Marine safety investigations & reports

Machinery failure on HC Rubina and subsequent contact with the wharf at Brisbane, Qld. on 29 October 2013

Investigation number:
Status: Completed
Investigation completed


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What happened

On 3 October 2013, immediately before HC Rubina sailed from Beira, Mozambique, the control system for its controllable pitch propeller failed. The ship subsequently made its voyage to Brisbane, Australia, with the propeller’s pitch manually operated from the local control station.

On the afternoon of 29 October 2013, a pilot boarded HC Rubina for its passage in to Brisbane. While the ship was being manoeuvred off its berth, a flexible coupling for the shaft alternator that was providing power to the bow thruster, suddenly failed. The aft end of the engine room rapidly filled with smoke, forcing the engineer controlling the propeller pitch to leave the local station. Consequently, the ship’s propulsion was no longer being controlled and the ship made contact with the wharf, sustaining minor damage.

What the ATSB found

The ATSB found that HC Rubina’s shipboard planned maintenance system provided no guidance for the maintenance of the shaft alternator’s flexible coupling.

The ATSB investigation also identified a number of other safety factors. The ship’s managers did not ensure that the defective propeller pitch control system was reported as required to relevant organisations to allow them to consider the risks arising from the defect. Further, the method used by the ship’s agent, in Brisbane, to collect information for the port’s online booking system did not ensure that such defects were captured.   

The increased risk arising from the ship’s defect and the weather conditions leading up to the incident were factors that should have been considered to determine whether the pre-prepared passage plan remained appropriate.

Although it did not directly contribute to the incident the ATSB investigation did note that at a critical time during the incident, the crew communicated in Russian instead of English, the mandated working language for all ship’s bridges. As a result, the pilot was left out of the communication loop and his ability to make informed decisions was limited.

What’s been done as a result

Maritime Safety Queensland (MSQ), Queensland’s maritime regulator, has updated the training that it provides to the state’s ship agents to raise awareness regarding the gathering of information and reporting of ship defects. Further, MSQ, in conjunction with Brisbane Marine Pilots, has revised the procedure used to exchange information between vessel traffic services (VTS) and the pilot. Specific emphasis was placed on the reporting of defects that could affect the safe navigation of the ship.

HC Rubina’s agent in Brisbane has revised the method used for collecting information, from ship masters, by including a question that specifically asks if the ship has any defects.

Safety message

The incident highlights the importance that needs to be given to the maintenance of critical items of ship equipment and the reporting of their operational condition. Doing so can ensure that pilotage and other high risk operations can be appropriately pre-planned and managed to reduce the likelihood of an incident.

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Safety Issues

Go to MO-2013-012-SI-01 - Go to MO-2013-012-SI-02 - Go to MO-2013-012-SI-03 -

Planned maintenance

HC Rubina’s electronic planned maintenance system did not contain any instructions to ensure that the shaft alternator flexible coupling was maintained in accordance with the manufacturer’s requirements.

Safety issue details
Issue number: MO-2013-012-SI-01
Who it affects: All ships
Status: Adequately addressed

Defect reporting

The ship’s managers did not have effective systems to ensure that the defective control system for the controllable pitch propeller was reported to the relevant organisations as required.

Consequently, Brisbane’s vessel traffic services, pilotage provider and the pilot remained unaware of the defect and could not consider it in their risk assessments before the pilotage started.

Safety issue details
Issue number: MO-2013-012-SI-02
Who it affects: All ships
Status: Partially addressed

Port entry procedures – Defect notification

The ship’s agent’s information questionnaire did not ask for all of the information required to complete the QSHIPS booking form and ensure that defects were reported.

Safety issue details
Issue number: MO-2013-012-SI-03
Who it affects: Port operations and vessel’s under pilotage
Status: Adequately addressed
General details
Date: 29 October 2013   Investigation status: Completed  
Time: 2000 UTC +10   Investigation level: Systemic - click for an explanation of investigation levels  
Location   (show map): Brisbane    
State: Queensland    
Release date: 14 November 2014   Occurrence category: Incident  
Report status: Final   Highest injury level: None  

Vessel details

Vessel details
Operator IMM Shipping  
Vessel Beira, Mozambique  
Flag Antigua and Barbuda  
IMO 9198226  
Sector Other  
Type of operation Pilotage  
Damage to vessel Minor  
Departure point Beira, Mozambique  
Destination Brisbane  
Last update 03 April 2020