“For want of a nail the shoe was lost.” -
Peetwo - 11-26-2022
P2 comment - Posted on behalf of P9 who was all thumbs and seven fingers when it came to initiating this new Forum -
Quote:“For want of a nail the shoe was lost.”
“It's a dangerous business, Frodo, going out your door. You step onto the road, and if you don't keep your feet, there's no knowing where you might be swept off to.”
All day, every day, across this planet people travel; and, in one form or another, they use publicly available transportation. Bus, train, ferry, aircraft - all available for the cost of a ticket. Included within the price of that ticket is a high percentage chance that they will arrive at their destination. While that 'safe arrival' is not 100% guaranteed, mostly it is a very, very safe bet. Ever wonder why. If you ask around, you will receive many different answers, but only those involved in providing that transport know how much work and money and research and training (blood, sweat and tears) has gone into providing that singular service safe result. The real answer is in one word 'Reliability'.
(Technology reliability) x (Human reliability) = System reliability.
Every mode of transport, from roller skates to space ships depends on system reliability to arrive at the destination in one piece. Many serious accidents have been the result of not only the failure of one element, but the events subsequent to that failure.
“For want of a shoe the horse was lost.”
Watching hours of Senate estimates is not a popular pastime; for example, when its my turn, I play it in the workshop and listen while I do something constructive; bit like the cricket on the radio. Mostly, the focus is on 'matters aeronautical' Canberra style, however as all methods of publicly available transport systems are all basically similar (in essence) almost any form of 'transport' event catches the attention; trucks, trains, boats and planes. Why, Well there is almost always a 'lesson' to be learned from every transport accident; and IMO they are, in principal at least, transportable. Human and system failures which lead to headlines.
“For want of a horse the rider was lost”
Once the 'headlines' are out there inevitably is an 'investigation and/or an 'inquiry' of some sort; aviation is famous for them (for some unknown reason). The investigation template in the aviation world mostly follows a well trodden pathway. When the return of that 'investigation' is serious; often some form of 'inquiry' is opened; and, that is when the 'fun' starts. The 'circuit breakers' are the first called in; they serve to protect the next level up the sheltered ladder of responsibility and are utterly disposable. If the powers that be persist with inquiry, the next layer in the protection racket is wheeled in and the dissembling and obfuscation begins in earnest – for they protect the ministerial appointment holders. They are wonderfully entertaining, masters of the no accountability game; and, serve the 'system' very well and rewarded in kind. Which keeps everybody happy, except for the public who have forgotten and those left behind to wonder. Every aviation inquiry has, more or less, finished in the same manner, an instantly forgettable report which resolves very little. The top shelf defenders have learned where they are vulnerable to any hint of 'responsibility' and take the steps necessary to cover the gap. Bigger budget to generate more complex rules which relocate 'blame' and additional 'responsibility' to those outside the 'agency' while ensuring that in no way can 'they' ever be accountable or responsible. Its a game, played publicly, in the open and available on any Senate estimates 'you tube' session you care to sit through.
“For want of a rider the message was lost”
One of our crew stumbled on an Estimates session from the NSW division – related to the Sydney Harbour ferry system. Ships at sea and the men who manage the business are very closely related to those who manage aircraft. The parallels easily drawn; the legal responsibilities on par as are the penalties for any mismanagement. Two ships collide – the Masters are the people in the dock. However; the Skippers of ferries seem to have a problem that no aircraft pilot would tolerate. Should an aircraft have any form of 'control' problem (airborne or on the deck) there are back up systems and/ or alternate methods which may be used to ensure a safe return to land. Once on the ground, that aircraft would not move out of maintenance until the 'problem' had be 'properly' resolved; and, a report made; and, that report made available to the world wide fleet if the 'problem' was deemed systematic. But, it goes a little further; the aircraft would be 'Returned to Service' with a 'signature' of the person ultimately carrying the legally enforceable responsibility for the RTS. All documented and legally binding. The pilot scheduled to operate the aircraft signs a 'maintenance release' (again legally binding) fully aware of the repairs. It is an almost fool-proof system, with clearly defined lines of 'responsibility and accountability' all the way back to the CEO - ultimately.
“For want of a message the battle was lost”
Recently in the news (courtesy Matt O'Sullivan) the plight of the Masters of the Sydney ferry system has been brought to the attention of the public. Aunt Pru took an interest and we were off to the races. The first item of real interest was the closely guarded secret of just how many abnormal 'steering' events have actually occurred. (Give any pilot the screaming me-mi's). Once, in any aircraft, would be enough. But not for the NSW government contractors; multiple loss of control events, the Masters (and the media) have forced the matter to the government attention - for action. We thought the antics of the aviation bureaucrats at Senate estimates were worthy of attention; but the NSW tribe beat the band, hands down. Below is a 'you tube' recording of the NSW estimates session. Click on at the 1 hour 56 second mark and watch carefully. These guys make the Canberra lot look like honest upright citizens; boy, they're good. Circuit breakers popping all the way back to the Minister, although, happily, his ultimate get out gaol card is 'the contract'.
The NSW state government seem to have several 'real' matters of transport safety to deal with. There are rumbles from within the Unions of those who actually operate the state's transport network. Trains and busses all with 'safety' matters which, (pardon the expression) should a wheel come off can only lead to more expense and embarrassment associated with 'accident', particularly if people are harmed or killed. But the one, easily definable 'safety issue' matter is a stand out example; that of the ferries which operate on Sydney harbour. Multiple steering failures; rumours of dodgy welding: AMSA getting involved, then not. Big bucks at stake if OTSI join hands with ATSB (etc.) – and yet the resident evil within the steering system of these large, high speed, passenger carrying vessels cannot be sheeted home and guaranteed, certified as rectified. What is it now 10, 15 – 20? incidents of failure; yet revenue and political denial of responsibility or accountability shy away from responsibility or accountability - eschewing centre stage (in Spades).
“For want of a battle the kingdom was lost”.
So, a new forum has been demanded by the BRB; one open to all 'drivers' of machinery which carries the fare paying public. Those who should be able to expect an equivalent level of operational reliability from a ferry, train, or even a humble bus as they are guaranteed when travelling by air. Imagine a bus with a steering problem; causing an accident making headlines for more than a day - unlikely. Then imagine that 10 steering failure related accidents occurring in a short space of time – what then? Aye; you imagine correctly. Bus carries what, 50 people; a ferry can carry 400 – and has a track record of provable 'steering failures'. Think on..Someone has to make certain that the basic of safety – reliability – is maintained. Just don't look to the political system support crowd to accept responsibility, be accountable or, better yet, get the problem sorted.
Ramble over; but at the end of the shift, after the accident, when the knives come out, someone has to pay the freight. Last man standing is the driver, easy target, far removed from the machinations of 'deals' - 'contracts' and the zero responsibility/ accountability of the administration.
Toot toot.
Arrgggh! - Victimology – from plagiarised victim to idiot in one one fell swoop – I will repay.
RE: “For want of a nail the shoe was lost.” -
Peetwo - 11-26-2022
Dots-n-dashes in the search 4 IP on the Emerald Class steering failure occurrences?? -
To begin I will start with an update on the latest news and opinions on the Emerald Class Gen II steering issues. Courtesy Chris Cowper, via Facebook:
Quote:Chris Cowper
1 d
STOP PRESS. STOP PRESS. STOP PRESS.
"BALMORAL" PULLED FROM SERVICE.
Transdev, the French owned Company with a contract to run the Sydney Ferries business, has been pressured by the combined Maritime Unions, who cover Ferry Crews, to withdraw their Chinese built Gen II Emerald, "Balmoral", from service until the Gen II Emerald steering problems are identified, rectified, successfully repaired and passed by AMSA.
Again.
"Fairlight" is still off the run after her recent steering failure and now has an AMSA order prohibiting her from entering service until AMSA is happy with repairs and modifications to her steering system.
As I posted earlier today, "Clontarf" is at BSY having damage warranty work completed.
I haven't seen any comments from Birdons, the Port Macquarie based Company contracted to supply the Gen II Emeralds.
And:
Chris Cowper
1 d
·
A former workmate sent me the message and photos below:
"Birdons of Port Macquarie undertaking warranty work on the Chinese built Gen II Emeralds,being carried out at BSY.
This is absolutely ridiculous.
The hull damage happened because of high seas and "tunnel slamming" crossing the heads.
French owned Transdev are trying to hide and erase the truth by repairing (cut and weld back) the damage.
These boats are not suitable for Manly run at all.
Whatever they do, the bow damage will come back.
It is unsafe to be running these boats, with passengers, across the heads.
I'm not sure how they pass for the 4.5m wave height limit.
It has put all our lives and careers in an extremely risky situation. .
They passed it only to save these boats.
Now need higher authorities, AMSA, Class Societies, etc to reassess the situation.
With experienced Manly Ferry Masters, Crews and Passengers."
Next I go back to the November 26 NSW Budget Estimates with a copy of the Hansard and AQON related to the Emerald Class Steering issues etc.
1)
https://auntypru.com/wp-content/uploads/2022/11/Transcript-PC-6-Transport-26-October-2022-CORRECTED.pdf
Quote:26 August Hansard ref: From the bottom of page 22 references to OTSI funding:
Quote:The CHAIR: When we were talking before, Minister, I was a little confounded by your response in relation to the Office of Transport Safety Investigations. Are you aware of the Office of Transport Safety Investigations, the New South Wales independent—
pg 27 reference OTSI and an increase in reporting incidents
pg 39 onwards: Ferry steering issues
2)
https://auntypru.com/wp-content/uploads/2022/11/Answers-to-Questions-on-Notice-Transport-supplementary-received-22-November-2022.pdf
Quote:AQON 15:
The Hon. DANIEL MOOKHEY: Sorry, Mr Collins, I'm directing these conversations to the secretary at first instance. I'm asking specifically about a report, not updates or information. I'm asking about a report. Secretary, did you provide the Minister the report? ROB SHARP: An interim report, because clearly the cause was not still not known. The Minister also directed Transport to engage an independent assessor, which was around that time as well. The Hon. DANIEL MOOKHEY: When did you provide the interim report? ROB SHARP: I'd have to take on notice when the team met with the Minister to provide an interim update— The Hon. DANIEL MOOKHEY: Was the interim report written? HOWARD COLLINS: Mr Mookhey, thank you. I know you're enthusiastic, and I appreciate your— The Hon. DANIEL MOOKHEY: Mr Collins, I'm sorry, but I'm asking these questions through the secretary. It is my prerogative. Secretary, the question was is this interim report in writing? ROB SHARP: I would have to take on notice the nature of the report. What I will say is the Minister has been kept fully briefed along this the whole way through. It has been moving because the aspiration was to understand the root cause much more quickly than has occurred. We're all aware that the vessels are still not in service yet. The Hon. DANIEL MOOKHEY: Sorry, Mr Secretary, I appreciate that. Of course I would expect the Minister to be constantly engaged, and there is no suggestion that the Minister is not. ROB SHARP: But if you're after the specifics on the report, I'd have to ask the team what the nature of that— The Hon. DANIEL MOOKHEY: It's a major safety incident in which one of the ferries drifted near a cruise ship. The Minister responded by ordering a report. You're honestly telling me here that you don't have any recall as to whether or not an interim report that you gave less than a month ago was in writing? ROB SHARP: I'll refer to the team and the nature of the actual report. But just to clarify, at no time was the ferry adrift in front of a cruise ship. I know the media ran that story but it is factually incorrect. There were fallback positions— The Hon. DANIEL MOOKHEY: Hence the need for a report to clarify this. But who knows whether or not this interim report was written?
HOWARD COLLINS: I think the secretary has asked me to answer this question, Mr Mookhey, if you're happy for me to— The Hon. DANIEL MOOKHEY: If you can actually answer the question, which is very specific. Was the interim report in writing? HOWARD COLLINS: I believe a report was provided in writing. Let me find out the details of that interim report. I will assure you, Mr Mookhey, that if that is available today, I will furnish you with the information of when it was provided. But it was a constant communication between the Minister's office and ourselves as to the progress, along with communication with AMSA, OTSI and the relevant parties.
Answer:
I am advised: A verbal briefing was provided to the office of the Minister for Transport. A written report was not provided.
The report to which I think they are referring is the OTSI IFS (interim factual statement) which, in the normal course of events (after a transport safety occurrence has been mandatorily reported to OTSI), should be released/made public within a matter of days of the occurrence and formally indicates that OTSI will be investigating and consequently highlights OTSI scoping of the investigation.
If at anytime there is a requirement for a re-scoping of the investigation (due to further evidence acquired etc.) then OTSI will release another IFS.
In this case (for some unexplained reason) the OTSI decision to investigate was not made until October 18th, some three weeks after the Fairlight steering failure occurrence (26 September 2022)??
Ref:
Safety and assurance systems for defect management (critical steering controls) in the Emerald Class Generation II Fleet
Quote:Incident overview
On 26 September 2022, Transdev Sydney Ferries (TDSF) removed from service three
(3) Emerald Class Generation II Ferries, the Fairlight, Balmoral and Clontarf, after two
steering failures in as many days occurred on Sydney Harbour. This incident was the
latest in a series of steering related failures. It involved a steering failure on the Fairlight
to the west of Fort Denison while conducting a passenger service. The previous day,
the vessel Clontarf was conducting a passenger service from Circular Quay to Manly,
when a steering failure occurred to the east of Fort Denison while travelling in an
easterly direction. Both incidents occurred on separate Generation II vessels and
resulted in a full loss of steering control. The master conducted the pre-determined
immediate response drills to respond to the incidents.
Following the second incident, TDSF temporarily removed the three Generation II
vessels from service. In the interim, two Freshwater class vessels have been reintroduced into service to support the regular Manly-Circular Quay passenger service.
The operator (TDSF) engaged an external engineering specialist to assist in root
cause analysis, engineering assessment and defect repair. As of 17 October 2022,
the cause was still under investigation and the vessels remain temporarily removed
from service.
