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Safety Recommendation Details

Safety Recommendation M-12-003
Details
Synopsis: On Saturday, May 8, 2010, at 0918 eastern daylight time, the 310-foot-long passenger ferry Andrew J. Barberi, owned and operated by the New York City Department of Transportation (NYC DOT) Ferry Division, allided with the terminal structure at slip No. 5 at the St. George terminal, Staten Island, New York. Eighteen crewmembers, 2 New York City police officers, 2 concessionaires, and 244 passengers were on board. As a result of the allision, 3 passengers sustained serious injuries; 47 passengers, crew, and others reported minor injuries. The damage to the vessel and the terminal structure totaled $182,238.1 The National Transportation Safety Board (NTSB) determines that the probable cause of the accident was a solenoid failure, which caused a loss of propulsion control of one of the vessel’s two cycloidal propellers. Contributing to the accident was the propulsion system’s lack of a propeller pitch deviation alarm, which was not required by regulation, but which would have alerted the pilothouse crew to the loss of propulsion control and permitted prompt action.
Recommendation: TO THE UNITED STATES COAST GUARD: Require all operators of U.S.-flag passenger vessels to implement safety management systems, taking into account the characteristics, methods of operation, and nature of service of these vessels, and, with respect to ferries, the sizes of the ferry systems within which the vessels operate. (Supersedes Safety Recommendation M-05-006)
Original recommendation transmittal letter: PDF
Overall Status: Open - Unacceptable Response
Mode: Marine
Location: New York, NY, United States
Is Reiterated: Yes
Is Hazmat: No
Is NPRM: No
Accident #: DCA10MM017
Accident Reports: Allision of Passenger Ferry Andrew J. Barberi With St. George Terminal
Report #: MAR-12-01
Accident Date: 5/8/2010
Issue Date: 5/24/2012
Date Closed:
Addressee(s) and Addressee Status: USCG (Open - Unacceptable Response)
Keyword(s):

Safety Recommendation History
From: USCG
To: NTSB
Date: 12/20/2018
Response: From the Fire on Board US Small Passenger Vessel Island Lady Pithlachascotee River near Port Richey, Florida, January 14, 2018, Report Number MAR-18-02, adopted on December 11, 2018. 2.4 Crew Emergency Response, Training, and Documentation When the high-temperature alarm for the port engine sounded, there was no obvious indication of fire on board the Island Lady. The captain and crewmembers said that they saw steam or light smoke coming from the engine room, and they tried to identify its source by lifting the access hatch to the engine room and by subsequently entering the space. However, at that time, there was no visible fire in the engine room. From what the deckhands told investigators, it is possible that they left the hatch open after the initial check of the engine room. Leaving the hatch open could have supplied the fire with oxygen once the fire spread into the engine room. After one of the deckhands informed the captain of the steam or light smoke in the engine room, the captain directed the crew to open the doors leading to the main deck to air out the enclosed main deck. Such an action could feed more oxygen to a heat source and is not advisable. Basic marine firefighting training includes closing all vents, doors, and other openings to a fire. The deckhands’ leaving the hatch open and the captain’s order to air out the enclosed main deck suggested that they lacked understanding of basic marine firefighting principles to limit oxygen to a suspected fire. Although federal regulations require that crewmembers know their emergency duties before getting under way and that captains conduct sufficient fire drills to ensure that crews are familiar with fire-related duties, only the senior deckhand on the Island Lady had participated in a recent fire and emergency drill (in mid-December 2017). The other deckhands, because of their recent employment with Tropical Breeze Casino Cruz, had not yet undergone any emergency training, including fire drills. Deckhand 1 was rehired a week before the accident and said he did recall drills during his previous employment with the company. However, the new-hire deckhand stated that, during his 5 and a half months of employment with the company, he had not participated in a drill. The pre-hire deckhand had boarded the vessel for the first time just minutes before departing on the accident voyage and had not participated in any onboard drills. Further, although activating the engine room’s fire suppression system was