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Safety Recommendation Details
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Safety Recommendation
M-17-029
Details
Synopsis:
On Thursday, October 1, 2015, the SS El Faro, a 40-year-old cargo ship owned by TOTE Maritime Puerto Rico and operated by TOTE Services, Inc., was on a regular route from Jacksonville, Florida, to San Juan, Puerto Rico, when it foundered and sank in the Atlantic Ocean about 40 nautical miles northeast of Acklins and Crooked Island, Bahamas. The ship had sailed directly into the path of Hurricane Joaquin, carrying a crew of 33, including 5 Polish contract repair workers. All those aboard perished in the sinking. As part of its accident investigation, the National Transportation Safety Board (NTSB) led a joint effort with the US Navy, Woods Hole Oceanographic Institution, and the National Science Foundation to locate the ship’s wreckage and retrieve its voyage data recorder (VDR). The VDR was pulled from 15,250 feet below the ocean surface in August 2016 during the third undersea mission and yielded more than 26 hours of parametric data and audio files. The NTSB’s accident investigation identified the following safety issues: captain’s actions, use of noncurrent weather information, late decision to muster the crew, ineffective bridge resource management, inadequate company oversight, company’s safety management system, flooding in cargo holds, loss of propulsion, downflooding through ventilation closures, need for damage control plan, and lack of appropriate survival craft. The NTSB made safety recommendations to the US Coast Guard; the Federal Communications Commission; the National Oceanic and Atmospheric Administration; the International Association of Classification Societies; the American Bureau of Shipping; Furuno Electric Company, Ltd.; and TOTE Services, Inc.
Recommendation:
TO THE UNITED STATES COAST GUARD: Propose to the International Maritime Organization that existing cargo vessels operating under the International Convention for the Safety of Life at Sea be required to have damage control plans and booklets on board that meet current standards.
Original recommendation transmittal letter:
Overall Status:
Open - Unacceptable Response
Mode:
Marine
Location:
36 NM Northeast Crooked Island Bahamas, AO, United States
Is Reiterated:
No
Is Hazmat:
No
Is NPRM:
No
Accident #:
DCA16MM001
Accident Reports:
Tropical Cyclone Information for Mariners
Sinking of US Cargo Vessel SS
El Faro
Atlantic Ocean, Northeast of Acklins and Crooked Island, Bahamas
Sinking of the US Cargo Vessel
El Faro
: Illustrated Digest
Report #:
MAR-17-01
Accident Date:
10/1/2015
Issue Date:
2/7/2018
Date Closed:
Addressee(s) and Addressee Status:
USCG (Open - Unacceptable Response)
Keyword(s):
Safety Recommendation History
From:
NTSB
To:
USCG
Date:
4/30/2019
Response:
We issued these recommendations to address damage-control plans and booklets for existing vessels involved in international shipping that were constructed before 1992. Your proposed alternative of addressing this issue in your guidance regarding a vessel’s SMS is not an acceptable alternative because it is not a proposal to the IMO, and your guidance only applies to your domestic inspection program, not to the majority of international shipping that does not involve US-flagged vessels. In addition, the damage-control plan should pertain to a particular vessel, and not to the operating company’s SMS. Please reconsider your actions to satisfy these recommendations. Pending your making the recommended proposals to the IMO, Safety Recommendations M-17-29 and -30 are classified OPEN--UNACCEPTABLE RESPONSE.
From:
USCG
To:
NTSB
Date:
7/17/2018
Response:
-From Karl L. Schultz, Admiral, U.S. Coast Guard, Commandant: I concur with the intent of this recommendation. The Coast Guard agrees that all oceangoing ships should be prepared to mitigate the effects of damage incurred at sea. Since 1992, SOLAS has required that comprehensive damage control information be provided aboard cargo ships (see SOLAS 90 regulations II-1/23-1 and II-1/25-8 and SOLAS 2009 regulation II- 1/19). The IMO did not apply these standards retroactively. The most expeditious means to provide appropriate damage control information aboard ships built before these standards became effective is for the company to include appropriate operational procedures in their SMS. The Coast Guard has addressed this matter in the recently promulgated supplemental flag State guidance regarding the development and implementation of SMSs. I consider the Coast Guard's action on this recommendation complete and request that it be closed.
From:
NTSB
To:
USCG
Date:
2/7/2018
Response:
On December 12, 2017, the NTSB adopted its report Sinking of US Cargo Vessel SS El Faro, Atlantic Ocean, Northeast of Acklins and Crooked Island, Bahamas, October 1, 2015, NTSB/MAR-17/01. The details of this accident investigation and the resulting safety recommendations may be found in the attached report, which can also be accessed at http://www.ntsb.gov. Among the safety recommendations are 29 issued to the US Coast Guard, which can be found on pages 248–251 of the report. The NTSB is vitally interested in these recommendations because they are designed to prevent accidents and save lives. We would appreciate a response within 90 days, detailing the actions you have taken or intend to take to implement these recommendations. When replying, please refer to the safety recommendations by number. We encourage you to submit your response to correspondence@ntsb.gov. If it exceeds 20 megabytes, including attachments, please e-mail us at the same address for instructions. Please do not submit both an electronic copy and a hard copy of the same response.