keep a watch alone during the night.
8. The Owner's standard instructions did not give clear direction to the ship's masters to comply with the STCW Convention requirements.
9. The habitual practice of not posting a look-out should have been detected by the ship operators and rectified.

Summary

The 182 m long, Australian flag bulk carrier River Torrens arrived off the Port of Newcastle, New South Wales, at 2100 on 31 May 1995, loaded with about 27,000 tonnes of wheat from South Australian ports. At 2107, a licensed pilot for the port boarded the ship to take the vessel to no. 3 berth, the Western Basin Grain Terminal. The night was fine, partly cloudy, with a light north-easterly wind and a swell of about 1.6 m at the harbour entrance.

The vessel's bridge passed the outer end of the Southern Breakwater at 2123. The vessel was to the south of the transit of the main leading lights and turning to port, although full starboard rudder had been applied. The vessel's speed at the time was estimated to be 8 to 9 knots. As soon as the vessel was in the lee of the Southern Breakwater, the vessel's speed was reduced to half ahead and then, after about a minute, to slow ahead.

River Torrens steadied as it approached no. 2 buoy and, as the vessel then began to swing to starboard, full port rudder was applied to counter the swing and avoid no. 2 buoy. However, the propeller and rudder came into contact with the steeply shelving channel bank 80 m east of no. 2 buoy. Although the rudder was kept hard to port and one of the waiting tugs pushed hard on the starboard bow, the vessel continued across the channel.

The Pilot ordered the anchors to be let go, but before they could be released the vessel grounded on the northern side of the channel at 2127, about 10 minutes before high-water.

After initial attempts to refloat the vessel, both tugs were positioned at the ship's stern to tow the vessel off the bank. Using the ship's engine and tug power, the ship was refloated at 2147 and resumed passage for the grain berth.

An inspection of the ship showed all propeller blades were damaged, the lower half of the spade rudder was bent to an angle of about 30 degrees from the vertical and some damage to the main engine crankshaft was evident. Forward, there were some superficial scrape marks to the bottom paint work. On 4 June, River Torrens entered dry dock where further assessment of the damage was made and repairs to the vessel began.

Conclusions

These conclusions identify the different circumstances and causes of the incident and should not be read as apportioning blame or liability to any particular organisation or individual.

The Inspector is satisfied that neither alcohol nor drugs (prescribed or illicit) were factors in this incident. The Inspector considers that the following factors are relevant to the contact made by River Torrens with the south bank of the channel, about 80 m east of no. 2 buoy:

1. The port entry had been inadequately planned by both the Pilot and ship's staff and insufficient action was taken to ensure River Torrens was in the intended position at the harbour entrance.
2. As the ship approached the harbour entrance the ship was south of the leading transit delineated by the 'deep water' leading lights.
3. When the vessel turned to enter harbour it was south of the transit delineated by the main leading lights.
4. There was an acceleration in the rate of turn of the ship as it passed the Southern Breakwater head and, because the ship was towards the south side of the channel, there was insufficient room for the situation to be recovered.

The absence of any planning of the port entry by the Master of River Torrens meant that the pilotage could not be effectively monitored and the ship's officers were not sufficiently alert to the significance of the ship's position relative to the leading lights, resulting in reduced support to the Pilot.

1. The planning and communication between the Master and Mate, the Master and Pilot, and the bridge team and the forward anchoring party was ineffective.
2. The bridge organisation, with the Master relaying the Pilot's orders and an experienced officer standing by the telegraph, did not allow for a physical check to be made of the ship's position.

The following factors contributed to River Torrens taking the ground on the northern bank:

1. After contact with the southern channel bank, the existing forward momentum, combined with the astern movements of the engine, maintained the ship's turn to starboard.
2. Although it is problematic whether, had the anchors been dropped immediately when ordered, one or both anchors would have prevented the ship taking the ground, the fact that they were not cleared must be considered a factor in the incident.

Summary

The German flag container ship Carola sailed from Sydney on the afternoon of 25 March 1995, bound for Singapore by way of the inner route of the Great Barrier Reef.

At 0100 on 29 March, the vessel embarked a licensed pilot off Cairns for the passage through the inner route to Goods Island. The vessel made good a speed of marginally over 15 knots.

At about 0230 on 30 March, the Pilot left the bridge in an area where there was to be no alteration of course for about two hours and where other shipping and fishing boats presented no potential hazard. The Pilot gave clear directions to the Second Mate, the officer of the watch, that he was to be called at a position that he had marked on the chart, or if the mate had any concerns.

At a little after 0400, the Mate relieved the Second Mate, who passed on the instruction about calling the Pilot.

At 0458 on 30 March, Carola ran aground on South Ledge Reef.