not applicable in the Island Lady accident, in postaccident interviews only the captain could explain how the system worked. Following the Express Shuttle II fire in 2004, the company agreed to implement NTSB Safety Recommendation M-06-13 to develop and implement a crew training program in marine firefighting. Based on the company’s correspondence, the NTSB classified that recommendation “Closed—Acceptable Action” in December 2006. However, the circumstances of the Island Lady fire and the postaccident interviews suggest that the Island Lady crewmembers were not, in fact, proficient enough in marine firefighting practices. The NTSB therefore concludes that the Island Lady crewmembers had insufficient training in firefighting. Moreover, as with its firefighting program, Tropical Breeze Casino Cruz’s job training program may need enhancement as well, including greater familiarization with the vessel, company policies, and duties (emergency and other). Given the recurring nature of this company’s accidents and the high risk to passenger safety, the NTSB therefore recommends that Tropical Breeze Casino Cruz revise its marine firefighting and job training programs, including documenting both on board and ashore that all crewmembers are qualified and can continually demonstrate proficiency in their duties, such as firefighting techniques and other emergency situations. The NTSB has long advocated SMS, which is a comprehensive, documented system to enhance safety.28 Safety of operations is the objective behind every action and decision by both those who oversee procedures and those who carry them out. Regardless of the size of the company, an SMS ensures standardized and unambiguous procedures for each crewmember during both routine and emergency operations. Duties and responsibilities are specified and supervisory and subordinate chains of command delineated. As a result, each crewmember understands precisely what he or she is to do in critical phases of operations. In addition, SMS calls for the creation of plans to respond to a range of possible emergency situations, with crewmember duties and responsibilities specified. As noted earlier in this report, SMS also covers preventive maintenance. The Coast Guard requires that US vessels engaged in oceangoing international service have SMS, but such a requirement is not yet in place for the domestic vessel fleet. Following the 2010 allision of passenger ferry Andrew J. Barberi with a terminal at Staten Island, New York, in which 50 people were injured, the NTSB issued Safety Recommendation M-12-3 to the Coast Guard29: Require all operators of U.S.-flag passenger vessels to implement safety management systems, taking into account the characteristics, methods of operation, and nature of service of these vessels, and, with respect to ferries, the sizes of the ferry systems within which the vessels operate. After the Coast Guard initially responded that it was developing appropriate regulations for all US-flag passenger vessels (part of Public Law 111–281), the NTSB classified Safety Recommendation M-12-3 “Open?Acceptable Response” in May 2013. However, in April 2014, after more than 3 years had passed since Congress authorized the Coast Guard to mandate SMS and nearly 1 year had passed since the Coast Guard (in its response to receiving M-12-3) expressed intent to initiate rulemaking, the NTSB reclassified the recommendation “Open?Unacceptable Response,” the status in which M-12-3 remains as of the date of this report. The NTSB continues to believe that SMS is an essential tool for enhancing safety on board all US passenger vessels and that the Coast Guard is the appropriate authority to ensure implementation and enforcement of such a system. In the case of the Island Lady and Tropical Breeze Casino Cruz, a Coast Guard requirement for SMS would likely have ensured greater adherence to completing crew training drills, appropriate responses to emergencies such as alarms and fires, and failsafe record-keeping of training and maintenance-related documents. The NTSB concludes that implementing SMS on all domestic passenger vessels would further enhance operators’ ability to achieve the higher standards of safety that the Coast Guard requires of US oceangoing vessels in international service. Therefore, the NTSB once again recommends that the Coast Guard require all operators of U.S.-flag passenger vessels to implement SMS, taking into account the characteristics, methods of operation, and nature of service of these vessels, and, with respect to ferries, the sizes of the ferry systems within which the vessels operate.

