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Safety Recommendation Details

Safety Recommendation M-07-009
Details
Synopsis: On May 14, 2007, about 0130 Alaska daylight time, the passenger vessel Empress of the North grounded at the intersection of Lynn Canal and Icy Straits, about 20 miles southwest of Juneau, Alaska, after the vessel failed to negotiate a turn to the west. No injuries resulted from the accident, but the vessel sustained significant damage to its underside and propulsion system. The 206 passengers were safely evacuated to assisting vessels and transported back to Juneau.
Recommendation: The National Transportation Safety Board recommends that the U.S. Coast Guard: Verify the functionality of Hammar model H20 remote-release units for liferafts by inspecting or delegating the inspection of a sample of the models, requiring authorized facilities to demonstrate functionality, or other equally effective method. (Urgent)
Original recommendation transmittal letter: PDF
Overall Status: Closed - Acceptable Alternate Action
Mode: Marine
Location: Chatham Straits, AK, United States
Is Reiterated: No
Is Hazmat: No
Is NPRM: No
Accident #: DCA07MM015
Accident Reports:
Grounding of U.S. Passenger Vessel Empress of the North
Report #: MAR-08-02
Accident Date: 5/14/2007
Issue Date: 7/5/2007
Date Closed: 4/23/2008
Addressee(s) and Addressee Status: USCG (Closed - Acceptable Alternate Action)
Keyword(s):

Safety Recommendation History
From: NTSB
To: USCG
Date: 4/23/2008
Response: As a result of its investigation, the Safety Board has learned that the failure of the rafts to deploy following manual activation after the vessel had grounded was the result of the crew’s failure to follow the manufacturer’s recommended lubrication schedule for the MRRS pumps units. The pump units are clearly marked in black letters on a yellow background on the cylinder housing, "Lubricate piston every second year." However, the Majestic America Line’s port engineer informed Board investigators that 20 of the 22 MRRS units had been kept on board the vessel for over 2 years and had not received the proper lubrication since installation. Majestic America Lines has since removed those units and replaced them with new ones and has taken steps to ensure that in the future, these units will be lubricated as required. The Safety Board commends all parties for the proactive actions taken to identify the cause of the inoperable release mechanisms and to correct problems. These actions include the following: ·The manufacturer’s revising its operations manual to emphasize the need for proper maintenance ·The manufacturer’s sending a notice to owners of the release mechanism advising them of the need for proper maintenance ·The Coast Guard’s issuing Safety Alert 4-07, Hammer Manual Remote Release System Pneumatic Pump Units, advising marine operators of the need to lubricate the units every 2 years ·The Coast Guard’s advising its field inspection units of the problems identified with the Hammer release mechanism in the Empress of the North accident, and advising them to ensure that the release mechanisms work properly and are being maintained as required during the course of routine inspections ·The operator of the Empress of the North’s revising the vessel’s Safety Management Manual to clearly explain the need, and process, for maintaining the release mechanisms on a regular basis The Safety Board believes that the Coast Guard’s efforts, in conjunction with those of the vessel owner and the manufacturer of the release mechanisms, have corrected the deficiencies identified on the Empress of the North and constitute an acceptable alternate means of satisfying the recommendation. Accordingly, Safety Recommendation M-07-9 is classified Closed Acceptable Alternate Action.

From: USCG
To: NTSB
Date: 8/21/2007
Response: Letter Mail Controlled 8/29/2007 10:08:39 AM MC# 2070445: We concur with this recommendation. The EMPRESS OF THE NORTH was equipped with 22 Hammar Manual Remote Release System (MRRS) pump units that would allow the crew to manually activate 22 corresponding Hammar H20 hydrostatic release units, each deploying one liferaft. Interviews of the crew after the grounding, as well as discussions with Majestic America Line’s port engineer, indicate that the failure of the rafts to deploy with manual activation after the grounding was likely due to failure to follow the manufacturer’s recommended lubrication schedule for the MRRS pump units. MRRS pump units are clearly marked in black letters on a yellow background on the cylinder housing, Lubricate piston every second year. According to information from the port engineer, 20 of the 22 MRRS units had been on board over two years and had not received the proper lubrication since installation. Majestic America Lines has since removed those units and replaced them with new ones, and is taking steps to ensure that in the future the MRRS units will be lubricated as required. On June 30, 2007, at the end of her drydock period, inspection staff from US Coast Guard Sector Portland inspected the EMPRESS OF THE NORTH, including testing over 50% of the newly installed MRRS units, and found them functioning satisfactorily. Our action on this recommendation is complete and we request that it be closed.