Since 1 December 2021 – 26 September 2022, OTSI received nineteen (19) notifiable
occurrence reports regarding the Generation II ferry class. Ten (10) of these related
to steering defects. The remaining notifiable incidents related to other general
passenger, engineering, operational or assurance incidents arising from regular
passenger ferry services onboard the Generation II vessels.
Scope of the investigation
Based on findings from OTSI’s preliminary enquiries, the Chief Investigator
determined that the matter warranted investigation in accordance with Section 46 of
the Passenger Transport Act 1990 (NSW).
The scope of the investigation includes, but is not limited to:- Defect management systems and associated assurance processes for critical
steering failures at introduction into service and throughout the service life of
the vessels;- The effectiveness of the SMS in managing risks to service operations while
critical steering defects are identified and repaired; and- Engineering resource and competence to support defect management and
associated assurance processes across the fleet.
The Chief Investigator has required the Investigator in Charge (IIC) to:
- Identify the factors, both primary and contributory related to critical steering
failure defect management at introduction into service and throughout service
life - Examine the effectiveness of controls in place to manage the related risks
- Advise on any matters arising from the investigation that would enhance the
safety of ferry operations
The IIC will consult with all Directly Involved Parties (DIPs) throughout the
investigation.
Hmm...funny that the Minister was not privy to the IFS, after all it was released over a week before the Budget Estimates...
Next I want to rewind to the previous 26 August Transport portfolio Budget Estimates hearing where the Emerald Class steering issues and OTSI was subject to several lines of questioning throughout the day's proceedings:
Passages of interest: 01:08 ; 02:30:45 ; 07:11 .
Hansard:
https://auntypru.com/wp-content/uploads/2022/11/Transcript-PC-6-Transport-Veterans-Western-Sydney-26-August-2022-CORRECTED.pdf
And finally the AQON:
https://auntypru.com/wp-content/uploads/2022/11/AQON-Hon-David-Elliott-MP-Transport-Veterans-Western-Sydney.pdf
Quote:QoN08
The CHAIR: How many inspectors does OTSI have?
ROB SHARP: You would have to refer that to OTSI. There is certainly a management structure that I'm aware of but I'm not privy to all the layers in the organisation. You would have to refer to them.
The CHAIR: When the funding decisions were made, that was made on the basis of not knowing how many inspectors they could afford?
ROB SHARP: No. There was a paper put together. I just don't have that information off the top of my head.
The CHAIR: Are you able to take it on notice? ROB SHARP: Yes.
ANSWER
I am advised that in the 2021-22 financial year, the investigation team within the Office of Transport Safety Investigations (OTSI) grew from six to nine Senior Investigators.
In the 2022-23 financial year, the Office of Transport Safety Investigations
QoN09
The CHAIR: Are you aware that in its annual report from last year OTSI reported a 20 per cent increase in reports of safety issues?
Mr DAVID ELLIOTT: I would have to take that on notice.
ANSWER
I am advised that in the 2020-21 financial year, the number of bus, rail and ferry safety incidents notified to the Office of Transport Safety Investigations increased from 1,172 to 1,406. Increases in reported safety incidents do not necessarily indicate a degradation in the safety of the network and can be an indicator of a growing positive safety culture through increased reporting.
QoN37
The Hon. DANIEL MOOKHEY: Mr Secretary, can I ask a few more questions about matters to do with our ferries? How many days have the three Emerald Class Generation 2 ferries, Balmoral, Fairlight and Clontarf, been taken out of passenger service in 2022 for maintenance reasons, both scheduled and unscheduled?
ROB SHARP: I would have to pass to Mr Collins for the detail on that.
HOWARD COLLINS: Thank you very much. Obviously the accuracy and detail of that we will have to take on notice. Just for the record, I think your colleague quoted an incident happening in July this year. I have found that report. The master lost—starboard steering occurred without his control. He immediately went to the backup control. The ferry was taken back to dock and it was repaired, and some investigation took place. I don't think it was quite as described by Mr Graham, but that's for the record.
The Hon. DANIEL MOOKHEY: Who did the investigation?
HOWARD COLLINS: I believe the investigation for that ferry took place by Transdev themselves. Obviously we have the capability of asking our safety and environmental risk people to carry out investigations or, as OTSI published, they can carry out investigations themselves if notified.
The Hon. DANIEL MOOKHEY: Did my colleague ask you when Transdev notified you of this?
HOWARD COLLINS: He didn't.
The Hon. DANIEL MOOKHEY: Let me. When did Transdev notify you of this?
HOWARD COLLINS: Of the July incident? I'll take that on notice. We were notified. I'll let you know what the date was.
ANSWER
I am advised that, to date in 2022, there have been a total of 114 days of scheduled and unscheduled maintenance across the Second Generation Emerald Class vessels.
Transdev Sydney Ferries notified Transport for NSW of the incident involving the MV May Gibbs on the day it occurred, 19 July 2022.
QoN38
The Hon. DANIEL MOOKHEY: Basically, the ferry effectively started to drive itself?
HOWARD COLLINS: I think what's described in the report that I've read in the interim was that, whilst travelling, the master noticed the ferry was taking a starboard direction without him operating the—it's a bit like a joystick on the Emerald Class. He took corrective action and went to put the engines into neutral. He took corrective action. There's always a backup. I think this is just to make sure people understand that when this happens, you can go into backup. It's a bit like in 2012; the Lady Northcott veered off and actually crashed into the harbour wharf. These things have occurred in the past, but what has happened is that investigation took place. They believe it was connected with the Australian-made and designed toggle device, and further work has been done on that particular project.
The Hon. DANIEL MOOKHEY: Look, kudos to the master—
HOWARD COLLINS: Absolutely.
The Hon. DANIEL MOOKHEY: —and respect to them for the professional skill that they—
HOWARD COLLINS: Hugely professional—they would do that every day. It is not as if it was an emergency situation.
The Hon. DANIEL MOOKHEY: It's why we train them. Mr Collins, I do want to congratulate the master for the action that he took, but the fact remains that the ferry started to steer itself. That's correct?
HOWARD COLLINS: Correct. But it was immediately corrected.
The Hon. DANIEL MOOKHEY: Indeed. HOWARD COLLINS: And there is a backup system.
The Hon. DANIEL MOOKHEY: I'm glad that that kicked in as well. How many people were onboard?
HOWARD COLLINS: I can't tell you exactly. I will find that report and tell you on notice.
ANSWER
I am advised that there were 12 passengers on board the vessel.
QoN39
The Hon. DANIEL MOOKHEY: Was it a typical service? Do we have any information about what time it took place?
HOWARD COLLINS: I, again, will get you—rather than give you a delay by looking for the report, I will give you that information regarding what time of the day it was, where exactly it was on the harbour and information regarding that report.
The Hon. DANIEL MOOKHEY: I presume the incident was disclosable, correct—as in, there was a mandatory disclosure obligation on the part of Transdev?
HOWARD COLLINS: All incidents, depending on their nature—but this one does sound very much, as you may be indicating, Mr Mookhey, that would be reportable so that AMSA or OTSI may wish to take investigations. We know reportable incidents—rail, ferry, buses investigations—can take place or it can be left with the organisation.
The Hon. DANIEL MOOKHEY: But has it actually been reported? Has it been reported?
HOWARD COLLINS: I will take that on notice and make sure I'm—
The Hon. DANIEL MOOKHEY: But this is an incident which took place on 11. There is an automatic—under all transport law, there is a requirement for mandatory reporting within a certain time period. It is not just that it's a reportable incident, you have to also, by law, report it in a timely way?
HOWARD COLLINS: Correct.
The Hon. DANIEL MOOKHEY: So, sitting here, some seven weeks later—maybe six weeks later— are we in a position to confirm that OTSI has, in fact, been notified?
HOWARD COLLINS: I will take that on notice rather than give you wrong information.
ANSWER
I am advised that the incident took place at 6:35am on 19 July 2022 and involved a regular passenger service operating between Rose Bay and Circular Quay. The incident was reported to the Office of Transport Safety Investigations, Australian Maritime Safety Authority and Transport for NSW.
The Office of Transport Safety Investigations was notified on the 20 July 2022.
QoN40
The Hon. DANIEL MOOKHEY: Are you aware of any OTSI investigation that is underway?
HOWARD COLLINS: Of this particular incident, I am personally not aware.
The Hon. DANIEL MOOKHEY: Mr Secretary, are you?
ROB SHARP: No, I'm not aware.
HOWARD COLLINS: I will just check that. I may have been notified. There are many—as you can imagine, there are thousands of incidents and operations during the services that are under my responsibility. Certainly, we are—my team, who are responsible for the contract, are always notified of OTSI incidents and also have regular updates with Transdev.
The Hon. DANIEL MOOKHEY: Perhaps, Mr Collins, on notice is it possible that you could tell us about how many reports have been notified to your team by Transdev in the past 12 months—
HOWARD COLLINS: No problem.
The Hon. DANIEL MOOKHEY: —how many of them have since been notified to OTSI or any other safety regulator, how many of them were then subject to an investigation by OTSI and, if you are in a position to do so, what was the outcome of the OTSI investigation?
HOWARD COLLINS: I think I've got the gist of your advice—we'll certainly take that on notice. As I said, not all incidents are necessarily reportable to OTSI.
The Hon. DANIEL MOOKHEY: Yes, I am aware there is a threshold.
HOWARD COLLINS: Yes, there is.
The Hon. DANIEL MOOKHEY: But hence my question as to how many of them are being notified from Transdev to you. I'm just going up the chain of responsibility, to be very clear, Mr Collins.
HOWARD COLLINS: Yes, thank you.
The Hon. DANIEL MOOKHEY: And I'm just wanting to go through each step of the chain of responsibility.
ANSWER
I am advised that there is an investigation underway by the Office of Transport Safety Investigations for the MV May Gibbs incident on 19 July 2022.
Following the loss of control incidents on 2 July 2020 and 23 November 2020, an investigation was undertaken by the Office of Transport Safety Investigations and completed with a report issued.
A number of findings were identified by the Office of Transport Safety Investigations for which Transdev Sydney Ferries completed a program of works to resolve.
An assurance check was conducted by Transport for NSW to verify that the actions were completed satisfactorily. The Office of Transport Safety Investigations’ report is publicly available.
QoN41
The Hon. DANIEL MOOKHEY: Has there been cracking reported on the hulls of the Emerald Class Generation 2 ferries, Balmoral, Fairlight and Clontarf?
HOWARD COLLINS: I believe so. Yes, they were identified in inspection—a number of cracks appeared.
The Hon. DANIEL MOOKHEY: How many?
HOWARD COLLINS: I can't tell you the number. But I know what has happened is that those identifiable cracks—again, this is an Australian-designed vessel by Incat Crowther. Those cracks have been identified and either repaired or have been of a nature that will be dealt with under maintenance.
The Hon. DANIEL MOOKHEY: When were you notified of the cracks?
HOWARD COLLINS: Again, I cannot give you the accurate date. But I will take that on notice of when we were first advised of identifying cracks on the Emerald ferries.
ANSWER
I am advised that on 4 April 2022, a number of cracks were identified in the Second Generation Emerald Class vessels following a structural inspection by an independent, Australian certified maritime surveyor. It is understood that these cracks do not compromise the overall structural integrity of the vessels.
Transport for NSW was immediately notified by Transdev Sydney Ferries when the cracks were identified.
Hmm...Minister to Transport Bureaucrat: "Nothing to see here right? Err...right?"
Much MTF...P2
RE: “For want of a nail the shoe was lost.” -
Kharon - 11-28-2022
Of Responsibility, accountability and ownership.
I am quiet genuinely puzzled; being a new 'interested party' in this saga of the Sydney harbour ferries. There is, it seems at first run through, a maze of disconnects between the parties involved; which makes it difficult to nail down the ultimate respondent to any claim made by the family of anyone unfortunate enough to have been harmed in an event such as a collision with Fort Dennison.
Perhaps it is time for AMSA to weigh in – but can they? What about the insurers can they declare that the risk outweighs the premium? Who pays that insurance and to whom? Who, in reality actually owns these ships? Who collects the revenue and how is that divided? Then the really curly questions pop up – maintenance – scheduled, routine and incidental? Who certifies rectification and repair? Who signs a vessel back to service. There is a long list of questions shrouding this saga; answers to which cannot be found in publicly available documents. The 'arrangements' should all be clearly defined, documented and available to the public without needing a FOI request or involve a twelve month letter writing campaign to a dead end automatic response generating system; try finding out just who Transdev are – good luck with that.
Then, try and work out what OTSI are doing about a clearly defined repetitive failure event of a critical system failure; to wit, the bloody steering system. When the lives of the travelling public are potentially at risk – then every, and I do mean every little thing which could affect their journey must be clearly visible. Welding; hull strength; steering; sea worthiness at
Lloyd's register standard.
Officials who cannot answer straight questions with direct answers; are OTSI staff being gagged because no-one has gone public? Contract back alleys and lots of duck shoving is not what the public pays for or signed up to. Nowhere near good enough is it? Not by a long shot..
Shape up or ship out seems a fair call to me.
Toot – toot...
RE: “For want of a nail the shoe was lost.” -
Peetwo - 11-28-2022
Emerald Gen II Ferry update; & OTSI another bureaucratic top cover agency??
First via FB today the NSW Opposition leader took a free kick on the Emerald class Gen II ferry debacle...
Quote:
Chris Minns
Ferries covered in cracks that can now fly and can’t be steered, a light rail shut down for months, ferries that can’t fit under bridges, trains that don’t fit the tracks and I can go on. The Liberal's obsession with offshoring must end.
And from the Daily Telegraph 2 days ago:
Quote:
Entire fleet of new Sydney ferries sent back to the dock
The last vessel in the problem-plagued fleet of Emerald ferries has been pulled off the water with emergency safety inspections to be done after a litany of ongoing failures...