From: NTSB
To: USCG
Date: 2/17/2017
Response: We understand that you are developing the necessary regulations to implement the requirements called for in the 2010 Coast Guard Authorization Act; however, we point out that over 6 years have passed since Congress authorized you to mandate SMSs, and it has been over 3 years since you indicated your intent to initiate rulemaking. Until SMSs are mandated for all US passenger vessels, an unacceptable variation in the standards of passenger and crew safety will persist among ferry operators. We are committed to SMS implementation on all US-flag passenger vessels. Accordingly, Safety Recommendation M-12-3 is classified OPEN--UNACCEPTABLE RESPONSE. We request that you expedite action to address this recommendation.

From: USCG
To: NTSB
Date: 10/18/2016
Response: -From Charles W. Ray, Vice Admiral, U.S. Coast Guard, Deputy Commandant for Operations: The Coast Guard continues to work on developing the necessary regulations to implement the requirements called for in the 2010 Coast Guard Authorization Act.

From: NTSB
To: USCG
Date: 3/11/2016
Response: This letter concerns 40 open safety recommendations that the National Transportation Safety Board (NTSB) issued to the US Coast Guard between 2002 and 2015. For several years, the NTSB received an annual update on all open safety recommendations issued to the Coast Guard; however, for 25 of the 40 recommendations listed, we have received no update in over 2 years regarding the status of action either taken or planned to address these important safety issues. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others. Please respond to this letter electronically at correspondence@ntsb.gov regarding your progress in addressing these safety recommendations, and do not submit both an electronic and a hard copy of the same response. To assist with your response, enclosure (1) is a list of the 40 recommendations highlighting the recommendation number, current status, source of the recommendation, and date of the last Coast Guard update; enclosure (2) is a print-out from our database with the complete correspondence history of each open recommendation.

From: NTSB
To: USCG
Date: 5/13/2014
Response: On April 8, 2014, in the Seastreak Wall Street Board Meeting, the Board classified Safety Recommendation M-12-3 “Open—Unacceptable Response,” with the following explanation: On May 23, 2013, the Coast Guard wrote to the NTSB, stating that it agreed with Safety Recommendation M-12-3 and was developing appropriate regulations for all US-flag passenger vessels. This response is a positive step. Nonetheless, over 3 years have passed since Congress authorized the Coast Guard to mandate SMS, and nearly 1 year has passed since the Coast Guard indicated its intent to initiate rulemaking?without result. Until safety management systems are mandated for all US passenger vessels, an unacceptable variation in the standards of passenger and crew safety will persist between ferry operators. The NTSB is committed to the implementation of safety management systems on board all US-flag passenger vessels and therefore reclassifies Safety Recommendation M-12-3 OPEN—UNACCEPTABLE RESPONSE.

From: NTSB
To: USCG
Date: 4/28/2014
Response: From the Marine Accident Report MAR-14-001, Allision of the Passenger Vessel Seastreak Wall Street with Pier 11, Lower Manhattan, New York, New York, January 9, 2013, adopted on April 8, 2014: Safety Recommendation M-12-003 is reclassified OPEN--UNACCEPTABLE RESPONSE.

From: USCG
To: NTSB
Date: 1/28/2014
Response: -From Peter V. Neffenger, Vice Admiral, Deputy Commandant for Operations: Enclosed is our semiannual report of actions on safety recommendations issued to the Coast Guard by the National Transportation Safety Board that are currently assigned an "open" status by the Board. There are currently 39 safety recommendations with an "open" status issued to the Coast Guard. Of those, I am providing our initial response to six new recommendations, proposing that seven recommendations be closed as acceptable, and updating five previously issued recommendations. At this time, there are no significant changes in action to be reported for the remaining 21 recommendations. These recommendations include: M-02-5, M-07-6, M-09-4, M-09-10, M-09-14, M-09-15, M-09-16, M-10-5, M-10-6, M-11-4, M-11-13, M-11-15, M-11-16, M-11-23, M-11-24, M-11-25, M-11-26, M-11-27, M-12-1, M-12-2, and M-12-3.

