Broström Tankers Singapore Pte Ltd F/SOPM/V1/11/1

Observation Report Page 1 of 3

Instruction: This form shall be used for reporting all incidents, personal accidents, injuries, non-conformities, technical
deficiencies and near misses (for personal accidents, additional information shall be reported using Personal Accident Report
form). Report shall be send to QSE & Technical Operation department via e-mail as soon as practicable after the observation.
The initial report can be send before the investigation is completed. No signature shall be required in this form.
Type of Observation: Near Miss Status: Submitted to QSE
Unit:Bro Easkem Location: Port Dickson Anchorage Date: 02.10.201 Time: 0930 LT
0
Title of Observation
Gangway Air Hose Burst
Details of the Observation describing series of events and extent of damage
Gangway air hose burst while deck crew lowering the gangway for routine test. The gangway
was already out of restored position and keep on moving down slowly due to its weight.
Involved deck crew tried to brake the winch, however there is no such equipment provided to
the gangway winch. Finally they tied two ropes to the gangway and secured to the ship's
structure in order to stop the gangway while the other crew renewing the air hose. After the
new hose was ready, the gangway later tested and restored to its position.
Corrective action(s) taken to eliminate immediate hazards
1. Immediately secured the gangway with ropes to prevent it from moving down
2. Renewed the air hose.
3. Restore the gangway after the new hose was ready.
Potentiality (select one or more from following categories)
Actual or probable threat to crew [Deaths or permanent disabilities=High; Loss Work Days=Mid; Other injuries=Low] Mi
d
Actual or probable threat to environment [Spillage into sea= High; Contained spillage=Mid; Minor controllable leakage=Low] Lo
w
Actual or probable cost of damage [More than 100KS$=High; 100K-10KS$=Mid; Less than 10KS$=Low] Mi
d
Maximum level from above Mi
d
Observation reported by- Name: Anthony Parlindungan Designation: Chief Officer.
Acknowledged by- HoD: Name: Anthony Parlindungan; Designation: Chief Officer & Master: Name: Capt.
Wang Zhi Qiang. Forwarded to QSED on: 07.10.2010
Above part of the report can be send before completion of the investigation.
Investigation (to be performed by Ship’s and/or H/O staff)      
Investigation presses – describe briefly what has been done to Checked the condition of air hose and our
investigate such as dismantling of equipment, interview of crew, finding was the air hose burst due to
checking of records etc. Simple observations can be
investigated just by reviewing the above report. material fatique
Is inadequate procedure, guideline or written instruction contributed No [If yes, describe]      
to the occurrence?
Is any equipment failure contributed to the incident? Describe the No [If yes, describe]      
fault, when and what maintenance/inspection was done before
incident and any overdue maintenance etc.
Direct Cause(s) (unsafe acts & conditions which were immediate causes to occurrence)
Unsafe act(s) No check on the air hose was done
Example: operating equipment without authority, before lowering the gangway
removing/bypassing safety devices, using effective equipment
knowingly, improper use of equipment, not using PPE, improper
lifting or position for a task, servicing equipment in operation
(without switching off/isolating), rough/ reckless/ silly behavior,
under influence of drink/ drug etc

Edition 2009 Revision 1 Date: 15 Jul 2009

 Broström Tankers Singapore Pte Ltd F/SOPM/V1/11/1
Observation Report Page 2 of 3
Unsafe condition(s) NA
Example: inadequate guards/ barrio, adequate/ proper PPE not
available, defective tools/ equipment/ material provided, workspace
restrictions, hazardous environment (dust, smoke, gasses etc),
noise, high/low temperature, inadequate ventilation, poor house
keeping
Indirect Cause(s) (human & job factors which were reason why direct causes happened)
Human factors(s) Poor motivation, Complacency
Example: physically not suitable for the job (not strong enough or
too big in size or sick etc), fatigue/mantel disturbance, lack of
knowledge, lack of skill/experience, stress, poor motivation etc.
Job factors(s) Inadequate supervision
Example: Inadequate leadership/ supervision, inadequate
engineering, inadequate supply, inadequate maintenance,
inadequate tools or equipment, inadequate work standard
Root Cause(s) (lack of control that initiated direct & indirect causes)
Lack of planning No [If yes, describe]      
Organizational structure, procedure, voyage/cargo plan, PMS etc
Lack of standard No [If yes, describe]      
International regulation (like SOLAS, MARPOL, STCW etc),
Certification, Industry recommendations, equipment/ship’s manuals
etc
lack of compliance No [If yes, describe]
Failure to comply with plans or standards
Name(s) & Designation(s) of the Investigator(s):       Date investigation completed:      
Preventive action(s) (to be proposed from Ship and/or H/O)
Sl Action Proposed Action Date Statu Remark
by by Due/Do s by H/O if any
ne
01 To check the condition of the air Chief Chief Conti ---      

hose before lowering the gangway Officer Offcie nuous

r ly
02 It is advisable not to lower the Chief All Conti ---      

gangway while the vessel is Officer Crew nuous

underway. ly
03                         ---      
04                         ---      
05                         ---      

Attachments
1. NA

Workflow / Comments Record

Date By Action / Comment
02.10. A/B Renewed the air hose
2010 Koyu
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 

Edition 2009 Revision 1 Date: 15 Jul 2009

 Broström Tankers Singapore Pte Ltd F/SOPM/V1/11/1
Observation Report Page 3 of 3
Evaluation at H/O
Element Remark By
Immediate corrective action(s)            
Investigation and cause(s)            
Preventive action(s)            

Closed Out by DPA or QSE Department -Name:      ; Date closed:      ; Remark (if any):      

Edition 2009 Revision 1 Date: 15 Jul 2009