What happened
Two engine crew members were shifting vertically stacked metal sheets (1200x 2500 x 3 to 5 mm) in the engine room. Towards the end of the task, two of the sheets suddenly started moving backwards resulting in both crew members getting caught between the sheet and a wooden box situated behind them.
Consequences
- One crew member was in a state of shock and had to visit shore doctor for further medical examination.
- Potential for severe injuries/fatalities
Causes
- Failure to follow procedures/instructions - work planning and toolbox meeting did not adequately assess all hazards and counter measures. COSWP guidelines not properly adhered to.
- Improper position for task - incorrect positioning of the crew while handling the plates lead to getting caught between the plates and the wooden box.
- Improper lifting - suitable tools for handling the steel plates were not available or used (plate clamps, chain blocks etc.).
- Poor housekeeping - permanent stowage and safe securing arrangement (horizontal or vertical storage rack) was not available for the metal sheets.
- Lack of situational awareness / risk perception - both crew members were caught unaware by the metal sheet due to lack of situational awareness. Only two persons was considered enough for shifting the plates. Adequate human resources not utilised.
- Inadequate supervision and coaching - lack of proper initial instructions and lack of regular supervision.