Via FB:
Hmm...1) No mention of whether there is an AMSA safety directive for the grounding of all 3 Gen IIs?? 2) Does this mean the OTSI investigation will now be expanded and will it include not only the latest steering failure of the 'Fairlight' but also the 'flying' structural fatigue cracking issues that have occurred after only a year in service?
Next I'd like to revisit the TOD (timeline of discontinuity) in this whole sorry saga...
To begin the following is an excellent back dated article from the 'Manly Observer' that helps IMO to fill some of the gaps:
Quote:‘And stay down’! Ferry critics double down after new fleet temporarily withdrawn
By Alec Smart
October 10, 2022
Councillor Candy Bingham staged a protest as part of the Save Manly Ferries campaign in October 2021. The former deputy mayor says it's time to take a new approach to the iconic route.
The Australian Maritime Safety Authority (AMSA) has directed that the three Emerald Class ferries on the F1 City to Manly route (Clontarf, Balmoral, and Fairlight) must not carry passengers until newly discovered steering faults are fixed and verified.
The three new Emerald Class Generation II vessels were withdrawn from service in late September after problems were identified. After the withdrawal, speculation began that the entire fleet of nine Emerald Class (Generation I and II) ferries would be withdrawn from the service between Circular Quay to Manly.
It was also rumoured that perhaps three of the original four older, larger Freshwater Class ferries might return to full-time duties (the fourth, MV Narrabeen, needs an engine rebuild). However, the TfNSW spokesperson said in a statement that the first generation Emeralds “remain in service and are running alongside two Freshwater vessels.”
But the three newer vessels are stood down, Transport confirm in this statement:
“The Second-Generation Emerald Class ferries are currently out of service following steering issues with two vessels in the fleet. The investigation continues with technical assessments nearing completion.
“This work is progressing well and as necessary the vessels will be tested on water under strict safety supervision with no passengers.
Our priority remains fixing the steering issues and returning the vessels to service as quickly as possible.”
“OUR PRIORITY REMAINS FIXING THE STEERING ISSUES AND RETURNING THE VESSELS TO SERVICE AS QUICKLY AS POSSIBLE.”
The issue that provoked the decision was the steering failure of the MV Fairlight ferry near Fort Denison on Monday 26 September. Of significant concern was that it occurred in the sea channel of a departing cruise ship, the Coral Princess, and its escort tug.
The previous day, the MV Clontarf, another Generation II vessel, also experienced steering difficulties.
The third Generation 2 Emerald Class ferry, the MV Balmoral, was then withdrawn with the other two on 26 September for risk assessment and they remain out of service until cleared for redeployment.
The Catherine Hamlin Emerald Class Generation I ferry at Manly Wharf. Photo: Alec Smart
Manly Observer understands the removal of the newer vessels should be a short-term setback, though that is dependent on the verification process. The vessels have already provided plenty of surprises.
Manly councillor and head of Save The Manly Ferry campaign group Cr Candy Bingham said the new “Chinese-built Mark II Emerald ferries have been a disaster.”
“Not only were they delivered with 80 defects, the issues continue with very concerning safety issues.. it’s alarming that French operator Transdev continues to play down just how serious things have been,” Cr Bingham said.
“They are not suitable for the iconic Manly route – and we don’t want them back!”
“THEY ARE NOT SUITABLE FOR THE ICONIC MANLY ROUTE – AND WE DON’T WANT THEM BACK!”
“Bring back at least three Freshwaters until a five year plan can be implemented with fully electric look-alike Freshwater ferries, built in Australia. The Manly Ferry is a major tourist attraction for Sydney. Transdev and the NSW Government are systematically destroying this iconic attraction and killing Manly’s economy in the process.”
The Freshwater class Manly Ferry.
A bit of history
On 18 August, Manly Observer reported on the redeployment of the historic Freshwater ferries into service. They were reintroduced for a number of reasons, not least because campaigners from Save The Manly Ferry campaign group petitioned to return and retain them until a larger replacement ferry was available.
On 25 March 2021 Northern Beaches Council then Deputy Mayor, Candy Bingham, presented a petition of 22,000 signatures to the NSW Parliament calling for the retention of all four Freshwater Class ferries, which were at the time all projected to be retired permanently.
Initially, the 1,100 capacity ‘Freshies’ were only used on weekends and public holidays, although their replacements, the significantly smaller, 400-capacity twin-hulled Emerald Class Generation II ferries introduced in October 2021, struggled to cope with passenger numbers during peak commuter periods and did not handle well in rough sea conditions.
The Department of Transport insists “both second-generation Emerald Class and Freshwater ferries are fully cleared to operate in up to 4.5 metre swells”.
Yet there was considerable public concern that the new Emeralds were unable to deal with the occasionally tumultuous waves that roll in through Sydney Heads, and vulnerable to capsize. That anxiety was inadvertently stoked by ferry operators TransDev in a 10 March 2022 Fleet Operations Temporary Memorandum, which was leaked to the media in April 2022.
The alarming memo, issued by TransDev, warned captains that the newest three Emerald Class vessels risked becoming ‘airborne’ when steered into large waves.
The memo cautioned: “It was evident during the trials when navigating the Emerald Class Generation 2 vessel directly into the waves or on a 45-degree angle to the waves at speeds of round 10 knots, caused the vessel to become airborne and resulted in tunnel slamming. This can be detrimental to the vessel’s integrity and the safety and comfort of the crew and passengers.
“Running ahead of the swell must be avoided, as this may cause ‘trapping’, which results in the vessel to bow-diving or broaching, and a loss of control.”
The leaked March 2022 TransDev internal memo that continues to cause public anxiety about the purported safety of the Generation II Emerald Class ferries in rough seas.
During the frequent storms attributed to the La Niña weather phenomenon, which brought torrential rains and surging seas over the 2021-2022 summer, the smaller Emerald Class ferries were cancelled numerous times. Replacement bus services were scrambled to transport commuters the long alternative journey by road to the City.
On 12 July 2022, NSW Shadow Transport Minister Jo Haylen visited Manly to meet with campaigners and call for the immediate return of the Freshwater ferries.
Ms Haylen had already voiced her support on 31 October 2021 when she posted an open letter to NSW Transport Minister Rob Stokes calling on him to reverse the Government’s decision to retire the Freshwater Class ferry MV Queenscliff.
In the letter she said, “The overseas-built Emeralds meant to replace the Queenscliff have been beset with design and operational problems. They are also unable to safely carry passengers in swells that are over three metres which commonly occur during the crossing of Sydney Heads….
“Capacity on the replacement Emerald Class is only 400, compared to the Queenscliff and other Freshwater Class Manly ferries which sit 1,100 passengers. Such a significant drop in capacity could mean that passengers are left on the wharf…”
A TfNSW spokesperson told Manly Observer in July, “It is a common misconception that Freshwater vessels can operate in a wider range of weather conditions than a modern catamaran, such as the Generation 2 Emerald Class ferries.
“The most pressing factor in service operation during more extreme weather events is customer comfort. Regardless of the vessel class operating the F1 route, ferry services rarely operate in conditions that are uncomfortable for customers.”
The MV Freshwater ferry arrives at Manly Wharf in March 2007. Photo: Alec Smart
That article was dated 10th of October and indicates the date that AMSA issued it's safety directive (grounding) on the Gen II ferries. However OTSI did not initiate an investigation until over a week later and some 3 weeks after the 2 serious safety steering failure incidences had taken place (25th and 26th of September). Presumably OTSI had received 2 mandatory serious safety incident reports within hours of those incidents occurring, so why did it take over 3 weeks for OTSI to decide to investigate?
Next I want to rewind to the 26th of August Budget Estimates Hearing and in particular focus on the answers to QON 39 & 40 :
Quote:ANSWER
I am advised that the incident took place at 6:35am on 19 July 2022 and involved a regular passenger service operating between Rose Bay and Circular Quay. The incident was reported to the Office of Transport Safety Investigations, Australian Maritime Safety Authority and Transport for NSW.
The Office of Transport Safety Investigations was notified on the 20 July 2022.
ANSWER
I am advised that there is an investigation underway by the Office of Transport Safety Investigations for the MV May Gibbs incident on 19 July 2022...
Hmm...however (despite the statements above) it would appear that the advisement to the Transport Dept and the Minister that there was going to be an investigation into the MV May Gibbs was a furphy, as there is no IFS published on the OTSI website?? Ref:
https://www.otsi.nsw.gov.au/ferry/investigations
MTF...P2
RE: “For want of a nail the shoe was lost.” -
Peetwo - 11-30-2022
Emerald Gen II clusterduck update: 30/11/22
Via
Channel 7:
Via FB comment in reply:
Quote:Donald Hunt
Come on Premier & Transport Minister, if you read this time to stop this fiasco, how many times do you pull these ferries of for repairs. Please return all four Freshwater ferries to the F1 route Manly to CQ. Starting with the Freshwater & Collaroy, when Queenscliff is finished please add back to Fleet & please consider doing the necessary repairs to the Narrabeen. Also please call for local tenders to build here replacement freshwater ferries. Until then please consider keeping the freshwaters in service. Surely you can see these Emerald 2’s are simply not suitable for the F1 route.
MTF...P2
RE: “For want of a nail the shoe was lost.” -
Peetwo - 11-30-2022
(11-30-2022, 07:41 AM)Peetwo Wrote: Emerald Gen II clusterduck update 2: 30/11/22
Via Channel 7:
Via FB comment in reply:
Quote:Donald Hunt
Come on Premier & Transport Minister, if you read this time to stop this fiasco, how many times do you pull these ferries of for repairs. Please return all four Freshwater ferries to the F1 route Manly to CQ. Starting with the Freshwater & Collaroy, when Queenscliff is finished please add back to Fleet & please consider doing the necessary repairs to the Narrabeen. Also please call for local tenders to build here replacement freshwater ferries. Until then please consider keeping the freshwaters in service. Surely you can see these Emerald 2’s are simply not suitable for the F1 route.
Plus (latest via FB):
Quote:Sue Barsi Wright
3 hrs ago ·
Transport workers shouldn’t have to be in a position where they have to stand up for passenger safety because the government is unable or unwilling to do so.
The government must explain why no risk assessment was done on the Balmoral for nearly a week.
They must release the reports that state the Emeralds' defects have been rectified and are actually fit for service. If they can't, the Emeralds should not be in service.
This is a neglect of safety and duty of care from the government.
Hmm...where the hell is AMSA??
MTF...P2
RE: “For want of a nail the shoe was lost.” -
Kharon - 12-01-2022
Good question P2...
Indeed, where is AMSA? These ferries are “Domestic Commercial Vessels”. AMSA has jurisdiction re 'seaworthiness, manning and operator certification, under the Maritime Safety (Domestic Commercial Vessel) National Law Act 2012.
Clearly there are some very real safety issues; concerns with regard to the basic design and construction; concerns with regard to the quality of structural welding; concerns regarding the damage inflicted crossing Sydney Heads in 'big swell' all of this and there is an on going systematic problem with the steering systems. The things which are most concerning are (in no particular order) the role OTSI has played thus far: the response to the NSW Estimates questions from government officers and, the clear lack of faith the Masters have in the 'reporting' system contained within the SMS (Safety Management System).
On land, in the air or at sea 'luck' will only get you so far; and the NSW government has, so far, been very fortunate, mostly due to the skill and experience of the crews. Time this whole mess was exposed and the public given back that which they paid for; a safe journey in a seaworthy ship. Perhaps that journey could begin with a home grown service operator who can be held to account and the profits kept 'on shore'. Before there is a serious event...
Toot – toot....
RE: “For want of a nail the shoe was lost.” -
Wombat - 12-01-2022
The cracking is the secondary problem. What happens when the steering fails on a bad day in the middle of the heads (off Middle Head) with a full load and the vessel is beam on to the swell just as the statistical “rogue wave” (twice the average wave height) on top of a two metre swell hits?
InCat won’t have designed for that and the rage of the General public will consume the Government, Transdev, AMSA and ATSB. There will be nowhere to hide..
Addendum:
Agree 100% - worst case scenario must be covered, despite the 'statistical' probability . Re the 'cracks' again agree – but; and this is only second and possibly even 'third' hand rumour related to the 'quality' of the structural welding. To quote my source verbatim “seen better welding on a garbage truck”. That must be a rumour worthy of investigation, even if only to disprove it. Cheers....'K'.
RE: “For want of a nail the shoe was lost.” -
Kharon - 12-02-2022
Ifs, buts and agenda.
Or, ducking, weaving and getting off the hook. There are, I'm told, two basic elements attached to any sort of investigation into matters which directly impact on 'public safety', particularly when a government minister must be included in the 'big picture'. Follow the money trail (all of it) is sound advice; but the other side of that coin is plausible denial of 'liability'/ responsibility and accountability. The salt in that particular stew is 'government involvement' in what should be either a State run or Privately run operation. Hybrids just create blurred lines and far too many bolt holes.
It will take a while to backtrack to the very beginning of the Sydney Harbour ferry debacle; in the beginning, there was the notion that a new breed of ferry was required to replace the ageing, slow if reliable ships servicing the harbour. Fair enough: increased demand, increased numbers and the potential costs involved in maintaining and insuring ageing vessels. Fair enough; a reasonable investment for the public purse to make and beneficial to the city, the State and the government election platform. Win – win you'd think, and, in a perfect world you would be correct.
So the journey begins - “we need new boats” and its game on. Long before any public announcement is made the words find their way to various ears and everyone wants a slice of this huge pie. But it is a complicated game; very complicated and the interests of those involved are not only in conflict but juxta opposed. The voice not heard in any of the negotiations is the public one; those who must, eventually pay for the whole shebang; one way or another.