From: NTSB
To: USCG
Date: 7/8/2013
Response: Thank you for the April 5, 2013, letter signed by Vice Admiral Peter V. Neffenger, Deputy Commandant for Operations, to the National Transportation Safety Board (NTSB) containing your semiannual update regarding actions to address 42 safety recommendations that the NTSB issued to the US Coast Guard. To assist with future updates and to align our records, we are enclosing a copy of the NTSB’s safety recommendation database history for these 42 recommendations. This response letter will be divided into four parts: • Part 1 – Evaluation of actions to address Safety Recommendations M 09 15 and 16 and M-10-2, recommendations for which Admiral Neffenger provided a substantive update. • Part 2 – List of 6 safety recommendations previously closed. • Part 3 – List of 7 safety recommendations that were the subject of a recent Coast Guard update and that the NTSB is currently evaluating; these recommendations will be addressed in detail in separate correspondence. • Part 4 – List of 26 safety recommendations for which the Coast Guard did not provide a substantive update or for which status has not changed since the last update. Part 1 – Safety Recommendations Updated in the April 5, 2013, Letter: We issued Safety Recommendations M-09-15 and -16, stated below, to the Coast Guard on October 20, 2009, as a result of a review of the involvement of obstructive sleep apnea (OSA) in several accidents investigated by the NTSB. M-09-15 Implement a program to identify licensed mariners subject to the Navigation and Vessel Inspection Circular on Medical and Physical Evaluation Guidelines for Merchant Mariner Credentials (NVIC 04-08) and who are at high risk for obstructive sleep apnea, and require that those mariners provide evidence through the medical certification process of having been appropriately evaluated and, if treatment is needed, effectively treated for that disorder before being granted unrestricted medical certification. M-09-16 Develop and disseminate guidance for mariners, employers, and physicians regarding the identification and treatment of individuals at high risk of obstructive sleep apnea (OSA), emphasizing that mariners who have OSA that is effectively treated are routinely approved for continued medical certification. We are encouraged that the Merchant Mariner Medical Advisory Committee is planning to review and revise Navigation and Vessel Inspection Circular 04-08, including Enclosure (4), Guidance on Specific Medical Conditions, which details the medical decision making criteria for common conditions (including sleep disorders such as OSA) as they relate to determining merchant mariner fitness for duty. Pending completion of these efforts, Safety Recommendation M-09-15 is classified “Open—Acceptable Alternate Response” and Safety Recommendation M 09-16 is classified “Open—Acceptable Response.” We issued Safety Recommendation M-10-2, stated below, to the Coast Guard on August 11, 2010, as a result of two recent maritime accidents involving Coast Guard patrol boats: the December 5, 2009, collision of the CG 25689 with the small passenger vessel Thriller 09 in Charleston, South Carolina, and the December 20, 2009, collision of the CG-33118 with a 24 foot recreational vessel in San Diego, California. M-10-2 Develop and implement national and local policies that address the use of cellular telephones and other wireless devices aboard U.S. Coast Guard vessels. The Coast Guard’s recent revision of Coast Guard Boat Operations and Training (BOAT) manual, volume I, COMDTINST M16114.32C, section F.2, prohibits the use of cellphones/texting devices and phone applications aboard all boat force assets without the permission of the coxswain, which will only be granted on a case-by-case basis and only when operational safety is not compromised. Because this action satisfies Safety Recommendation M 10-2, it is classified “Closed—Acceptable Action.” Part 2 – Safety Recommendations Previously Closed: M-06-5 (Closed—Acceptable Action, March 14, 2011) Revise regulations to require that passenger capacity for domestic passenger vessels be calculated based on a statistically representative average passenger weight standard that is periodically updated. M-06-6 (Closed—Acceptable Action, March 14, 2011) Identify a method for determining the maximum safe load condition of a small passenger vessel at the time of loading, such as a mark on the side of the hull, and require that the vessel owners implement that method. M-06-7 (Closed—Unacceptable Action, March 14, 2011) Revise the stability criteria for small passenger pontoon vessels for all passenger loading conditions to minimize the potential for capsizing in wind and waves. M-06-8 (Closed—Unacceptable Action, March 14, 2011) Until such time as