The New Zealand Transport Accident Investigation Commission (TAIC) has issued an investigation report into an incident where a bulk carrier in Cook Strait suffered a lifting operation failure, causing serious head injuries.
What happened
On 20 March 2025, a bulk carrier was drifting in Cook Strait while waiting for an available berth at the Port of Wellington. The weather had been rough in the days leading up to the incident, resulting in two cargo lashing chains washing off the deck and trailing over the ship’s side. The crew developed a plan to retrieve the chains using an improvised lifting system powered by a mooring winch. During the recovery of the second lashing chain, a web sling used to anchor the lifting system to the ship’s structure failed. As a result, components of the lifting system struck one of the able seamen, causing him to fall into the bosun. The able seaman sustained serious head injuries and required medical evacuation by helicopter.
Findings
- The Commission found that previous damage to the eye of the web sling, and its overall poor condition, contributed to its failure
- Testing revealed that while the sling withstood a load greater than its 1-tonne safe working load, it failed at only 48% of its expected minimum breaking load of 6 tonnes
- It is very unlikely that the failed web sling was one of the four web slings that had been thoroughly examined and found to be in good condition as shown on the SMS lifting gear register
- The Commission considers it is very likely that the failed web sling was inherited from the previous operator and remained on board in addition to the slings included in the SMS lifting gear register
- It is likely that the crew underestimated the importance of the sling to the lifting system and did not recognise the dangers associated with the rigged lifting system under load
- It is virtually certain that the bosun picked up the sling to use without realising it had not been subject to the SMS quality assurance
- Given the condition of the web sling and the fact it was not listed in the register, it is unlikely that the sling had been inspected by the chief officer or chief engineer as required by the SMS
- During the lifting operation, the bosun and an able seaman were standing in the bight of the lifting system
- Neither a toolbox risk assessment nor formal risk assessment was conducted for lifting the lashing chains, which was a non-routine task
- A supervisor was not assigned for this task because the bosun was part of the team conducting the work
- Implementation of the safety management system toolbox meeting and risk assessment requirements would have increased the opportunity for crew to recognise the risks involved and take steps to make the job safer
- Risk assessment, planning and supervision of the work increase the likelihood of the work being carried out safely and provide a deeper appreciation of the risks associated with the job
Onboard inspection and control of loose gear
- Safety issue: The safety management system did not ensure that all equipment used for lifting operations was maintained in a safe condition
- As a result, unsafe equipment remained in service and failed, resulting in serious injury
- The operator implemented the following actions
- Implementation of inspection, maintenance, and control procedures for lifting gear
- Introduction of colour coding and inspection status tracking
- Enhanced inventory control and segregation of defective equipment
- Review of procurement, inspection, maintenance, and disposal processes
- Standardisation of lifting gear management across the fleet
- The Commission considers the safety action taken has addressed this issue and no recommendation was made
Planning and execution of safe work
- Safety issue: The safety management system included procedures for risk assessments and toolbox meetings
- However, onboard implementation and audit follow-up did not ensure that non-routine tasks were properly planned and safely executed
- The operator acknowledged improvements could be made and implemented the following actions
- Requirement that toolbox meetings be conducted at the worksite where practicable
- Reinforcement of supervision requirements, including assignment of a responsible person not directly involved in the task
- Revision of safety management system procedures to strengthen risk assessment and toolbox meeting requirements
- Enhanced audit focus on practical onboard implementation
- The Commission considers the safety action taken has addressed this issue and no recommendation was made
Other safety actions
- The operator acknowledged the following lessons from the occurrence
- Importance of identifying indirect hazards
- Risks associated with high-powered winches used in improvised systems
- Need for pre-use inspection of lifting components
- Role of personal protective equipment as a last line of defence
- These lessons were incorporated into fleet safety circulars, training and awareness programmes, and internal safety campaigns.
https://safety4sea.com/wp-content/uploads/2026/06/TAIC-Injury-bulk-carrier-2026_06.pdf