Tall Ships America Conference

Transcription

1 Tall Ships America Conference San Diego, California February 5, 2014 Captain Rob Jones Office of Marine Safety 1

2 Maine Maritime Academy 2

3 Previous 3

4 Current 4

5 What is the NTSB? Independent Government Organization Independent Investigations Promote Transportation Safety 5

6 Current NSTB Board Members 6

7 Board Members Presidential Appointments Serve limited terms Launch to accidents with investigative team Rule and vote on adoption of staff report 7

8 Nature of NTSB Investigation 49 CFR Nature of the investigation. Accident and incident investigations are conducted by the Board to determine the facts, conditions, and circumstances relating to an accident or incident and the probable cause(s) thereof. 8

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10 Why the NTSB Major Marine Casualty Significant Marine Casualty Six or more lives lost Total loss of a self-propelled vessel of 100 gross tons or more More than $500,000 in estimated property damage Involving serious threat, Chairman and Commandant, concur with regard to release of hazardous materials Significant Safety Issues Public Non Public Accident 10

11 When the USCG leads and NTSB Participates: The NTSB can produce its own investigation report Report based on The Marine Board proceedings Any additional evidence the NTSB may acquire under its own authority: 46 CFR (e) 11

12 Product Accident report with probable cause Findings Recommendations Company/Operator Association Regulator 12

13 Participant Buy In Participate in interviews Share in the evidence Review the Technical Report comment Submit own findings and PC Published in public docket 13

14 Safety Culture A set of established attitudes, values, beliefs, norms and practices where safety is revered, promoted and treated as an overriding priority. 14

15 Safety Culture..It begins at the top of, and permeates throughout, an organization. 15

16 Safety Culture Components: Management commitment and emphasis Standardization and discipline Training Data collection and quality control program 16

17 Management Commitment The President & CEO of has approved this policy and it is the responsibility of the Master to implement and motivate the crew in observing this policy. 17

18 Tools for Safety Culture Safety Management System or SMS Risk Management 18

19 Risk Management Marine Accidents Typically - multiple contributing causes Errors are or can be the result of shortcomings elsewhere in the marine system In hindsight these shortcomings tend to have been easily identifiable 19

20 SMS - statement The policies, procedures, permits, and checklists within the SMS are intended to ensure that there are standard operating practices throughout the organization and to this end they shall be adhered to. However they are not intended to replace the practices of good seamanship for the purpose of saving life or the protection of the environment and the Master has the overriding authority to make decisions with respect to safety and the protection of the environment, and requesting company assistance as necessary. 20

21 Accident Examples Marine operations large Complex and dynamic Multiple operators-multiple interactions Highly trained operators Marine operations small Single vessel Single operator Standard operation 21

22 Harbor Safety Plan Members Port Administrators Dry Cargo and Tanker Companies Oil and Dry Cargo Terminal Operators Longshore Operations Commercial Fishing Operators Recreational vessel organizations Tugs, Towboats and Barge Operators Ferry Operators Pilot Organizations Federal and State Regulators 22

23 Documented Procedures Safety Considerations in Adverse Weather Conditions. Reduced visibility during periods of fog requires that mariners observe caution. During reduced visibility, vessels may remain docked, reduce speed if underway or anchor in or near a channel to await improved conditions. Extra vigilance must be used in reduced visibility, particularly in or near navigation channels. Vessels within the Bay at a dock or at a safe anchorage should not commence movement if visibility is less than.5 nautical miles throughout the intended route, unless the operator s assessment of all variables is that the vessel can proceed safely. The operator s local knowledge should include an understanding of historic weather patterns during that time of year, current weather reports and checking with reporting stations along the route. This guideline acknowledges that the Bay region is a series of bays and rivers, in-bay distances are long and that there is not a single Bay region climate, but a series of many microclimates with variable fog. The Captain of the Port has the authority to prohibit movement of vessels within all or portions of the Bay during adverse weather conditions. 23

24 Excerpt: Vessels within the Bay at a dock or at a safe anchorage should not commence movement if visibility is less than.5 nautical miles throughout the intended route, 24

25 Following sentence..unless the operator s assessment of all variables is that the vessel can proceed safely. 25

26 Cosco Busan 26

27 Acta non Verba Deeds not Words Kings Point 27

28 Eagle Otome - Collision 28

29 Operation - small Mom and Pop Known risk (s) Confidence in ability and vessel Desire to please customers 29

30 Taki-Tooo 30

31 Risk Mitigation Written Go No/Go policy Developed in static environment with due regard for conditions Relieves the individual from deciding and judge in the present Takes pressure off individual decision to go Developed for individual operations 31

32 NOAA Graphic Oct. 25 am 32

33 October 29, am 33

34 Risk Can never be eliminated, only identified and addressed to the extent possible True or false? 34

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36 Risk Elimination Cannot be Attained A history of safe operations can be detrimental to safety Promoting safety by slogans and posters is minimally effective Safety enhancement costly to bottom line or profits If it ain t broke, fix it 36

37 What Works Comprehensive risk mitigation involving all elements of the system working together Effective SMS programs and effective audits Company and regulator oversight that effectively monitor operations Regulatory action that demonstrates decision, skill, and experience Open and safe communications 37

38 NTSB.GOV

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