you revise the passenger weight standard as requested in Safety Recommendation M-06-5 and the stability criteria used to evaluate small passenger pontoon vessel safety as requested in Safety Recommendation M-06-7, develop interim pontoon passenger vessel stability guidance based on static and dynamic intact stability considerations. M-06-9 (Closed—Unacceptable Action, March 14, 2011) Establish limiting environmental conditions such as weather in which pontoon vessels may safely operate, and list those limiting conditions on the vessel’s certificate of inspection. M-11-11 (Closed—Acceptable Action, November 13, 2012) Develop and implement procedures to ensure that your coxswains follow established automatic identification system transmission policies. Part 3 – Recommendations Recently Updated and Under Evaluation by the NTSB: M-10-5 (Open—Unacceptable Response, May 24, 2012; USCG Update February 12, 2013) Require installation of voyage data recorders that meet the international performance standard on new ferry vessels. M-10-6 (Open—Unacceptable Response, May 24, 2012; USCG Update February 12, 2013) Require installation of voyage data recorders on ferry vessels built before the enactment of voyage data recorder carriage requirements that will record, at a minimum, the same video, audio, and parametric data specified in the International Maritime Organization’s performance standard for simplified voyage data recorders. M-12-1 (Open Initial Response Received; USCG Update February 12, 2013) Require new-construction U.S.-flag passenger vessels with controllable pitch propulsion, including cycloidal propulsion, to be equipped with alarms that audibly and visually alert the operator to deviations between the operator’s propulsion and steering commands and the actual propeller response. M-12-2 (Open Initial Response Received; USCG Update February 12, 2013) Where technically feasible, require existing U.S.-flag passenger vessels with controllable pitch propulsion, including cycloidal propulsion, to be retrofitted with alarms that audibly and visually alert the operator to deviations between the operator’s propulsion and steering commands and the actual propeller response. M-12-3 (Open—Initial Response Received; USCG Update February 12, 2013) Require all operators of U.S.-flag passenger vessels to implement safety management systems, taking into account the characteristics, methods of operation, and the nature of service of these vessels, and, with respect to ferries, the sizes of the ferry systems within which the vessels operate. M-12-6 (Open—Initial Response Received; USCG Update March 21, 2013) Develop and implement a policy to ensure adequate separation between vessels operating in the Bayport Channel and Bolivar Roads Precautionary Areas and any other similarly configured precautionary areas in the Houston Ship Channel. M-12-7—(Open Initial Response Received USCG Update March 21, 2013) Graphically delineate precautionary areas on appropriate Houston Ship Channel nautical charts so they are readily identifiable to mariners. Part 4 – Safety Recommendations Not Substantively Updated in the April 5, 2013, letter: M-02-5 (Open—Acceptable Response, February 4, 2013) Require that companies operating domestic passenger vessels develop and implement a preventive maintenance program for all systems affecting the safe operation of their vessels, including the hull and the mechanical and electrical systems. M-07-1 (Open—Acceptable Response, February 4, 2013) Require that all small passenger vessels certificated to carry more than 49 passengers, regardless of date of build or hull material, be fitted with an approved fire detection system and a fixed fire suppression system in their enginerooms. M-07-6 (Open—Acceptable Response, February 4, 2013) Finalize and implement the new towing vessel inspection regulations and require the establishment of safety management systems appropriate for the characteristics, methods of operation, and nature of service of towing vessels. M-08-2 (Open—Acceptable Response, February 4, 2013) Propose to the International Maritime Organization that it mandate the recording on voyage data recorders of heel angles through the complete range of possible values. M-09-4 (Open—Acceptable Response, February 4, 2013) Require mariners to report to the Coast Guard, in a timely manner, any substantive changes in their medical status or medication use that occur between required medical evaluations. M-09-10 (Open—Unacceptable Response, February 4, 2013) Seek legislative authority to require that all commercial fishing vessels be inspected and certificated by the Coast Guard to ensure that the vessels provide an appropriate level of safety to those on board. M-09-14 (Open—Acceptable Response, February 4, 2013) Modify Form 