Think about the cost involved in providing a tender; lobbying; presenting and researching a proposal. A big outlay without any guarantee of success on a stand alone basis, let alone being under attack from the competition. An expensive dog-fight with the CEO of any bidder under the pump from the board and investors. You can see why the 'rough' edges of any submission would be smoothed off, buried and never see the light of day, let alone logic. But, the kicker is in how to avoid 'liability' if or when the 'cracks' begin to appear; the ifs, the buts and the escape plans. From the builders al the way through to the operating crews; the agenda is to avoid any and all liability if the wheels come off and the good ship Glorious Notion goes down in flames, or breaks up crossing the harbour heads; or capsizes due to a loss of command steering? Ever see the seagulls scattering when chased of spilled chips; slow in comparison to the Buzzards off the ferry carcase when startled.
So much for the private sector. But here there is government involvement to consider. Elections to worry about, credibility which goes with the job. But there is also 'liability' to add to public condemnation; this before any sort of official, independent inquiry sees public opinion (if there ever is one). But, the kicker is in 'how to' avoid all 'liability' if or when the 'cracks' begin to appear; the ifs, the buts and the escape plans. From the buyers to builders, all the way through to the operating crews; the agenda is to avoid any and all liability if the wheels come off and the Glorious Notion goes down in flames.
Take a long look at the picture today; to say that nearly all the 'ifs and buts' chickens have come home to roost is a fair call. The responsibility, accountability and liability agenda clearly visible; all the stops pulled out, all of them. Department heads back peddling like billy o. Safety watchdogs on short leashes, if not hobbled. Private entity spinning like tops trying to keep 'the facts' under wraps. Such is the reality for a humble member of the public who simply wants to travel from A to B at a reasonable cost, in reasonable comfort; reasonably expecting to arrive in one piece with the kids at Manly for 'fish and chips' on the beach...
The men responsible for and highly experienced in managing the this routine task have raised some very serious safety matters. These matters IMO demand the use of the full powers, without political influence, granted to OTSI (who seem to be conflicted (and 'all at sea')and the AMSA who do have a legal right and obligation to take a long hard look at the situation. I say that if only half of the public safety matters are only half true; then there must an open, no stone unturned investigation. I can only imagine the consequences if there was any sort of cover up or even obfuscation should there ever be a fatal accident involving a fully laden ferry. The Commonwealth spent millions on an aircraft ditching off Norfolk Island; Senate Inquiry, overseas agencies, etc; almost 70 'safety recommendations made (long story) but the NSW government 'safety agency' OTSI see little point in taking the lid off. Nothing to see; no one drowned; so let's not rock the boat –
Bollocks....
Toot – toot..
RE: “For want of a nail the shoe was lost.” -
Peetwo - 12-02-2022
Emerald Gen II clusterduck update: 2/12/22
Via Facebook:
Quote:
Jenny Forster
3 h ·
More ferry nonsense from state Liberal Government and Transdev. Coming back from Quay between 2-3 pm on 2December, an Emerald was loaded up with passengers who were directed to the gangway by staff. At last minute gate was opened to empty Freshwater and four minutes later it left with 22 passengers on a 1100 capacity vessel. Staff were counting passengers physically under instruction so their bosses can report Freshwaters are ‘unpopular’.
Had a response from James Griffin’s office to my letter describing last fiasco saying he was dismayed & had passed it on etc. I’d already done that. Next response from his staff informed me that locals preferred Emeralds as they were faster. Well, hello James, I and all the folk on this Save Manly Ferry list do not.
Comment in reply:
Andrew Drylie
It would Seem that The Government wants to get rid of Manly Ferries altogether and force everyone onto Busses. They ordered Emerald 2s that they knew had a limited capacity and that could not be used in high wave and rough conditions now it seems they are trying to force people on to the Emeralds and
Then send the Freshwaters off Empty.
Responses to Facebook
Posts re Emeralds or Freshwaters Indicate about 85% or more Respondents prefer The Freshwater type Vessels. So keep up The posts re The Freshwaters Especially as The State Government Election is approaching. Make the Retention Of The Freshwaters and the Design and Building of New Large Capacity Double Ended Manly Ferries a Election Issue.
Next via the AP email chains:
Quote:
A Emerald struggling to stay straight and level (just about to “rotate”) out of Manly. Also, a Freshwater class handling big swell just entering the heads open water from Manly.
No wonder the Emeralds have structural issues from hull twisting and impact. To add salt to the wound, you’ve seen the welding quality on these vessels. I was advised that “this quality of weld wouldn’t pass a TAFE examination!
Finally I want to go back to the question of... 'WHERE THE HELL IS AMSA??'
Ref:
(12-01-2022, 05:35 AM)Kharon Wrote: Good question P2...
Indeed, where is AMSA? These ferries are “Domestic Commercial Vessels”. AMSA has jurisdiction re 'seaworthiness, manning and operator certification, under the Maritime Safety (Domestic Commercial Vessel) National Law Act 2012.
Clearly there are some very real safety issues; concerns with regard to the basic design and construction; concerns with regard to the quality of structural welding; concerns regarding the damage inflicted crossing Sydney Heads in 'big swell' all of this and there is an on going systematic problem with the steering systems. The things which are most concerning are (in no particular order) the role OTSI has played thus far: the response to the NSW Estimates questions from government officers and, the clear lack of faith the Masters have in the 'reporting' system contained within the SMS (Safety Management System).
On land, in the air or at sea 'luck' will only get you so far; and the NSW government has, so far, been very fortunate, mostly due to the skill and experience of the crews. Time this whole mess was exposed and the public given back that which they paid for; a safe journey in a seaworthy ship. Perhaps that journey could begin with a home grown service operator who can be held to account and the profits kept 'on shore'. Before there is a serious event...
Toot – toot....
The following is an extract from the
OTSI website (my bold):
Quote:Ferry Occurrence Notification
The Marine Safety (Domestic Commercial Vessel) National Law 2013 requires, in part, that the owner/master of a vessel must report accidents to the Australian Maritime Safety Authority (AMSA). This is required under Section 88 and 89 of the Marine Safety (Domestic Commercial Vessel) National Law Act 2012, Schedule 1 (National law).
Under NSW Law the Marine Safety Act 1998 No 121, Division 2, Section 99 requires:
99 Duty to report marine accidents to Minister
When a marine accident occurs in connection with a vessel, the master of that vessel (and the owner of the vessel if aware of the accident) must send a report to the Minister containing particulars of the accident as soon as practicable by the quickest means available.
After receiving a report of a marine accident, the Minister may require further information from the owner or master of a vessel involved in the accident to determine whether an investigation should be ordered into the marine accident.
Incidents and accidents include:
(a) the loss of life of, or injury to, any person on board the vessel,
(b) the loss of a person from the vessel,
© the loss of life or injury to a person that is caused by the vessel,
(d) the loss, or presumed loss, of the vessel (including the sinking or abandonment of the vessel),
(e) the capsizing, grounding or flooding of the vessel,
(f) the collision of the vessel with another vessel or with any object,
(g) the vessel being disabled at sea (in any case in which it requires assistance),
(h) any fire on board the vessel,
(i) any damage being caused to the vessel (including any structural failure),
(j) any damage to the environment caused by the vessel or by any substance on, or discharged from, the vessel,
(k) any incident that causes danger of any of the above,
Ferry operators can make notifications to the OTSI Duty Officer 24 hours a day by telephoning 1800 677 766 or emailing transport.safety@otsi.nsw.gov.au.
If you are a member of the public and wish to report an incident involving a ferry or obtain information about service disruptions, call 131 500 or visit transportnsw.info.
If you are a transport employee, depending on the nature of the incident or issue you may wish to make a report through the Confidential Safety Information Reporting Scheme (CSIRS).
(K) above IMO would have to include steering failures of all high capacity Sydney Harbour ferries ie the operator would have to fwd through to OTSI. And according to the relevant section (Section 88 and 89) of the
Marine Safety (Domestic Commercial Vessel) National Law Act 2012 the operator and the Masters are also obliged (with threats of criminal sanctions) to report such serious incidents to AMSA:
Quote:Section 88:
(2) The owner of a domestic commercial vessel commits an offence if:
(a) the vessel is involved in a marine incident; and
(b) neither the owner nor the master of the vessel gives a written report of the incident, in the form approved by the National Regulator, to the National Regulator within 72 hours after the owner becomes aware of the incident.
Section 89:
(2) The master of a domestic commercial vessel commits an offence if:
(a) the vessel is involved in a marine incident; and
(b) neither the master nor the owner of the vessel gives a written report of the incident, in the form approved by the National Regulator, to the National Regulator within 72 hours after the master becomes aware of the incident.
Penalty: 60 penalty units.
So with that in mind my curiousity was piqued when AMSA shared the LinkedIn post:
Quote:Australian Maritime Safety Authority
19,642 followers
1d • 1 day ago
During October 2022, there were 67 reported incidents involving domestic commercial vessels. Of these, 10 were serious. We publish the incident report monthly and the information is broken down by state, vessel type and a description of the incident. Read the incident report: http://ow.ly/UsST50LQGUb
If you go to the provided
link you will see that there is monthly records of incident reports for the whole of 2022...
Now given that AMSA grounded the Emerald Gen II fleet (albeit 2 weeks after the serious incidents) I was somewhat stunned to discover that the 2 steering failure occurrences were not listed in the 'serious incident' column for month of September, yet these incidents were??
Quote:"..Passenger fell from stairs and sustained injury to wrist and ribs. Sought medical assistance at hospital...
..Crew member slipped when disembarking and fell into water between vessel and wharf. Crew member recovered without injury... "
More curious now I then flicked through to the July serious incident reports to see if the catastrophic steering failure on Emerald Class Gen I MV May Gibbs on the 19th July was listed but yet again no report..na da (or at least not reported as serious)??
Hard to work out whether the reports have just been filtered out; or if indeed AMSA have actually been notified of these incidents at all?
MTF? - Yes much...P2
RE: “For want of a nail the shoe was lost.” -
Kharon - 12-03-2022
Rue the day -
It's a funny old world; (never sure if its funny 'Ha-Ha or funny peculiar) – no matter. Arranged to meet a fellah at the local watering hole for an Ale and to discuss a project; that done the conversation strayed from the Cricket to other matters. “Don't suppose you blokes dabble in 'matters nautical' “ says he (knowing about the aviation interest). “Well, as it happens” says I. Etc.. Turns out he'd been following the saga of the Sydney ferries closely – his brother was a marine surveyor when the State funded the then fearlessly independent unit. His brother at the time had only one statement about the closure of that unit; in favour of 'independent contractors'. -
“They'll rue the day this was done”.
“Rue comes from the Old English word hreowan, meaning "to make sorry," and rue can still sum up a lot of sorrow in one small syllable.”
How prophetic; absolutely spot on. From ministers to bureaucrats; from Operators under contract to repair docks, from 'safety agencies' to in house surveyors; the great arse covering game is running red hot in the murky world of ferry operations.
I wonder if anyone is game to take the lid off this can of snakes? Get back to design standards; or Production Design Standards and testing of component parts? Then there are questions of structural integrity and the QC of the welding; the stuff that keeps the boat together? A quick run through the workshop and a Return To Service (RTS) after a quick change of defective parts, for the same parts 'out of the box' may solve the short term problems and reopen the revenue stream – but how long will it be before the same problems reoccur?
You really don't need to contemplate the 'worst case' scenario; just remove a dollop of 'luck', degrade the 'skill factor' to a bad hair day, and, think about the near miss incidents; those which have crept into public record. Loss of control of any vehicle from roller skates to a space rocket has the potential to create a serious event. NOT an accident – that is a misnomer; especially when someone is 'pushing their luck' or trading on the percentage chances of it not happening.
Bumping into things like Fort Dennison; or the wharf at Circular Quay are warning flags; trading blows with other vessels are warning lights. But the big siren is the potential for a fully loaded ferry, crossing the Heads in a strong wind with a high sea swell, loosing directional control and broaching. Two, three hundred fully clothed passengers; some below deck to avoid the weather – duck me. The fall out would be monolithic. Time for independent surveyors; OTSI and AMSA to step out from behind the political smoke screen and Perform Design Function (PDF) without fear or favour. If it were a single aircraft; the roof would be off the hanger by now, well and truly. If it was 'fleet wide' - well; you can imagine the ructions (see 737 Max).....
Wiki -
A broach is an abrupt, involuntary change in a vessel's course, towards the wind, resulting from loss of directional control, when the vessel's rudder becomes ineffective. (Rudder aka Steering).
Full, independent survey and AMSA clearance of
all outstanding matters;
all published, before return to service (RTS) is what the public expect and have a right to. Anything less is a corruption of the promises made. If anyone believes 'safety' is expensive; wait until the accident bill turns up....
Toot toot.
RE: “For want of a nail the shoe was lost.” -
Peetwo - 12-05-2022
Emerald Class mouldy Swiss Cheese update: 5/12/2022
Courtesy MattO, via the SMH:
Quote:High number of steering failures involving new Manly ferries revealed
Matt O'Sullivan
December 5, 2022 — 5.00am
The extent of defects plaguing three new Manly passenger ferries has been revealed in internal government data that shows they have suffered at least a dozen steering failures over the past year...
...The internal figures also show the six-strong fleet of older first-generation Emerald-class ferries, used mostly on inner-harbour routes, have suffered seven steering failures over the past two years.
The Australian Maritime Safety Authority has confirmed that one of those six vessels – the Catherine Hamlin – had a steering failure a week ago.
The regulator still has an order in place on the Fairlight preventing it from carrying passengers until steering control system faults have been fixed and verified by a marine surveyor...
Hmm...so AMSA do have a safety directive on the Fairlight but yet they haven't grounded all the Emeralds despite evidence of common system failures across the whole fleet??
