2.9 ASSESSMENT OF PERSONNEL AND WORKING PRACTICES
2.9.1 Effective assessment
Neither the master on Timor Stream nor the chief officer on Seagate was working as their company managers would have wished. Managers need to have trust in their crew, but at the same time must make efforts to ensure that their trust is being earned and not misplaced. The nature of both these vessels’ trading patterns made it difficult for managers to conduct sea-going audits or personnel assessments. No assessment scheme is infallible, but this and the other similar accidents show that there is a need for company managers to implement systems which seek to identify and correct poor professional standards.
Zodiac, the managers of Seagate, operated a personnel evaluation system, which has since been modified to make it more effective. It is considered below in order to help other vessel managers develop their own systems. 39
As Timor Stream was not UK registered, the personnel evaluation system operated by Triton Schiffahrts GmbH has not been reviewed. However, given the performance of Timor Stream’s master during this accident, it would be appropriate for the vessel’s managers to reassess the effectiveness of their personnel reporting system.
2.9.2 Zodiac’s personnel evaluation system
Zodiac’s managers’ records of its personnel’s performance were primarily recorded in numerical format from 1 (highest), to 5 (lowest). The evaluations did not necessarily consider whether a bridge watchkeeper was proficient in their watchkeeping duties. Personnel were asked to account for their poor performance only when required to do so by a company manager; they were not routinely provided with feedback about their performance from their reporting officer.
The chief officer’s written evaluations varied from the highest to the lowest levels of performance. Zodiac’s managers had warned him about his poor performance on one occasion and he had subsequently provided assurances that his performance would improve. However, the chief officer’s reports were primarily related to his work with cargo operations, and during his 6 years working for Zodiac there had been no specific assessment of his competence as a bridge watchkeeper. He had joined the company as a senior officer and was expected to have adequate watchkeeping standards.
Similarly, the chief officer had been on board Seagate for only a relatively short time before the accident, giving the master little time in which to assess his performance and identify any shortcomings in his watchkeeping. Even if he had, there was no guarantee that he would have identified any concerns in such a short period.
A more detailed evaluation system, which included the opportunity to write a description of an individual’s performance across the whole range of their duties, would have helped Zodiac’s managers improve their knowledge of crew performance over the long term. There are also benefits in reporting officers routinely providing more immediate feedback to crew on their performance. Zodiac’s managers have since implemented a more open and wide-ranging form of evaluation, which should be more beneficial to them and their personnel.
2.9.3 Company audits
Seagate was previously audited by Zodiac managers in December 2011, a few months before the accident. The previous audit of the ship’s navigational practices was carried out in 2008 when the ship was at sea.
The company’s ability to carry out internal audits of its bulk carrier fleet was limited by the ships’ long sea passages and unpredictable trading patterns. By accepting the limited scope and frequency of audits, Zodiac’s managers reduced their oversight of the performance of their sea staff. They came to rely increasingly on their masters to ensure that standards of navigation and collision avoidance were appropriate. While this is appropriate to a certain extent, this accident highlights the importance of managers maintaining an effective inspection and audit system of vessel operations at sea.40
Following the accident Zodiac’s managers have reviewed their system for internal and navigation auditing of their bulk carrier fleet to ensure that they are provided with an effective oversight of bridge watchkeeping standards.
2.10 VOYAGE DATA RECORDERS
VDR data is a significant aid to accident investigation, and the data is equally beneficial to ship managers, masters and their crew. In this instance, the total lack of VDR data from one vessel, and incomplete data from the other, significantly hampered the reconstruction of events.
Seagate’s VDR data was not saved after the accident, despite the MAIB inspector’s and Zodiac’s manager’s requests to the master. The master was aware of the request and focused on downloading the data, rather than making sure it was safe. He was subsequently evacuated from the ship before he was able to download the data. When limited electrical power was later restored the VDR restarted, without the crew realising, and the data was overwritten.
The VDR data would have provided valuable factual information as to the sequence of events prior to the collision, particularly the conversations between the chief officer and the lookout. While the saving of VDR data should not interfere with actions to protect the safety of the ship and crew, it is considered likely that there was time to press the save button or remove the data capsule. Once the situation had stabilised, there were further opportunities to make sure the data was safe before the electrical power was restored. Masters and bridge officers should be familiar with the process for saving their VDR data. Emergency response drills should include the protection of VDRs’ data so that it becomes established as a routine procedure.
Timor Stream’s VDR had faults that prevented the data from the accident being downloaded as designed. Consequently, the local technician was unable to retrieve any data. Although the MAIB’s technicians were later able to download some of the data, ship managers should ensure that the VDRs on their vessels can both record and be downloaded correctly. One way, and perhaps the best way, to have confidence that a vessel’s VDR will work when it is needed is to practise recording, downloading and interrogating the data regularly.