719K (Merchant Mariner Physical Examination Report) to elicit specific information about any previous diagnosis of obstructive sleep apnea and about the presence of specific risk factors for that disorder. M-09-17 (Open—Unacceptable Response, February 4, 2013) Require that out-of-water survival craft for all passengers and crew be provided on board small passenger vessels on all routes. M-11-3 (Open—Acceptable Response, February 4, 2013) Regulate and enforce the restriction on nonoperational use of cell phones and other wireless electronic devices by on-duty crewmembers in safety-critical positions so that such use does not adversely affect vessel operational safety. M-11-4 (Open—Acceptable Response, February 4, 2013) Until you can develop regulations governing nonoperational use of cell phones and other wireless electronic devices by on-duty crewmembers in safety-critical positions, continue your outreach program of information and education to the maritime industry on this issue. M-11-8 (Open—Acceptable Response, November 13, 2012) Develop and implement procedures for your special purpose craft–law enforcement that allow crewmembers to compensate for obstructions affecting forward visibility from the helm and the forward port positions. M-11-9 (Open—Acceptable Response, November 13, 2012) Examine your oversight of small boat operations to determine where local procedures are inadequate, implement procedures nationally and at each station (including Station San Diego) to provide continual, systematic, and thorough oversight information, and require action on information obtained to ensure that crewmembers are operating their vessels safely in all conditions and circumstances. M-11-10 (Open—Acceptable Response, November 13, 2012) Require each small boat station, including Station San Diego, to establish specific operating procedures governing small boat speeds that account for prevailing conditions and circumstances affecting the safety of small boat operations. M-11-12 (Open—Acceptable Response, November 13, 2012) Establish a structured data monitoring program for your small boats that reviews all available data sources to identify deviation from established guidance and procedures. M-11-13 (Open—Acceptable Response, November 13, 2012) Conduct a ports and waterways safety assessment for the Sabine-Neches Waterway, determine from that whether the risk is unacceptable, and if so, develop risk mitigation strategies. M-11-14 (Open—Acceptable Response, November 13, 2012) Work through the International Maritime Organization to encourage the application of human factors design principles to the design and manufacture of critical vessel controls. M-11-15 (Open—Acceptable Response, November 13, 2012) Facilitate and promote regular meetings for representatives of pilot oversight organizations to communicate information regarding pilot oversight and piloting best practices. M-11-16 (Open—Unacceptable Response, November 13, 2012) Establish a database of publicly available pilot incidents and accidents and make the database easy to use and readily available to all pilot oversight organizations. M-11-23 (Open—Unacceptable Response, June 12, 2012) Establish standards for new and existing commercial fishing industry vessels of 79 feet or less in length that (1) address intact stability, subdivision, and watertight integrity and (2) include periodic reassessment of the vessels’ stability and watertight integrity. M-11-24 (Open—Unacceptable Response, June 12, 2012) Require all owners, masters, and chief engineers of commercial fishing industry vessels to receive training and demonstrate competency in vessel stability, watertight integrity, subdivision, and use of vessel stability information regardless of plans for implementing the other training provisions of the 2010 Coast Guard Authorization Act. M-11-25 (Open—Unacceptable Response, June 12, 2012) Require each person on deck of a commercial fishing industry vessel to wear a flotation aid at all times. M-11-26 (Open—Unacceptable Response, June 12, 2012) Require owners of commercial fishing industry vessels to (1) install fall overboard recovery devices appropriate for the vessel, (2) periodically ensure the functionality of such equipment, and (3) regularly conduct drills in which crewmembers demonstrate their competence in the use of such devices. M-11-27 (Open—Unacceptable Response, June 12, 2012) Require all crewmembers to provide certification of completion of safety training before getting under way on commercial fishing industry vessels, such training to include both prevention of and proper response to emergency situations as well as actual use of emergency equipment. M-12-8 (Open—Await Response) Align your standards for postaccident toxicological testing of Coast Guard military