The Master, who was asleep in his cabin, was woken by the change in the characteristic vibration of the ship. He went to the bridge where he found only the Mate and lookout. The Pilot was called from his cabin.

The damage was assessed, soundings of the ship's tanks were taken and the Maritime Rescue Coordination Centre was informed. It was established that the fore peak tank was breached and some water was entering the bow thruster space. However, the ship's pumps were able to handle the ingress of water.

No injury was sustained to the Pilot or any crew member and no pollution resulted from the grounding.

The Carola refloated about six hours later at 1115 on the high tide and, after the Master established that it was safe to do so, the ship continued its passage to Goods Island. It anchored off Goods Island after 1530. In the evening of 30 March, a surveyor from the ship's classification society boarded the vessel and over the next three days the vessel was inspected by divers and repairs carried out, to allow it to continue the voyage to Singapore.

Carola resumed its voyage on 4 April.

Conclusions

These conclusions identify the different factors contributing to the accident and should not be read as apportioning liability or blame to any particular organisation or individual.

The grounding was not due to any mechanical failure on board Carola or any deficiency in the navigational aids marking the reef.

The grounding was the result of the Mate neither ensuring the Pilot was called to the bridge at the designated position, nor altering course in the Pilot's absence.

The Mate was overcome by drowsiness which caused him to loose track of time and space.

The Mate's condition was induced by both an intake of alcohol some four hours before going on watch and reduced sleep time. His condition was compounded by the ambience of the bridge and the avaliablity of a comfortable chair at the command position. The conditions on the bridge were not under the control of the Mate, however any intake of alcohol and duration of sleep were under his control.

The rest periods taken by the Pilot, under the prevailing conditions of weather and shipping traffic, were reasonable and in accordance with the practice of Reef Pilots.

The part bottle of beer consumed by the Pilot just before midnight on 29 March would not have impaired his performance or efficiency.

Summary

On 22 February 1995, tropical cyclone 'Bobby' was moving in a west-south-westerly direction off the north-west coast of Australia, gradually increasing in intensity.

At 0600 on 23 February, Bobby was located 136 nautical miles to the north of Dampier and, as a safety precaution, vessels lying at anchor in Dampier Roads were instructed to weigh anchor and proceed to sea.

The Maltese flag, 61,297 deadweight tonnes bulk carrier Bulkazores, one of six vessels at anchor, was the first vessel to clear the anchorage. The Master took the vessel two miles beyond port limits and then hove-to, to ride out the developing storm.

At 0722 on 24 February, the Master of Bulkazores advised Dampier Port Control that Bulkazores was being set towards the shore and, at 1026, the vessel took the ground close to Kendrew Island.

Bulkazores refloated at 1633, at high water, and the Master, on advice from the Harbour Master, let go the starboard anchor. Bulkazores then safely rode out the remainder of the storm. After inspection by divers, the vessel was moved on 28 February, to a position close to Dampier public wharf.

An inspection by divers indicated extensive scratching and paint removal, but only relatively minor indentations in the bottom plating. On 2 March, after an internal inspection confirmed that no tanks had been ruptured, the Classification Society declared Bulkazores fit to load cargo.

Conclusions

These conclusions identify the different factors contributing to the incident, not for the purpose of apportioning blame or liability, but for identifying areas where mariners need to exercise extreme caution and proper planning and bridge resource management in order to prevent a similar occurrence.

The grounding of Bulkazores in shoal water off Kendrew Island, Western Australia, on 24 February 1995, was caused by poor seamanship, in that Bulkazores did not clear the area when the tropical cyclone changed direction and moved towards the Dampier Archipelago, as a result of which the vessel came within the dangerous semicircle of the cyclone and was trapped on a lee shore.

Other decisions and actions, both before Bulkazorres arrived at Dampier and after it was instructed to leave Dampier Roads anchorage, are considered to have contributed to the incident:

The initial recommendation of the weather routing consultant was disregarded, probably in order that Bulkazores would arrive before a competing vessel and, apparently, without taking into account the known behaviour of tropical cyclones off the north-west coast of Australia and their propensity to curve towards the coast.

Despite ample early indication of the probability of strong winds and rough seas being encountered near the coast, additional ballast was not taken in no.4 hold before the weather deteriorated.

The Master relied solely on his own judgement, at no time did he discuss his course of action with his officers, to gain other opinions as to the dangers posed by the cyclone and the appropriate action to be taken.

Summary

On 3 February 1995 the Norwegian flag tanker Team Heina was at anchor off Sydney Harbour, waiting to berth at Gore Bay, when, at about 0945, a compression fitting on a line to a fuel pressure gauge on No.3 diesel generator blew out. The resulting spray of hot heavy fuel oil at about 6 bar pressure, ignited on the engine's exhaust manifold and then spread burning oil over the deckhead above the engine. The fire intensified and expanded rapidly.