Coming back to safety surveying and certification:
Quote:Two, three hundred fully clothed passengers; some below deck to avoid the weather – duck me. The fall out would be monolithic. Time for independent surveyors; OTSI and AMSA to step out from behind the political smoke screen and Perform Design Function (PDF) without fear or favour. If it were a single aircraft; the roof would be off the hanger by now, well and truly. If it was 'fleet wide' - well; you can imagine the ructions (see 737 Max).....
Wiki - A broach is an abrupt, involuntary change in a vessel's course, towards the wind, resulting from loss of directional control, when the vessel's rudder becomes ineffective. (Rudder aka Steering).
Full, independent survey and AMSA clearance of all outstanding matters; all published, before return to service (RTS) is what the public expect and have a right to. Anything less is a corruption of the promises made. If anyone believes 'safety' is expensive; wait until the accident bill turns up....
On the parallels with the 737-MAX certification, the following is an article from the popular US Avweb publication:
Quote:FAA Proposes Overhaul Of Airliner Certification
By Russ Niles -Published: November 30, 2022 Updated: December 1, 2022
The FAA has published its response to the 737 MAX certification debacle in the form of a 117-page Notice of Proposed Rulemaking (NPRM) that aims to rid the system of loopholes and regulatory gaps that played a role in the tragic crashes of the aircraft shortly after it was signed off. “The FAA proposes revised and new safety standards to reduce the likelihood of potentially catastrophic risks due to latent failures in critical systems,” the agency says in its overview of the NPRM. “With this action, the FAA seeks to reduce risk associated with airplane accidents and incidents that have occurred in service, and reduce risk associated with new technology in flight control systems.” The overhaul is directed at Part 25 transport category aircraft.
The NPRM focuses mainly on what it terms “latent failures,” which it defines as failures that are “not apparent to the flightcrew or maintenance personnel” and can combine with other failures with catastrophic results. In the case of the MAX, bad data from angle of attack indicators caused a hidden software system designed to improve handling characteristics to push a Lion Air and an Ethiopian Airlines aircraft into unrecoverable dives. A total 346 people were killed.
Because much of the technology is new, the way systems can fail are also new and that, says the FAA, requires an overhaul of the certification process. Fundamental to that overhaul is the standardization of safety criteria not only at the FAA but with regulators in other countries, the NPRM says. The document is likely to prompt much discussion among regulators and the industry, but the agency says it’s work that has to be done so that accidents can be prevented rather than serve as a primary source of data on aircraft flaws. “The proposed standards would also improve the likelihood that operators discover latent failures and address them before they become an unsafe condition, rather than discovering them after they occur and the FAA addressing them with airworthiness directives (ADs),” the NPRM says.
Now with the subject of 'latent failures' front of mind consider this 25 July article by MattO...
:
Quote:Damage to new Manly ferries to worsen, leaked report says
Matt O'Sullivan
July 25, 2022 — 5.00am
Damage discovered on a new Manly ferry just months after it began carrying passengers is expected to worsen and occur on the other overseas-built vessels now used on the popular Sydney harbour route, a leaked report warns.
Independent inspectors found a deformed plate, buckling to a crucial internal rod, and cracked coatings and welds near the front of the new Fairlight ferry in April not evident during an examination about four months earlier.
They warned that similar damage appeared to be on the Balmoral, one of the three new Emerald-class ferries which sail between Circular Quay and Manly. The Balmoral was not subject to the same inspection as the Fairlight in April.
The leaked report reveals damage to a new Manly ferry just months after it started services.
The leaked report by independent inspectors hired by Transdev, which operates the government-owned fleet, warns that the damage to the Fairlight’s port side “will only increase with time due to further fatigue of the area”.
The inspectors say that, while unlikely to compromise the 34-metre ferry’s structural integrity, it is likely that over time the damage will appear on the starboard side of the Fairlight as well as the two other new Manly ferries because they “share the same design and operational loadings”.
“Some evidence of this is already present on Balmoral,” the report says.
The inspectors who examined the Fairlight in April believe the damage to the plating near the front of the ferry was the result of flexing of its hull. They do not think the buckling was due to the ferry hitting a wharf or other structure.
“If the damage is simply repaired without addressing the cause, any repairs are likely to be ineffective in the long term,” the report said.
The new Emerald-class ferries are at the centre of a fierce debate over whether they can handle large swells near the entrance to Sydney Harbour as capably as the larger Freshwater vessels they are designed to replace on the Manly route.
Damage to the new Fairlight ferry.
A leaked Transdev memo in February revealed captains of the new Manly ferries had been warned not to sail directly into waves near Sydney Heads in heavy swells in case their vessels became airborne.
Labor transport spokeswoman Jo Haylen said Manly ferry services had been cancelled and passengers stranded because the new vessels had serious systemic flaws.
“This damning internal report shows that normal repair works won’t be enough to fix the government’s defective overseas-built Emerald-class Manly ferries,” she said. “Their decision to purchase overseas-built ferries has led to a marked decline in the quality of ferry services.”
Transport for NSW launched a review in May of the Emerald-class vessels. The new ferries’ poor performance has also led to the agency taking “contractual actions” against Transdev.
Last month the Fairlight was temporarily removed from service after the ferry’s fire pump was found to be faulty.
The transport agency said in a statement that it was “closely monitoring” the performance of ferry services, especially the fleet’s reliability and availability.
“We are focused on providing a reliable service for customers and will continue to work with the operator of the service to ensure the best outcome for customers,” it said.
Transdev said inspections in April confirmed the second-generation Emerald-class vessels were structurally sound, and the “minor cosmetic issues” identified had “no impact on safety”.
The costs of repairs were covered under warranty with the shipbuilder, the French company said.
However, Action for Public Transport spokesman Graeme Taylor said the larger Freshwater ferries needed to be permanently returned to the Manly route, and the smaller Emerald-class ferries used on easier inner harbour runs instead.
“As the Emeralds continue to flex, the welds on the hulls will start to crack and water will get into the hulls and the vessels will corrode from the inside out,” he said.
“They are simply not a strong enough to withstand the wave action at Sydney Heads.”
Hmm...so questions on original vessel and operator certification to AMSA? Yeah..Nah..maybe??
MTF...P2
PS: "Fasten your seatbelts!"
Wonder what the ferry operator's EPs are for a capsized Emerald class vessel with 300 odd POB in the Sydney harbour heads...
RE: “For want of a nail the shoe was lost.” -
Kharon - 12-06-2022
On a wing and a prayer..
P2 -
“Wonder what the ferry operator's EPs are for a capsized Emerald class vessel with 300 odd POB in the Sydney harbour heads..
I took a very quick look at the RFFS services available on Sydney Harbour; although being hampered by a lack of insight and operational experience, it seems as though the services are there, in good order and competent. The 'training' in safety for crew seems to be well managed and documented, particularly the AMSA input. So, it seems that in an emergency situation there is an adequate supply of assistance, rescue and recovery available from folk who know what they are about. On the other hand, I have done my share of sailing and been involved with the chaos when a boat has been 'in trouble' in big seas and know how very quickly it can go from risky to downright dangerous.
Pilots and cabin crew know and understand the difficulties associated with being fully clothed (boots and all), in the water and attempting to load a fully clothed passenger onto a life raft. Part of the deal, every year – we call 'em 'the wet drills'. Tough stuff, and not everyone is a 'strong' swimmer or calm in an emergency. Think shocked, panicked, fully clothed passengers and a capsized boat. (Shudder).
Now, for the 'ifs and buts'. Numbers first – what are the chances of a high wind, high seas day on the harbour? Of those days how many would pose a serious risk to a ferry plodding along to Manly? We don't really know; but we can rely on the Masters to know. Same as pilots? Do they have the same final say? The same latitude in decision making? Are they allowed to exercise that right, without fear or retribution?
What are the mathematical chances of systems failure at a critical moment? In an aircraft highly unlikely; particularly unlikely in any of the 'flight control' systems or in the structural integrity of the aircraft. These are made as robust as possible, rigorously tested, and where possible backed up. I've always thought it is a good thing that passengers cannot 'see' the air in motion; if you think the sea can get get wild and scary; don't even think about the dynamics of moving air.
The point is a simple one: when the structural integrity of a vessel is suspect; when the steering system is proven unreliable; when the element in which the vessel is required to operate is beyond the design capability – would you operate it? Aircraft get a hammering – on occasion – does the crew need to worry about structural integrity – no, not if the limitations are observed; does the crew need to be concerned that the control system may or may not work at a critical juncture, no, provided the limitations are observed. Why, well the testing and certification standards allow for 'worst' case' reliability demonstrated and a percentage over the top of that.
A ferry carrying hundreds of people, multiple times a day on a mill pond can have the odd failure and no one need get overly concerned. But when it become thousands of people a day, across a body of water which can and does get 'rough' in vessels which are beginning to show signs of 'structural' weakness, revealing 'light weight' construction, combined with multiple 'control' problems; then perhaps it is time to reduce the percentage chances of a serious event to a sensible number.
Backing the wrong horse in a race may cost you your shirt; backing the wrong vehicle in any form of public transport would cost an election; a fortune in payouts and everlasting infamy for every death arising from the event (can't claim 'accident' - no way!). There is no 'bullet proof' escape clause; not when the problems are identified; reporting has been downgraded (tick and flick) and certainly not for those who should be out there ensuring that the ferries are as safe as skill, technology and money can make them. Not even those deep within the sheltered halls of government quangos can avoid being haunted; should the worst happen. Expect the worst; hope for the best; always a good notion. Just saying - denial , deflection, spin and obfuscation can only get you so far when the chips (ships) are down...
Toot – toot...
RE: “For want of a nail the shoe was lost.” -
P7_TOM - 12-06-2022
My turn.
Clock in _ HERE -
At 03:00 – for about six seconds; and a massive reality fix.
Watched the short section? – Good. Now; imagine the wind at 15 knots. (28 clicks +/-) or even 20 knots (37 Kph) and one of those 'things' hitting the water and departing the touch down spot; downwind at the same rate. Could you, from the bottom of a 1.6 metre swell, fully clothed, boots on, swim well enough to catch it and hang on for grim death. Even if you do; two on one side – one on the other – Whoops; sorry too much (back to swimming).
Didn't think so – government safety thinking hard at work; looks great, seems simple; even if tethered and the boat goes down; what then? – Just pray that you never have to test the veracity of the 'safety speak' as you cross Sydney heads on a wet, windy evening with a high sea running. Catch it if you can – life or death depends.
This is the rubbish spouted – in the name of 'it will never happen'. Bull-shit....It ain't good enough; not by a long shot it ain't..
Well, it makes me cranky. !@#$... deleted...
RE: “For want of a nail the shoe was lost.” -
Kharon - 12-08-2022
Blurred vision.
Perhaps someone could help me out here. Not having the vaguest notion of how things are done in the world of 'big business' questions arise to which I cannot find a satisfactory answers. Well not a straight forward ones anyway.
Why were these ferries not built in Australia? Under our standards and quality scrutiny? We have the steel; we have shipyards, we have a highly skilled workforce; and should any 'problems' emerge, its not too hard to ask the questions directly of the builder and get the issues sorted out.
Why were the benefits to the national economy not factored in? An Australian shipyard employing Australian labour would surely be of value, the profits from the build subject to taxes and a healthy boost to local business would have benefited the local economy. Those benefits were given to off-shore builders and to tackle any sort of 'perceived' or real problems with the build will be a lengthy, expensive business serving to benefit the legal profession alone.– why?
Why is it necessary to utilise a foreign company to manage the Sydney ferry system. Are there no 'home' based outfits capable of running a dozen or so ferries. Once again, maximised profits from minimum input vanish overseas, and any form of legal action becomes not only expensive but difficult to prosecute, should the need arise. I will only mention 'submarines' and 'One Sky' to jog the memory of the perils associated.
There seems to be a long row of circuit breakers between the NSW government and any form of responsibility for the system. It may be unlikely that there will be a major accident; but, already the furious back peddling can be seen in Estimates sessions. Safety agencies throwing up defensive barriers and disclaimers; OTSI a stand out performer: AMSA a reluctant one. The blame game opening set being played now.
These ferries may or may not be outright dangerous; but already any savings made are being burned up in on going repetitive and patch up/ catch up repairs; the risk to travelling public may not be large; but it exists, quantifiable and tangible. Risk mitigation is a cornerstone of safe operation. Murphy's Law -
"Anything that can go wrong will go wrong, and at the worst possible time.” Works for me.
Toot – toot..
RE: “For want of a nail the shoe was lost.” -
Peetwo - 12-10-2022
OTSI a pale version of the ATSB?? -
I have been tasked by Aunty Pru to troll thru past NSW Budget Estimates Hansard (plus associated documents) and the OTSI website for anymore Transdev Emerald class Gen 1 & 2, AMSA and OTSI DCV investigation mentions &/or dots-n-dashes.
To begin I came across the following answers to 'Supplementary Questions':
https://auntypru.com/wp-content/uploads/2022/12/ASQON-Hon-David-Elliott-MP-Transport-Veterans-Western-Sydney.pdf
Ironically this PDF document was created two days before the
Clontarf and three days before the
Fairlight steering failure incidents, three weeks before AMSA grounded (safety directive) the Emerald Gen IIs and nearly a month before the OTSI decided to investigate the steering failure incidents??
These were the recommendations from the MV Pemulwuy 'Loss of Control' investigation final report:
On recommendation 4.6, this is what AMSA define as a 'serious incident':
"...Serious incidents (none of the above) include serious injuries
(operational), fire, explosion, collision, grounding, contact, heavy
weather damage, ice damage, hull cracking, or suspected hull defect,
critical equipment failure (i.e. main engines, steering gear), extensive
accommodation damage, severe structural damage (penetration of the
hull under water), loss of stability, pollution, and breakdown
necessitating towage or shore assistance..."