personnel with the requirements specified in 46 Code of Federal Regulations 4.06-3. M-12-9 (Open—Await Response) Align your standards for postaccident toxicological testing of Coast Guard civilian personnel, seeking appropriate legislative authority if necessary, with the requirements specified in 46 Code of Federal Regulations 4.06-3. M-12-10 (Open—Await Response) Disseminate guidance within the Coast Guard so that commanding officers have unambiguous instruction detailing the requirements for timely drug and alcohol testing of Coast Guard military and civilian personnel whose work performance may be linked to a serious marine incident. Thank you for your commitment to marine safety. We look forward to receiving further updates on the action being taken to implement the following safety recommendations: M-02-5 M-07-1 M-07-6 M-08-2 M-09-4 M-09-10 M-09-14 M-09-15 M-09-16 M-11-3 M-11-4 M-11-8 M-11-9 M-11-10 M-11-12 M-11-13 M-11-14 M-11-15 M-11-16 M-11-23 M-11-24 M-11-25 M-11-16 M-11-27 M-12-8 M-12-9 M-12-10

From: NTSB
To: USCG
Date: 5/23/2013
Response: We are pleased that the Coast Guard agrees with this recommendation and is developing appropriate regulations for all US-flag passenger vessels. Accordingly, pending issuance of the final rules, Safety Recommendation M-12-3 is classified OPEN—ACCEPTABLE RESPONSE. We encourage the Coast Guard to expedite action on this issue.

From: USCG
To: NTSB
Date: 4/9/2013
Response: -From Peter V. Neffenger, Vice Admiral, U.S. Coast Guard, Deputy Commandant for Operations: Please find enclosed our agreed upon semiannual update of actions on safety recommendations issued to the Coast Guard by the National Transportation Safety Board that are currently assigned an "open" status by the Board and are awaiting Coast Guard response. There are currently 42 safety recommendations with an "open" status issued to the Coast Guard. Of those, we attest that our actions are complete for six, six are pending resolution, and five require long-term agency action. Updates for the remaining 25 have been or will be provided in separate correspondence. Enclosure (1) provides specific information for each recommendation. Initial responses and updates of action since the previous update for the following 25 recommendations have been or are being provided (recommendations M-12-8, M-12-9, and M- 12-10) in separate correspondence: M-09-4 Require mariners to report to the Coast Guard, in a timely manner, any substantive changes in their medical status or medication use that occur between required medical evaluations. M-10-5 Require installation of voyage data recorders that meet the international performance standard on new ferry vessels. M-10-6 Require installation of voyage data recorders on ferry vessels built before the enactment of voyage data recorder carriage requirements that will record, at a minimum, the same video, audio, and parametric data specified in the International Maritime Organization's performance standard for simplified voyage data recorders. M-11-8 Develop and implement procedures for your special purpose craft - law enforcement that allow crewmembers to compensate for obstructions affecting forward visibility from the helm and the forward port positions. M-11-9 Examine your oversight of small boat operations to determine where local procedures are inadequate, implement procedures nationally and at each station (including Station San Diego) to provide continual, systematic, and thorough oversight information, and require action on information obtained to ensure that crewmembers are operating their vessels safely in all conditions and circumstances. M-11-10 Require each small boat station, including Station San Diego, to establish specific operating procedures governing small boat speeds that account for prevailing conditions and circumstances affecting the safety of small boat operations. M-11-11 Develop and implement procedures to ensure that your coxswains follow established automatic identification system transmission policies. M-11-12 Establish a structured data monitoring program for your small boats that reviews all available data sources to identify deviation from established guidance and procedures. M-11-13 Conduct a ports and waterways safety assessment for the Sabine-Neches Waterway, determine from that whether the risk is unacceptable, and if so, develop risk mitigation strategies. M-11-14 Work through the International Maritime Organization to encourage the application of human factors design principles to the design and manufacture of critical vessel controls. M-11-15 Facilitate and promote regular meetings for representatives of pilot oversight organizations to communicate information regarding pilot oversight and piloting best practices. M-11-16 Establish a database of publicly