Smelly Containers and Dodgy Engines

Australia’s Transport Safety Bureau has released two incident reports, one involving improperly packed hazardous cargo in a container and one about an engine failure due to a fatigued gudgeon pin and questionable maintenance.

Independent investigation into the leakage of dangerous goods on board the Liberian registered container ship, Kota Pahlawan off the coast of Australia on 16 June 2006

Occurrence Details

Occurrence Number: 228 Location: En route Singapore to Torres S
Occurrence Date: 16 June 2006 State: QLD
Occurrence Time: 1000 local time Highest Injury Level: None
Occurrence Category: Incident Investigation Type: Occurrence Investigation
Occurrence Class: # Investigation Status: Completed
Occurrence Type: Equipment Release Date: 20 November 2007

Vessel Details

Vessel: Kota Pahlawan Flag: Lib
IMO: 9142942
Type of Operation: Container
Damage to Vessel: Nil
Departure Point: Singapore Departure Time: N/A
Destination: Brisbane

On 16 June 2006, during Kota Pahlawan’s voyage from Singapore to Australia, a foul odour was noted coming from two containers on board the ship. The containers were packed with xanthates, dangerous goods which produce carbon disulphide vapours and can spontaneously combust.

Later that day, the master informed the ship’s charterer of the ‘incident’ and that the odour indicated that the packaging of the xanthates was not ‘gas-tight’, in accordance with international rules. He also asked for the containers to be discharged at Brisbane, the ship’s next port of call.

At 0411 on 18 June, the master reported the incident as a defect to the Australian Maritime Safety Authority (AMSA). At 0720, the ship embarked a coastal pilot and started its transit of the Great Barrier Reef.

At 0907 on 19 June, AMSA issued a defect report and started collecting information about the incident. At 1252, the pilot disembarked from the ship after it had completed its transit of the northern part of the Great Barrier Reef Inner Route.

The ship berthed in Brisbane on 22 June after an ‘emergency’ was declared in the port. All eight xanthates containers on board the ship were discharged and purged with nitrogen gas to mitigate the risks posed by the foul smelling, highly flammable and toxic carbon disulphide vapours. On 24 June, the master was asked to reload the containers. He agreed on the condition that AMSA provide a written acceptance of the proposal with regard to ‘compliance’ with international rules.

By 0400 on 25 June, the xanthates containers had been reloaded onto the ship before it sailed from Brisbane. On 6 July, the ship discharged the last of the xanthates containers in Fremantle.

The report identifies several safety issues and the safety actions to address them.Download complete report [1.6 MB PDF]

Independent investigation into the main engine failure on board the self discharging bulk carrier Enterprise in Bass Strait on 10 July 2006.

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Occurrence Details

Occurrence Number: 229 Location: Eastern Bass Strait
Occurrence Date: 10 July 2006 State: VIC
Occurrence Time:   Highest Injury Level: None
Occurrence Category: Incident Investigation Type: Occurrence Investigation
Occurrence Class:   Investigation Status: Completed
Occurrence Type: Engine Failure Release Date: 20 November 2007

Vessel Details

Vessel: MV Enterprise Flag: A&B
IMO: 8321890
Type of Operation: Self Discharging Bulk Carrier
Damage to Vessel: Minor
Departure Point: Adelaide, SA Departure Time:
Destination: Newcastle, NSW

At about 1540 on 10 July 2006, while Enterprise was in Bass Strait, Australia, an alarm sounded indicating that the main engine lubricating oil pressure was low. When the duty engineer started changing over to a second filter, lubricating oil pressure was lost; causing the engine to stop and the ship to black-out. The engine was restarted and the passage was resumed.At 1805, the main engine low lubricating oil pressure alarm sounded again. At 2000, after further inspections had been undertaken, the chief engineer advised the master that the main engine could not be run due to probable bearing damage and that the ship would need to be towed to the nearest port for repairs. The main lubricating oil pump was also found, at this time, to have failed.

The ship was towed into Melbourne, arriving on 15 July, where all main and bottom end bearings were inspected. A large gouge mark was found on one bottom end bearing.

Further investigations revealed that the gudgeon pin in number five piston had failed when a pre-existing, undetected flaw led to fatigue cracking of the gudgeon pin. The engine manufacturer had not provided sufficient guidance for monitoring the fatigue life of gudgeon pins or for inspecting gudgeon pins for cracks.

The investigation also found that maintenance planning for the main lubricating oil pump was inadequate in that maintenance was not undertaken according to the manufacturers instructions, despite the fact that the pump had failed previously.

The execution of routine maintenance on the lubricating oil filter was also inadequate in that the spare filter was not ready for use. The shipboard procedures did not identify the error and the procedures for operating and monitoring the filter were also ineffective.

The report makes three recommendations to address the identified safety issues with the aim of preventing other similar occurrences.

Download complete report [PDF 601kb]


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