While on the subject of AMSA and OTSI DCV completed investigations, I noted the following FR from the OTSI ferry investigation webpage: https://auntypru.com/wp-content/uploads/2022/12/190202-Lady-Rose-Passenger-Fatality-Final.pdf
These were the AMSA related recommendations:
Quote:AMSA
4.7 In consultation with industry and in collaboration with other relevant agencies, develop and implement standards for the safe design, construction and maintenance of sewage systems for DCVs.
4.8 Consider the introduction of a requirement that a suitably qualified technical assessor with plumbing qualifications carries out an inspection of sewage systems in conjunction with the AMSA survey processes.
4.9 In consultation with industry and collaboration with other relevant agencies consider the inclusion in certificate of competency syllabuses, education on risks involved with hazardous gases in DCV sewage systems for onboard staff.
4.10 Further support the adoption and implementation of safety management systems for DCV operators through AMSA’s regulatory activities.
Hmm...would be very interesting to see the responses from AMSA in the DIP DRAFT report process? In both reports, plus in subsequent actions since (eg non-listing of any of the Emerald class steering failure occurrences as 'serious incidents' ), there seems to be certain areas of confliction and animosity between AMSA and OTSI??
On a final note it is worth perusing the latest OTSI Annual Report: https://www.otsi.nsw.gov.au/sites/default/files/otsi_assets/documents/OTSI%20Annual%20Report%202021-22.pdf
From the Chief Investigator report:
Quote:..During 2021-22 we revised OTSI’s business operating model in line with our legislative functions to increase our focus on proactive, data-driven activities which will enable us to better identify risk and share this information with the transport industry.
This revised model was implemented with a new organisation structure in February 2022. We have expanded OTSI’s investigations team to enhance our capacity to investigate both standalone incidents and more complex rail, bus and ferry systemic safety issues to support industry to manage risk and eliminate or reduce common safety incidents.
During the year we established the foundations on which to build our data analysis and reporting arm which, once fully staffed, will power our ability to better identify safety risks, to undertake research and programmed investigations into known risks, and to deliver more insights to the transport sector.
Upping the ante on our engagement with government, operators, regulators and peak bodies was a key focus during the year and we will continue to refine and expand our safety promotion strategy in 2022-23 so we can better support industry and government to achieve safety improvement.
Embedding major structural reform while also delivering on ‘business as usual’ is a challenge for any organisation and in a small agency, these impacts can be felt more keenly...
Hmm...why does that word weasel confection sound so familiar? Why is it that bureaucrats that step into leader positions, that they have absolutely NFI ie experience or skills in (think HVH or Su_Spence), always try to reinvent the wheel by restructuring and refocussing the organisation? If it ain't broke...etc...
(Also check out the 'Management and accountability' pages for a more than doubling of the workforce in one year and the increase executive level salaries)
MTF...P2
RE: “For want of a nail the shoe was lost.” -
Kharon - 12-12-2022
“No enemy is worse than bad advice.”
Hundreds of years ago Sophocles turned that phrase; still valid today I reckon. But it got me thinking. -
HERE – is a transcript of a NSW Budget Estimates session. Every answer is preceded by the words
“I am advised”. It set me to wondering 'why'?
Now then, 'the law' is an extraordinarily complex beast – I tried for an hour or so to define 'why' the phrase was used in the NSW Estimates; having never heard it used in Commonwealth Senate Estimates. I found a couple of
'links' which sort of shine a small light on the subject; but found little to clearly define the deliberate purpose of doing so when questioned in Estimates. However, to the lay mind the repetitive use of the phrase seems 'odd' in the way of the real world, far away from a court of law. Although I am advised that the 'real' world only exists in a court – go figure.. But I digress. So a legal puzzle it must remain until I can have a chat with an ancient 'legal eagle' on who's 'opinion' I'd bet my life. So MTF on that.
“Everything we hear is an opinion, not a fact. Everything we see is a perspective, not the truth.”
And so, back to the NSW Estimates and the ever increasing size and budget of the OTSI organisation which, like Topsy – just grew in 'administrative' - but has little to show in the way of additional investigators. Then, there is the big brag, the one that claims their Safety Management System (SMS) is proving effective and the reports are flowing in. Which is great, except for a few 'small' points – like:- the clearance times between a report and positive action; or, in the way that they have ensured the cleanly identified problem is 'unlikely' to reoccur (again). Then there are the lightweight responses to several matters which, in the opinion of many, demand some serious attention. Like an assurance that every weld in the boats is up to standard; or, that the ongoing steering problems are sorted out; and, that the cost of constantly repairing battered, bent hulls and structural members will be sourced from – where? Not from French Transdev's pockets; that is a short odds racing certainty.
“Does a man of sense run after every silly tale of hobgoblins or fairies, and canvass particularly the evidence? I never knew anyone, that examined and deliberated about nonsense who did not believe it before the end of his enquiries.” {{ Luv it }}...
Perhaps the Qld certification transmogrified – into RMS easy acceptance of Survey had some bearing on the how and the why these vessels are allowed to continue. Now the DCV's certificates are grandfathered to the AMSA portfolio. That, stand alone begs questions to be answered. However, while AMSA may take their time to 'take a hand', as the Bard says, 'the wheels of the Gods grind slow; but they grind exceeding fine'. AMSA is the only realistic hope for survey probity and operational reliability: that which generates the real reduction of tangible risk, providing the true compliance which in turn provides real operational (and legal) safety outcomes.
“The status-quo habits for 'grandfathered' vulnerabilities do not legitimise them.”
But the bit which really grabbed attention was the delightful obfuscation about the steering failures; 100% guaranteed to totally bamboozle the average politician asking questions. “Not the steering at fault – but the 'toggle' control”. Uhhmm – Yeah, BUT – the toggle actuates the steering – lose the toggle – lose the steering: QED – seriously? Not everyone on this planet is as disconnected from the way machinery works as the local member for the
rotten borough of 'Ocean Views'. This, in part, forms a proportion of the basic 'stumbling block'. The way different groups perceive the 'risk' in relation to their own 'rice bowl'. That which may keep a pilot or ship's skipper awake would not bother, not in the slightest, the local member for Puddle jump. That which will keep a public servant hot and bothered all night would not concern the local member, or the Skipper:not in the slightest. And yet, for all the disconnection, it is, and must be, by default, be a truly symbiotic relationship –for vastly dissimilar reasons. Non involved need anything to go awry and result in the death of a traveller in a public service vehicle to end up in the courts. For there they must face the fiercest of all foes; the ultimate insurers of the hull and all contents. Not to mention the public humiliation of even being remotely associated with a demonstrable 'death-trap' being approved to operate on the water, in the air, or on the road.
“There are in nature neither rewards nor punishments — there are consequences.”
Any fatal accident involving mass transport must inevitably become 'political'; the history of aviation events classic case. If there is even the smallest whiff of political sleight of hand or 'deals' done; the roof will be off the building; the 'enemies' will ensure that. Ben Franklin said it all, best and shortest.
“He that drinks his cider alone, let him catch his horse alone.”
Toot – toot.
RE: “For want of a nail the shoe was lost.” -
Peetwo - 12-13-2022
Recommendations and inquiry lessons from the past ignored in favour of political expediency -
Under the TSI Act the ATSB can compel an individual/ unincorporated association/ Federal or State/Territory agency to respond to a 'safety recommendation':
Quote:Responses to reports of, or containing, safety recommendations
(1) This section applies if:
(a) the ATSB publishes a report under section 25 in relation to an investigation; and
(b) the report is, or contains, a recommendation that a person, unincorporated association, or an agency of the Commonwealth or of a State or Territory, take safety action.
(2) The person, association or agency to whom the recommendation is made must give a written response to the ATSB, within 90 days of the report being published, that sets out:
(a) whether the person, association or agency accepts the recommendation (in whole or in part); and
(b) if the person, association or agency accepts the recommendation (in whole or in part)--details of any action that the person, association or agency proposes to take to give effect to the recommendation; and
© if the person, association or agency does not accept the recommendation (in whole or in part)--the reasons why the person, association or agency does not accept the recommendation (in whole or in part).
(3) A person commits an offence if:
(a) the person is someone to whom a recommendation is made in a report published under section 25; and
(b) the person fails to give a written response to the ATSB within 90 days setting out the things required by paragraphs (2)(a), (b) and © (as applicable).
Penalty: 30 penalty units.
(4) Subsection (3) applies to an unincorporated association as if it were a person.
(5) An offence against subsection (3) that would otherwise be committed by an unincorporated association is taken to have been committed by each member of the association's committee of management, at the time the offence is committed, who:
(a) made the relevant omission; or
(b) aided, abetted, counselled or procured the relevant omission; or
© was in any way knowingly concerned in, or party to, the relevant omission (whether directly or indirectly or whether by any act or omission of the member).
The ATSB publish all their safety recommendations and make public all the subsequent responses until a point in time when they consider the SR matter to be closed - see
HERE.
In OTSI world there appears to be no legal requirement for SR recipients to even acknowledge the OTSI issuance of a SR, let alone actually making public any safety actions implemented in response to the SR.
However whilst OTSI doesn’t have the power to enforce a response to their safety recommendations, the Minister does and it’s written in the PTA Act 1990:
Quote:151 Recommendations arising from investigations
(1) The Minister, in consultation with TfNSW, may, by written notice, direct a person who carries on a ferry service to comply with a recommendation contained in a report on a transport safety investigation or transport safety inquiry provided to the Minister under this Part.
(2) A person who, without reasonable excuse, fails to comply with a requirement of the Minister under this section is guilty of an offence.
Maximum penalty—1,000 penalty units.
Hmmm...in the 32 years that the PTA Act 1990 has been in force I wonder how many times the Minister has enacted a section 151?
Next, in the process of doing some research for Aunty on the history of transport safety inquiry and the implementation of recommendations in NSW (OTSI, TFNSW, RMA, Transdev etc..etc) as a parallel to the Commonwealth (ATSB, CASA, Airservices, AMSA), I came across this intriguing SMH article from 15 years ago:
Quote:Call to hand over Sydney Ferries to ATSB
May 22, 2007 — 1.49pm
Federal authorities should take over the running of Sydney Ferries until the organisation gets its ship in order, the NSW opposition says.
NSW opposition transport spokeswoman Gladys Berejiklian said the Australian Transport Safety Bureau (ATSB) should be called in to sort out cultural, management and safety issues that are plaguing Sydney Ferries.
Ms Berejiklian said the opposition, in its submission to the Special Commission of Inquiry into Sydney ferries, called on Commissioner Brett Walker SC to consider bringing in the ATSB.
"For too long the state government has ignored the recommendations made by OTSI (Office of Transport Investigations), the state agency looking at safety issue in Sydney Ferries," she said.
"For too long the state government has ignored the cultural, management and safety issues plaguing Sydney Ferries, and for too long the state government has allowed these issues to be swept under the carpet."
The opposition also renewed its calls for the inquiry to be made public to ensure it was "open and transparent".
Ms Berejiklian said the terms of reference must be extended to cover the two fatal accidents which occurred in January and March this year.
Hmm...I wonder if the current Coalition incumbent Minister has the same take on the clusterduck that is Sydney Ferries (ie Transdev)??
Moving on, I went to the reference that was the '
Special Commission of Inquiry into Sydney Ferries'.
The inquiry was conducted by well known Barrister Bret Walker SC and is a particularly heavy read of over 400 pages (WOW!) -
These were the recommendations:
Quote:RECOMMENDATIONS
1 It is recommended that the Government undertake to pay a price fixed
by a service contract to a private-enterprise corporation for the provision
of ferry services pursuant to a service contract as required by the
Passenger Transport Act 1990 but on a provisional basis, that is, until it
proves to be no more expensive than a.SOC providing ferry services
pursuant to a service contract as required by the Passenger Transport
Act 1990. This means, it is recommended that:
a. processes should be started as soon as possible to offer a
comprehensive service contract, including fleet replacement
responsibilities, to the market;
b. if bids from the market compare favourably with the financial and
quality performance of SFC as a.SOC providing the same service,
the best (not necessarily the cheapest) bid should be accepted by
the Government; and
c. if bids from the market do not compare sufficiently favourably with
the prospects offered by SFC continuing as a SOC, SFC could
continue to provide the service subject to a statutory contract.
(Chapter 1)
2 It is recommended that a coordinating body is established, whose role it
is to ensure the transport network is properly integrated. In particular,
such a body must ensure that timetables are properly coordinated
across modes. In default of agreement between service providers, it
should be empowered to determine changes for all of them. (Chapter 2)
3 It is recommended that an access agreement is negotiated between the
operator of Sydney ferry services, whether it be SFC or a private
operator, and NSW Maritime which:
a. gives the operator priority access to all wharves to which access is
required in order to operate ferry services in accordance with
current and future timetables;
b. enables the operator to install ticket machines, CCTV systems, PA
systems, help points and customer information systems where
appropriate;
c. enables, in appropriate locations, the operator to berth vessels
overnight and implement appropriate security arrangements;
d. enables the operator to display appropriate signage on the
wharves; and
e. establishes clear and practicable responsibility for maintenance.
(Chapter 3)
4 It is recommended that commuter wharves be standardized. The
operator of Sydney ferry services, whether it be SFC or a private
operator, and NSW Maritime must work together in relation to the redesign
and standardization of commuter wharves, to ensure that
wharves are appropriately designed to accommodate SFC’s operational
requirements, particularly with a view to the specifications of a
replacement fleet. (Chapter 3)
5 It is recommended that, when current access agreements in relation to
Jetty 6 expire in January 2008, new access agreements are negotiated
with commercial operators on the basis that Jetty 6 must be reasonably
available for use by the operator of Sydney ferry services, whether it be
SFC or a private operator, during the morning and afternoon peak hour.
