Inaccurate Stability Calculations Found as Probable Cause in Golden Ray

So the software could automatically trigger the ballast pumps and move water across to compensate? That’s fancier than I got.

Looking at the stow plan and cargo spread sheet I don’t see anywhere that the charterer broke down the load by deck and hold. The spreadsheet gives weights and number of units by port but not by deck and hold (holds on 5 deck and above are designated by frame number).

Here’s the top four decks for example:

image

That might have been why the C/M was estimating the vehicles weights Not each individual unit of course but for example 347 GM SUVs at 867 MT the unit weight is 2.5 tons each. It’s not shown by deck and hold which is what the LOADCOM requires.

Estimating like this is OK if there are large margins, for example the ship is discharges 3000 mt tons and backloads a couple hundred units but if this is the info the ship is getting with a big load it could be an issue. C/M shouldn’t have to be estimating big loads with small margins, draft restrictions etc.

This is from the NTSB final report and describes the preliminary load plan in the post above.

GR_Stablity_10

The preload plan was for the chief officer to review and determine if the vessel meets stability requirements but it’s not in a format that’s directly useable aboard ship - it has to be converted to a more useable form to entered into LOADCOM. A time consuming task that should be done shoreside.

Or maybe this is the pre-stow. This is from the report but I don’t see it in the Docket.

Most likely the stow plan in post #22 is the final stow which is sent to the ship after departure.

The mate could estimate the GM from that pre-stow.

We have LOADCOM with all these wonderful features but my experience has been that tank sounding equipment in ships other than tankers was regarded as nice to have rather than a requirement.
Then we turn around ships, particularly car carriers, like aircraft without the back up. There is no ability for the two other mates on 6 on 6 off with mooring operations etc to assist. I also have no doubt that the master had no trouble filling in the 5 hours alongside without sitting in front of the LOADCOM.
Surely with communications and data exchange we can do better.

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There is a mistake in the docket - numbers 77 and 78 are the same document and neither is the pre-stow plan as shown in the final report:

Of-topic a bit but why would that be? Which tanks are we talking about cargo, fuel of ballast? Don’t modern tankers use sensors/gauges in all three types?

The ship I sailed on for many years (not a tanker) switched out all the old mercury pnuemercators with Levelcom Tank Level Indicators on the fuel and ballast tanks to get more accurate readings of what was in the tanks. These days you can’t afford to sail around flying blind. Even then we (or I) sounded fuel tanks to verify what was there.

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The chief mate was using some bad numbers. I wonder if he was just looking at the GM and not the wind heel? It was page 2 on our system. I did have a mate that was unaware he had to check the stress which as page 3 of the calculation results.

C/M Calc MSC Calc Required w/ add ballast
Depart Freeport 1.96 1.84 2.4
Depart Jacksonville 1.96 1.91 2.47
Depart Bruswick 2.45 1.76 2.54 2.25

The “w/ add ballast” was with about 1400 mt added, about what was pumped out to meet draft restrictions.

MSC is the CG stability report.

We are going back a few summers since I was in tankers but we were able to maintain our own tank sounding equipment. Each tank had a local and a remote reading gauge.
My experience with pneumatic systems has been a bit hit and miss similar to Chief-Seadog and manual sounding of tanks still needed to be done.

The sounding tape never lies.

Unless you take an innage when you’re supposed to take an ullage!

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Lol! Doh

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Doc #83 in the docket is the Coast Guard report on stability and it is an excellent document with a lot of information.

Doc #20 is an interview of the vessel manager, from reading it I think he is the supervisor of what I’d call the vessel operator. The people asking question have no idea what his role is in the organization and none of the questions are relevant.

Do this many people in the NTSB and the USCG really believe that the key to the capsize is the difference between density of salt and fresh water or does that just seem like a smart question?

This is Lt (redacted) first question:

This is LT (redacted) with the Coast Guard. Just two things. You mentioned that the salinity on board was measured with a device.

Here’s the whole exchange:

This is LT (redacted) with the Coast Guard. Just two things. You
25 mentioned that the salinity on board was measured with a device.
Do you know what kind or brand is used on the ships?
2 A. I don’t remember now.
3 Q. Okay. That’s fine. And there seems to be some moving parts
4 within G-Marine. Is there an organizational chart that kind of
5 has the titles and roles of the employees?
6 A. So I’ll ask the attorney to provide them.
7 Q. Okay. Thank you.

jfc

World-wide there is a lot of variation between different ports as to the quality of the cargo information provided to the ship.

For example if the loading at a port is controlled by the new car manufacturer the stow plan will be provided several days in advance. The plan will show the precise location of each car and will include a spreadsheet showing number of units and weight by deck and hold. There’s no pre-stow and final stow sent later in these ports, there is only a single stow plan.

By contrast in some ports, for example where used cars and other general cargo is loaded there is sometimes no or very little advance notice and no stow plan to speak of or only vague plans.

The situation aboard ship also varies, sometimes there is plenty of space aboard, no draft restrictions and lots of margin on stability. Other times things are tight.

In general when the ship is in a tight situation on board it is also in a well organized situation shoreside. And conversely in a wild west type situation shoreside the ship will have generous margins for error wrt to space, drafts and stability.

The situation shoreside in ports like Brunswick and Jacksonville is somewhere in the middle but the situation on the ships in those ports has changed over the years. The ships are now working with tighter margins but the shoreside is still as ad hoc as ever. That makes the margin for errors aboard ship tighter.

From the docket interviews # 18, the lead longshore foreman and # 19 the vessel agent (a former mariner), both know what they are talking about and give a sense of how things work shoreside.

Also they make short work of the uninformed questions, for example the salinity, in the river just assume fresh water and only needed to compute the drafts, not relevant wrt stability.

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The ship got the request for the required drafts for Jax 5 days before which is sufficient time. The pre-stow for Brunswick about 30 hrs before arrival which means the C/M might only has one session to enter the numbers into the computer. That’s not just matter of typing the numbers in because they are not in the same form as required by the program. Some estimates have to be done etc.

Don’t really think that was a factor here as the C/M had a couple extra days from Freeport to Jax with the correct numbers and he still did not have the stability right for that leg.

Looks like the C/M didn’t have sufficient understanding of stability, specifically the severe wind and rolling criteria.

Nether the ship nor the company had a procedure in place to catch this type of error.