available pilot incidents and accidents and make the database easy to use and readily available to all pilot oversight organizations. M-11-23 Establish standards for new and existing commercial fishing industry vessels of 79 feet or less in length that (1) address intact stability, subdivision, and watertight integrity and (2) include periodic reassessment of the vessels' stability and watertight integrity. M-11-24 Require all owners, masters, and chief engineers of commercial fishing industry vessels to receive training and demonstrate competency in vessel stability, watertight integrity, subdivision, and use of vessel stability information regardless of plans for implementing the other training provisions of the 2010 Coast Guard Authorization Act. M-11-25 Require each person on deck of a commercial fishing industry vessel to wear a flotation aid at all times. M-11-26 Require owners of commercial fishing industry vessels to (1) install fall overboard recovery devices appropriate for the vessel, (2) periodically ensure the functionality of such equipment, and (3) regularly conduct drills in which crewmembers demonstrate their competence in the use of such devices. M-11-27 Require all crewmembers to provide certification of completion of safety training before getting under way on commercial fishing industry vessels, such training to include both prevention of and proper response to emergency situations as well as actual use of emergency equipment. M-12-1 Require new-construction U.S.-flag passenger vessels with controllable pitch propulsion, including cycloidal propulsion, to be equipped with alarms that audibly and visually alert the operator to deviations between the operator's propulsion and steering commands and the actual propeller response. M-12-2 Where technically feasible, require existing U.S.-flag passenger vessels with controllable pitch propulsion, including cycloidal propulsion, to be retrofitted with alarms that audibly and visually alert the operator to deviations between the operator's propulsion and steering commands and the actual propeller response. M-12-3 Require all operators of U.S.-flag passenger vessels to implement safety management systems, taking into account the characteristics, methods of operation, and the nature of service of these vessels, and, with respect to ferries, the sizes of the ferry systems within which the vessels operate. M-12-6 Develop and implement a policy to ensure adequate separation between vessels operating in the Bayport Channel and Bolivar Roads Precautionary Areas and any other similarly configured precautionary areas in the Houston Ship Channel. M-12-7 Graphically delineate precautionary areas on appropriate Houston Ship Channel nautical charts so they are readily identifiable to mariners. M-12-8 Align your standards for postaccident toxicological testing of Coast Guard military personnel with the requirements specified in 46 Code of Federal Regulations 4.06-3. M-12-9 Align your standards for postaccident toxicological testing of Coast Guard civilian personnel, seeking appropriate legislative authority if necessary, with the requirements specified in 46 Code of Federal Regulations 4.06-3. M-12-10 Disseminate guidance within the Coast Guard so that commanding officers have unambiguous instruction detailing the requirements for timely drug and alcohol testing of Coast Guard military and civilian personnel whose work performance may be linked to a serious marine incident.

From: USCG
To: NTSB
Date: 2/12/2013
Response: -From J.A. Servidio, Rear Admiral, U.S. Coast Guard, Assistant Commandant for Prevention Policy: I partially concur with this recommendation. As noted by the Board in its safety recommendation letter, Public Law 111-281 granted the Coast Guard the authority to require safety management systems on passenger vessels and small passenger vessels and that in doing so we consider certain criteria, such as the characteristics of the vessels, with respect to the extent those requirements are applied. However, Congress also made it clear that we are not simply to apply these requirements to all U.S.-flag passenger vessels by including in the applicability criteria that they are only to apply to a passenger vessel or small passenger vessel that "is transporting more passengers than a number prescribed by the Secretary based on the number of individuals on the vessel that could be killed or injured in a marine casualty". We are beginning a rulemaking project to implement this provision, during which we will perform the necessary analysis, including the consideration of public comments, to determine what the appropriate number of passengers transported is for which the new requirements will apply. I will keep the Board informed of our progress on this recommendation.