(Chapter 3)
6 It is recommended that King Street wharf be developed as an extra
operational hub to Circular Quay and a new entry point to the city for
ferry passengers. The term ‘operational hub’ requires that all necessary
infrastructure is put in place for King Street wharf to operate as an
alternative to Circular Quay. This requires:
a. replacement of the current floating pontoon with a different wharf
structure which includes appropriate disabled access;
Recommendations 336
b. a ticket office, ticket machines and barrier gates;
c. security measures to protect vessels berthed overnight and
infrastructure such as ticket machines;
d. appropriate crew and staff amenities; and
e. facilities to service vessels such as sewerage pumps, access to
shore power and fresh water. (Chapter 3)
7 It is recommended that, in planning the redevelopment of the foreshore,
the Government explicitly consider a range of possibilities for ferries
including an additional facility at White Bay or even, depending upon
land use considerations, an entirely new facility including a new
Shipyard. Any decision in relation to the future location of SFC’s
operations including its Shipyard should be made in consultation with the
Office of the Coordinator General. (Chapter 3)
8 It is recommended that SFC disaggregate its service reliability figures
including on time running and services that actually run so that separate
statistics for each of Manly, Inner Harbour and Parramatta River are
kept. (Chapter 3)
9 It is recommended that Division 2 of Part 3 of the Passenger Transport
Act 1990 (Ferry service) is amended so as to make it consistent with
Division 3 of Part 3 of the Passenger Transport Act 1990 (Regular bus
services) in these respects:
a. removing the distinction between commercial and non-commercial
contracts;
b. removing those provisions which confer upon a contract holder
exclusive rights, potentially in perpetuity, to operate passenger ferry
services on a particular route or in a particular region;
c. removing the provision that allows the terms of a service contract to
prevail over Government’s standards of safety and maintenance
and any relevant legislative standards or requirements; and
d. inserting a provision, equivalent to sec 28C which overcomes the
equitable doctrine against penalties and allows agreed penalties to
be enforced against providers of passenger ferry services for a
failure to meet minimum service standards set out in the service
contract. (Chapter 5)
10 It is recommended that the Portfolio Minister give a written direction to
the Board pursuant to sec 35K of the Transport Administration Act 1988
or sec 20P of the State Owned Corporations Act 1989 on the grounds of
public safety or that it is necessary for the public interest that SFC take
all steps necessary for it to obtain one EBA with all afloat staff. (Chapter
8)
11 It is recommended that the Balmain Shipyard performance indicators be
disaggregated to properly understand whether there are sufficient
vessels available to service all routes, and if not which routes will suffer.
(Chapter 11)
12 It is recommended that, in consultation with NSW Maritime, SFC review
the safety management system to achieve the following goals:
a. an integrated safety information system which;
i captures all hazards, OH&S incidents, audit results, noncompliance
findings and near-miss reports (‘incidents’);
ii guarantees and delivers feedback;
iii permits confidential reporting;
iv enables the costs of incidents to be calculated and reported
upon;
v consistently defines incidents which are to be reported within
SFC;
vi permits the accurate reporting of ‘reportable incidents’ to
NSW Maritime which are required to be reported pursuant to
legislative obligations and the MOU;
vii enables the implementation of corrective action to be
monitored;
viii permits measurement of outcomes; and
ix is capable of systemic analysis.
b. a just culture in which there are clear lines drawn between
acceptable and unacceptable behaviour and which encourages and
rewards the provision of essential safety-related information;
c. document control;
d. effective communication of lessons learned from incidents;
e. robust and scheduled internal audits;
f. regular external audit; and
g. effective tracking of training undertaken by staff to ensure only
those fully and up-to-date qualified to crew vessels, do so. (Chapter
10)
13 It is recommended that, in relation to its KPIs, SFC categorize the
significant and reportable incidents by reference to:
a. the nature of the incident e.g collision with wharf, collision with
other vessel, collision with submerged object, other collision,
grounding, near miss etc;
b. whether any injury or fatality resulted and the seriousness of any
injury;
c. whether any damage to property including a vessel occurred and if
so, the seriousness of any damage; and
d. minor vessel incidents including near misses. (Chapter 10)
14 It is recommended that a new fleet be procured in accordance with the
process outlined in Chapter 13. The overall aim of the replacement is to:
a. provide capacity for more routes and more frequent services on
existing routes;
b. enable the large vessels to shorten travel time to and from Manly;
and
c. maximize environmental suitability, efficiency and economic
maintenance. (Chapter 12)
15 It is recommended that the existing high speed JetCat service to Manly
is discontinued. (Chapter 12)
16 It is recommended that existing ferry services on the upper Parramatta
River, between Rydalmere and Parramatta, are discontinued. (Chapter
12)
17 It is recommended that the devising of a specification for a replacement
fleet, and the terms of a service contract including the obligation to
deliver a replacement fleet, should urgently address all matters relevant
to a sensible risk allocation between government and a contractor –
including those set out in Chapter 13. (Chapter 13)
Hmm..other than recommendation 1 I am not sure how many have been implemented; or what progress has been made on the other 16 recommendations?
However I do make the observation that the implementation of recommendation 1 is proving to be problematic, especially in the areas of vessel survey, addressing identified latent risks, Transdev SMS and incident reporting standardisation across all Federal/NSW Govt agencies and departments.
Chapter 9 & 10 of the 'Special Commission of Inquiry into Ferries' IMO should be required reading. After reading those chapters then ask yourself the question, on the available evidence, what has changed? What has been done to mitigate the many systemic marine safety issues that were identified in that inquiry conducted over 15 years ago?
MTF...P2
RE: “For want of a nail the shoe was lost.” -
Kharon - 12-15-2022
Dangerous liaisons..(
Just an idle twiddle).
Every once in a while you start a project with good intentions; do your homework and begin to piece together the 'whole'. Just like a jig-saw puzzle, eventually, with patience and determination, the picture emerges. My jig-saw puzzle began when P2 dropped a link in my mail box to - “Chapter 9 & 10 of the 'Special Commission of Inquiry into Ferries” (2007).
“Read Chapter Nine” wrote our inveterate research Guru (dustbin specialist) and; dutifully, I did. Three times; then I found a pencil and a sheet of paper to make a 'flow chart' you know the kind of thing – that which clearly lays out who does what, to whom and who pays for it all. Mission impossible – so paper abandoned for the large white board on the workshop wall and 'round two'. This time I was determined to 'sort it out'. Well, I got my 'mud map' - a confused abstract of disconnections, blurred lines and a total shemozzle in the 'safety training system' (for want of a better descriptor).
The analysis did however define one stand out item – the 'safety' of the travelling public, in practical terms, came home well to the back of the pack. Ministerial safety won by a handy margin, closely followed home by 'legal' safety, with fiscal safety' running home in the minor placing. There seems to be a great confusion within the ranks of those who 'prescribe' safety procedures as what the ultimate purpose of a 'safety system' actually is; in practical terms. Bear with me, I shall endeavour (in my clumsy way) to illuminate the dark places. To business then:-
“Still, he figured, sometimes you've got to do what you've got to do, and then sometimes you've just got to run like hell after it's done.”
'Fire' for example in one form or another is something most people can relate to. So there we are, fine Sunday afternoon, coming back to town from Manly on the ferry. Where on the boat is the most likely place for a fire to kick off? There are options here, so choose carefully. The ingredients for 'fire' are what? Oxygen, Heat and fuel: correct. Plenty of good rich oxygen on the harbour; so we now need a heat source and fuel. Where on the ferry is the most likely place for a 'heat' source? Plenty of those, there is a large engine driving the boat, where fuel, oxygen and heat are combined to provide the power needed. To get that fuel to the engine there must be storage (tanks) pumps to provide the motive flow; pipes to deliver the fuel to the combustion chamber. There are some pretty hefty rules in place to almost guarantee, beyond reasonable doubt, that if the 'system' is properly inspected and maintained, then the risk factor is reduced to a very, very low percentage probability.
“Human beings, like plans, prove fallible in the presence of those ingredients that are missing in manoeuvrers - danger, death, and live ammunition.”
Any 'safety system' associated with 'fire' management and control on the ferries is heavily dependent on the 'human' element. This reliance begins in the most unlikely place; the head man (or woman) in the head office and his (or her) masters; the money men (or women). They must manage the cost and maximise the profits; 'tis their task in life and much depends on 'the numbers'. Here, the first potential obstacle emerges from the heart of darkness – Costs.
“Any order is a balancing act of extreme precariousness.”
The 'money' factor features throughout this story and there must be a 'balance' struck between the ridiculous and the 'cor-blimey'. This is where the 'standards' crew join in. For example; to use say garden hose to deliver fuel to the engine is out of the question; the notion of using gold plated space age pipes is 'off the planet'. So somewhere in between a serviceable, affordable medium must be found, tested, installed, secured and certified as meeting the 'standard' demanded, this is applicable across the whole 'system'. So far, So good. Item next falls into the routine inspection bracket; this must be clearly defined – documented – and demonstrable. At grass roots level the 'Engineer' or his mate probably do an inspection of the fuel delivery system - “nothing hanging – nothing dripping” - signed off as good to go. But, what if? Say there is a minor leak; what then? This is where it becomes subjective and the 'pressure' is turned on.
The Engineer has several options here: much depends on the 'human factor' – some will stop the service until the leak is fixed; or, some will let it run on with only a bucket underneath until the service has finished, depending on how they see it. No matter; whatever action is taken must be able to satisfy the questions in the worst case scenario. This is where the Safety Management System' (SMS) fits into our puzzle and once again, bumps into human frailty, where both daemon and detail reside. The man who 'grounds' the ferry until repairs are made expects there will be questions to answer; management will want to know the why and the how of it, 'justify the expense and loss of service'; may even be taken to task and have his card marked for future attention (it happens). Unless he's smart and passed the problem up the line and someone else makes the decision and cops the incoming managerial flack. The man who fixed the problem 'on the run' is at a higher level of risk; this once again is subjective. A quick twist of spanner and screwdriver and all is well is great – back on the road – but; should this end up in a coroners court, the basics of liability will be clearly demonstrated, in Spades. The fellah who just shoved a bucket underneath the leak is in a much higher risk bracket again. Ramble over; the point follows.
There are four risks involved in my ramble; to wit:- Fiscal, legal, operational and human; all have consequences.
The whole point of a SMS is to reduce or nullify those risk elements. This is achieved (in theory at least) by clearly defining the basic structure; and ensuring that the basic is not cast in stone, put in a cupboard and ignored. Now, I don't imagine that the Skipper of a ferry would simply hop on board and start her up like he does the Falcon and roar off down the highway to work. Is there a clearly defined 'daily inspection' and a reporting process – a check list – so the Engineer can report his leak? Yes, great; does the Skipper have clear guide lines for decision making, is he qualified and authorised and 'arse covered' to make that decision? If not then who?
So, the Deckhand spots a fuel leak, reports to the Engineer, he takes a look and reckons it needs to be fixed, he calls the Skipper and reports. Here we bump into the perennial problem of 'command'. The service needs to run; passengers expecting it; revenue lost and a potential expense to be met for repairs. All of this does, (it should not – however) have a bearing on the 'command' decision. You see, this is one of many scenarios where it is not 'crystal clear' and these are the most dangerous – across the board. Damned if you do; damned if you don't. “Can you fix it Charlie?” asks the Skipper - “I can patch it up to keep us going, but its a yard job when we get back” says Charlie. There is the proverbial 'rock and hard place'. Charlie may well be able to work his magic and keep 'em going; but – (big one) Charlie doesn't know 'why' the leak has revealed itself – does he. So he patches it up and off they go – all is well until someone yells “FIRE”. This is the part when it all turns to worms. You can guess the rest, history will repeat (again).
Sods law of the ocean is appropriate and highly applicable.
The first and probably the most important 'rule' of any SMS is to clearly define the lines of 'responsibility' – all the way back to the 'head of power' – Managing director, chairman, minister etc from the lowliest deckhand. It must also unequivocally define the 'command prerogative'. Skippers says 'No Go' that should be the end of it – no questions asked. Why – well, when the other boot lands – it lands on the Skippers neck – always. History is full of parallels; time and time again the governing 'agency' walk away with more money and a larger work force to fiddle and twiddle with the mountain of paper work they generate, reams of fine words and oodles of obfuscation and elegant exits; all care but little responsibility and well able to afford serious legal counsel.
You see the problem – 400 passengers stood in the rain at Manly waiting for their ferry to work – highly pissed off because the boat has not arrived on time have a much bigger voice than the Skipper who declared the boat not serviceable. Should the Skipper have decided to 'run' and the wretched thing caught fire – what then M'lud?
SMS – daily inspection – clearly defined decision making rules and support for the decisions made is an imperative. It is almost as important as 'training': not in the way the current load of cobblers stands, but real training; twice a year. Bring in the Fire brigade to teach how to manage a fire; bring in the Navy to teach survival at sea – properly; make absolutely certain that the ships are as serviceable and as well maintained as possible.
For no matter how trained and prepared the crew are – their ultimate safety depends on the absolute reliability of the ship and the systems used in daily operations. The SMS is NOT an arse covering tenet, it must be clear, concise and definitive.
Final note before I shut up; if an aircraft Skipper had to put up with the stuff the ferry Masters have to live with there would be Hell to pay and the Devil to dance with. That's it...
Toot toot.
RE: “For want of a nail the shoe was lost.” -
Peetwo - 12-16-2022
Back to RRAT for DCVs; a Popinjay confession; and Harmonising the National transport safety regulatory system??
While
trolling the internet for research on behalf of Aunty Pru, I came across a government response to the
RRAT Committee report into the performance of AMSA (parts in bold highlight the parallels to the aviation RRP, CASA etc..
):
Quote:May 2021
PDF Version
PDF: 346 KB
Preamble
On 17 June 2020, the report of the Senate Rural and Regional Affairs and Transport Legislation Committee’s (the Committee) Inquiry into the ‘Performance of the Australian Maritime Safety Authority’ (AMSA) was tabled in Parliament.
The Committee’s Inquiry was established to review the performance and operations of the Australian Maritime Safety Authority (AMSA), with a particular focus on the tragic death of Mr Damien Mills in October 2014, who attended a function aboard the charter vessel Ten-Sixty-Six, operated by the Dolphin Dive Centre Fremantle.