Most of the engineering department personnel were working around the engine room at the time. The First Engineer ran to the engine control room and shut down the generator before attacking the fire with an extinguisher. The extinguisher, however, failed to discharge. The motorman had grabbed another extinguisher but that, too, failed to discharge. By the time other extinguishers had been brought to the scene and used, the fire had increased to the point where the Chief Engineer decided to evacuate the engine room.

The engine room was evacuated, the vent flaps were closed and the vessel's fixed fire- fighting system (Halon) was discharged. When it became apparent to the ship's crew, who were making their way to their muster stations on deck, that it was a serious fire, a number of them ran to the port lifeboat.

Ten to fifteen minutes after discharging the Halon, a crew member, wearing breathing apparatus, made a re-entry and reported that some small patches of fire remained. These were put out by two other crew members with portable extinguishers.

The First Engineer, wearing breathing apparatus made an entry and started one of the diesel generators, restoring power to the vessel which had remained blacked out since No.3 generator had been stopped. The emergency generator had started but failed to come online.

The engine room was ventilated, and the damage was assessed. Initially it appeared that the damage was superficial, but closer inspection of the main cable run above No.3 generator revealed that it had suffered some damage. The classification society imposed a condition of class on the vessel, requiring repairs at the next drydocking. Pending repairs, only Nos. 1 and 2 generators could be used.

Conclusions

These conclusions identify the different factors contributing to the accident and should be not read as apportioning blame or liability to any particular organisation or individual.

1. The fire in the engine room was caused by a spray of hot fuel oil, from a failed compression fitting on the fuel rail of the starboard generator engine (No.3), being ignited by the hot exhaust manifold.
2. The pipe to the fuel pressure gauge had blown out of the compression fitting following prolonged fretting of the pipe within the olive and of the olive within the compression fitting. The fretting was caused by misalignment of the pipe with the fitting and the added fact that the pipe had probably not been inserted sufficiently far into the olive on initial assembly. The combined effect would have been exacerbated by engine vibration.
3. The actions taken by the ship's staff to fight the fire were correct and the speed with which the preparations for Halon flooding were made was commendable.
4. It is speculative as to whether the failure of the first two dry powder fire extinguishers to discharge had any effect on the overall fire-fighting operations. However, it is not expected that two extinguishers serviced only six days previously, should fail in such a manner. The Inspector considers that the workload and schedule for servicing the ship's fire-fighting equipment by one man was such that the service could not have been sufficiently thorough.
5. The re-entry to the engine room, without breathing apparatus, was made on the assumption that there had been sufficient ventilation for sufficient time. As portable oxygen analysers are part of the safety equipment carried by tankers, it would have been prudent to have used one to check the atmosphere before the re-entry was made.

Local safety action

As a result of this investigation, the operator issued a safety notice to flight crew advising the circumstances of the occurrence, and emphasising the need for sterile flight deck requirements during critical phases of flight.

Summary

A little before 1700 on 12 January 1995, the Australian flag tanker Conus sailed from the tanker berth, Townsville Harbour, under the direction of a pilot.

In navigating the narrow entrance channel, the vessel was set to the north and west by the east-south-easterly wind, blowing at 16 to 20 knots and the flood tide. The vessel first touched the side of the channel about 500 metres from the harbour entrance, and then came into contact with a channel marker beacon before coming to a stop just over 1000 m from the entrance.

Nobody was hurt as a result of the grounding. The seabed on either side of the approach channel is soft mud and no apparent damage was sustained by the ship, no pollution resulted, and the risk of pollution in the circumstances was minimal.

After about 45 minutes the ship was refloated with the ship's main engine and bow thruster and assistance from the two harbour tugs. At 1758 the vessel had regained the channel and at 1815 the tugs were dismissed. The ship cleared the pilotage area, disembarking the Pilot by 1836.

Conclusions

These conclusions identify the different factors contributing to the circumstances and the causes of the incident and should not be read as apportioning liability or blame to any particular organisation or individual.

1. The Pilot did not plan the undocking and take full account of the wind strength and direction.
2. The Pilot and Master did not jointly consider any sailing plan for Conus, taking into account the prevailing conditions, rather they relied on a 'standard' departure which did not take into account the possible effect of the wind or tide.
3. The prevailing wind conditions were not severe or unusual, but they were such that the ship's position and speed at the harbour entrance were critical to a safe transit of the Platypus Channel.
4. The ship had not gained sufficient speed at the harbour entrance to counteract the ship setting to the port side of the channel.
5. The correction for leeway and drift in increments of two degrees over a three-minute period, rather than an immediate alteration of ten degrees, was inappropriate in the circumstances.
6. No accurate assessment could be made of the tidal stream, given the absence of any tidal meter monitoring the tide in Platypus Channel.