The report considered a range of maritime safety measures such as headcounts, examined the investigation and scope for prosecution in relation to the death of Mr Mills, and ultimately considered a range of areas for future review and reform.
In addition to making recommendations for changes in relation to enforcement powers under the Marine Safety (Domestic Commercial Vessel) National Law Act 2012 (National Law), and for an independent review of the legislative framework established under that Act, the report also highlighted potential areas for reform, such as:
- considering changes to grandfathered arrangements for certain older vessels, such as for survey and crewing;
- further action on safety concerns identified in past coronial inquiries, such as vessel stability, electrical safety, or the alignment of regulatory frameworks for marine safety and work health and safety;
- ongoing improvement in the collection, analysis and dissemination of data relating to maritime safety by AMSA;
- ensuring AMSA’s activities and resourcing are efficient, and that regulatory burden for industry is reduced where appropriate;
- several other potential improvements to the National Law, such as adding or clarifying definitions, and resolving unproclaimed provisions.
Australian Government Response
The Australian Government welcomes the Committee’s report, and commends the work of all Senators in pursuing timely improvements to maritime safety outcomes. The Government extends its thanks to all those individuals and organisations that made constructive contributions to the Committee’s Inquiry.
The Government acknowledges that the death of Mr Damien Mills in 2014 was a tragedy. The Government sincerely extends its sympathies to Mr Mills’ family and friends. The Committee’s efforts continue to help the Government and AMSA to reduce the risk of a similar tragedy occurring again in Australia.
The Government joins the Committee in commending AMSA’s actions to improve passenger safety on Australian commercial vessels, which were implemented through changes to Marine Order 504 (Certificates of operation and operation requirements — national law) 2018. The Government acknowledges that it took time to get these changes right so that they are effective and practical. The passenger safety changes implemented by AMSA in early 2020 take a holistic approach to passenger safety and follow extensive industry and public consultation to deal with the complex and diverse needs of our commercial vessel sector.
The Government further acknowledges and supports AMSA’s efforts to establish a truly National System for Domestic Commercial Vessel Safety (national system) since service delivery responsibility transferred from the states and territories to AMSA in 2018. In that time, AMSA has brought together seven disparate regulatory regimes, and has introduced measures to improve safety culture and safety outcomes nationally.
The Government recognises the importance of ensuring that vessels are safe. People working or travelling as passengers on domestic commercial vessels should have confidence that these vessels meet safety standards that will ensure they return home safely from their voyages. The Government is committed to ensuring the national system delivers safety outcomes for the diverse range of maritime businesses across Australia, including commercial transport, tourism, fishing and charter boating operations. These are important industries, particularly for our regional and coastal communities.
The Government supports continuous improvement of the national system to support the safe design, construction, equipping, operation and crewing of these vessels. The Government also recognises the challenges in achieving appropriate safety regulation settings across the diverse sectors that make up Australia’s 22,000 domestic commercial vessels. These sectors comprise vastly different operations, ranging from an individual fisher working in a tinnie to a corporation running a fleet of passenger ferries; they may operate on a calm inland lake or in the open ocean. As a result, safety requirements for these diverse operations are broad, spanning vessel design, construction, equipping, operation and crewing, and can change over time, such as to respond to new technology or shifts in the fleet’s composition. This means that safety regulation needs to balance national consistency with the need for flexibility, including across different industry sectors and operation types, if it is to remain practical and reflect industry diversity.
Consequently, the Government supports AMSA in continuing to carefully consider and work with industry to ensure safety requirements are balanced with the costs of compliance across its spectrum of regulated businesses. The Government recognises that maritime safety regulation requires flexibility, and should be practical for all industry sectors to implement.
The Government supports all of the Committee’s recommendations, and intends to pursue a suite of improvements to the national system and National Law, informed by an independent review as recommended by the Committee. As set out in this response, specific aspects of each recommendation require further consideration based on the best available data and evidence, and consultation, to ensure implementation arrangements improve safety and can be actioned by industry. Consultation with Australia’s maritime industries and with state and territory governments will be important in this process.
The Government notes that any changes to safety requirements need to work as part of the whole system of domestic commercial vessel safety. In responding to other matters explored in the Committee’s report, as well as in related reports and inquiries such as the Productivity Commission’s Inquiry into National Transport Regulatory Reform, the Government intends to pursue a range of operational, legislative, and strategic actions to improve maritime safety.
This statement...
".. In responding to other matters explored in the Committee’s report, as well as in related reports and inquiries such as the Productivity Commission’s Inquiry into National Transport Regulatory Reform.."
...led me to that report:
https://www.pc.gov.au/inquiries/completed/transport/report
Quote:National Transport Regulatory Reform
Inquiry report
This report was sent to Government on 7 April 2020 and publicly released on 1 October 2020.
The Australian Government asked the Productivity Commission to assess the economic impact of reforms to transport regulation agreed to by the Council of Australian Governments (COAG) in 2008-09. Those reforms relate to heavy vehicle safety and productivity, rail safety and maritime safety.
The Government also asked the Commission to recommend further reforms towards a more integrated national market for transport services.
Some related DCV recommendations:
Quote:FINDING 5.3 – AMSA IS RESPONSIBLE FOR A BROAD RANGE OF VESSELS The Australian Maritime Safety Authority (AMSA) has a complex regulatory task. AMSA is responsible for regulating a diverse set of vessels, from kayaks to fishing boats and passenger ferries. Operators of domestic commercial vessels are also diverse. Some large operators are able to implement sophisticated risk management systems, while many smaller operators have difficulty in using AMSA’s centralised, online systems. The diversity of the fleet and operators has complicated the process of transition to consistent national regulation of domestic commercial vessels.
RECOMMENDATION 4.2 – TRANSFER REGULATORY POWERS TO THE NATIONAL REGULATORS The Transport and Infrastructure Council should agree to transfer all regulatory functions still held by participating jurisdictions to the National Heavy Vehicle Regulator by 2022. To ensure consistent application of the national laws, the National Heavy Vehicle Regulator and Australian Maritime Safety Authority should phase out service-level agreements with State and Territory agencies. However, where there is a business case for the national regulators to retain service-level agreements with third parties, those parties should act under the direction of the national regulators to ensure consistent decisions across jurisdictions.
RECOMMENDATION 9.2 – NATIONAL REGULATORS SHOULD TAKE A RISK-BASED APPROACH The Australian Government should work with the Transport and Infrastructure Council to develop a statement of expectations for the National Heavy Vehicle Regulator (NHVR) and the Australian Maritime Safety Authority (AMSA). The statement should direct the national transport safety regulators to take a risk-based approach to regulation, enforcement and other functions.
FINDING 4.3 – ONGOING GRANDFATHERING OF DOMESTIC COMMERCIAL VESSELS HAS COSTS It is unclear whether grandfathering was intended to be a temporary or permanent measure under the Marine Safety National Law. Open-ended grandfathering perpetuates the inconsistencies of previous State and Territory regimes, delays the adoption of new safety practices and complicates enforcement.
RECOMMENDATION 6.6 – END GRANDFATHERING OF VESSEL SURVEY REQUIREMENTS The Council of Australian Governments and the Australian Maritime Safety Authority should wind up the grandfathering of safety regulations under the Marine Safety National Law. Priority should be given to ending grandfathering arrangements that relate to vessel survey requirements and fire detection and smoke detection systems. The Australian Maritime Safety Authority should use the information from vessel survey and other sources to review the safety risks arising from other grandfathering arrangements and the costs to vessel operators of removing the arrangements. Where the safety benefits exceed the costs, grandfathering arrangements should be removed.
FINDING 5.2 – STATE AND TERRITORY AGENCIES SHOULD REGULATE HIRE AND DRIVE VESSELS Class 4 ‘Hire and Drive’ recreational vessels have more in common with recreational vessels (which continue to be regulated by State and Territory government agencies) than with other types of commercial vessels. The decision to transfer safety regulation of these vessels from State and Territory agencies to the national regulator was not justified on the basis of safety, or efficient or effective regulation. State and Territory government agencies are better placed to regulate these vessels than the Australian Maritime Safety Authority, particularly in relation to enforcement.
RECOMMENDATION 5.3 – RETURN HIRE AND DRIVE VESSEL REGULATION TO THE STATES The Australian Government should negotiate with State and Territory governments to return responsibility for regulating Class 4 Domestic Commercial Vessels (Hire and Drive) to State and Territory agencies.
RECOMMENDATION 6.5 – IMPROVE MARITIME INCIDENT REPORTING AND DISCLOSURE The Australian Government should direct the Australian Maritime Safety Authority to take steps to improve: incident reporting by owners of domestic commercial vessels its public disclosure of safety incidents. AMSA should report fatalities and injuries in greater detail, including a state-by-state and vessel-type breakdown of fatalities and injuries.
Last but by no means least we had this (Popinjay to the rescue -
) recommendation:
Quote:RECOMMENDATION 9.4 – IMPROVING SAFETY THROUGH NO-BLAME INVESTIGATION AND RESEARCH The Australian Government should: provide a sufficient annual appropriation to enable the Australian Transport Safety Bureau (ATSB) to carry out its functions, both existing and as proposed in this inquiry formalise the role of the ATSB in conducting investigations and research involving Domestic Commercial Vessels and rail amend the Transport Safety Investigation Act 2003 to enable the ATSB to conduct research and investigate incidents involving heavy vehicles, and autonomous vehicle technologies direct the ATSB to undertake a clearly defined, phased transition into the heavy vehicle role, including an initial period of data collection and research to identify any systemic issues and incident types with the potential to inform policy. The costs of the ATSB should not be subject to cost recovery from industry, but the States and Territories should support the Australian Government by providing a consistent contribution to its total costs, rather than on a case-by-case basis.
Which got me going back to this, recently updated, ATSB webpage:
https://www.atsb.gov.au/about_atsb/inquiry-submissions
Quote:Inquiry submissions
Consistent with the Minister’s Statement of Expectations, the ATSB provides input into government inquiries reviewing the ATSB’s jurisdiction across different modes of transport. Below are recent submissions the ATSB has made to relevant government inquiries.
To which it can be discovered that the ATSB made submissions to the NTRR:
National Transport Regulatory Reform Inquiry draft report
National Transport Regulatory Reform Inquiry issues paper
Plus the Review of DCV safety legislation:
Independent Review of Domestic Commercial Vessel Safety Legislation and Costs and Charging Arrangements
Quote:Organisation conducting the inquiry
Independent reviewers, reporting to the Minister for Infrastructure, Transport, Regional Development and Local Government
Purpose of the inquiry
The Australian Government has commissioned an independent review to consider whether Australia’s legal framework regulating the safety of domestic commercial vessels is fit for purpose. The review is also to consider whether this regulatory framework is being delivered efficiently and effectively, and to consider options for future cost recovery arrangements.
Date of the ATSB's submission
5 April 2022
Summary of the ATSB's submission
This submission is a response to the consultation aid, released in February 2022, prepared for phase 1 of the independent review. The ATSB’s submission outlines matters for the reviewers to consider in relation to expanding the ATSB’s role.
Key points in the ATSB's submission
- The ATSB does not have an agreed role in relation to DCVs.
- In general terms, ATSB investigations improve safety.
- The ATSB does not have resources to prepare a considered comment on whether expanding its remit to include DCVs would support substantially improved safety outcomes.
- Any recommended change to the ATSB’s role should be considered in the context of any other jurisdictional expansion.
Ref: https://www.atsb.gov.au/sites/default/files/2022-11/dcvir-submission-2-australian-transport-safety-bureau.pdf
Which brings me (finally) to Popinjay's confession...
From page 4 of the ATSB DCV submission:
Quote:3.1.4 The ATSB is not in a position to continue conducting DCV-only investigations or taking on a
new role in DCVs in future unless new resources are made available for this purpose.
The ATSB’s financial position is already under strain in relation to its current jurisdiction.
The majority of the ATSB’s investigations are into aviation occurrences. As an indication,
in 2020-21, 85 per cent of the investigations the ATSB initiated were into aviation accidents
and incidents.
3.1.5 However, even with that level of activity, the ATSB did not investigate enough accidents
and incidents to fully meet the international standards and recommended practices
for aircraft accident and incident investigation outlined in Annex 13 to the Convention
on International Civil Aviation. In the rail sector, the ATSB is critically underfunded
to conduct rail investigations across Australia. The Productivity Commission inquiry into
national transport regulatory reform noted some of the challenges of the current rail funding
arrangements for the ATSB and recommended the Australian Government provide sufficient
annual appropriation to enable to ATSB to carry out its existing functions2.
MTF...P2
PS: P2 OBS - I note that OTSI made a brief but incisive submission to the NTRR inquiry:
https://www.pc.gov.au/__data/assets/pdf_file/0018/243504/sub040-transport.pdf
However for some unexplained reason, especially considering the prevalence in recent times of completed /active investigations and significant negative publicity on safety issues in the DCV Ferry sector, it would appear that OTSI has not made a submission to the DCV legislation review -
PPS: With the evidence of OTSI's apparent reluctance to investigate the Emerald Class Ferries steering failure incidents and subsequent limited scope investigation (without including regulatory and/or survey issues), could it be that the current incarnation of OTSI has been captured by the regulator AMSA??
Quote:Scope of the investigation
Based on findings from OTSI’s preliminary enquiries, the Chief Investigator determined that the matter warranted investigation in accordance with Section 46 of the Passenger Transport Act 1990 (NSW). The scope of the investigation includes, but is not limited to:
- Defect management systems and associated assurance processes for critical steering failures at introduction into service and throughout the service life of the vessels;
- The effectiveness of the SMS in managing risks to service operations while critical steering defects are identified and repaired; and
- Engineering resource and competence to support defect management and associated assurance processes across the fleet