San Francisco: The US Coast Guard yesterday finally released the marine casualty investigation report for the November 7, 2007, collision between the Hong Kong-owned boxship Cosco Busan and the San Francisco-Oakland Bay Bridge.
The accident led to more than 53,000 gallons of oil spilling into San Francisco Bay.
The report indicates the main causes of the accident were:
Navigational error by the pilot of the Cosco Busan, who navigated the vessel at a high, unsafe speed in near-zero visibility, failed to properly monitor the vessel's position and progress, and lost situational awareness;
Failure of the master of the Cosco Busan to adequately monitor the navigational actions of the pilot and to maintain sufficient situational awareness to question or correct navigational errors made by the pilot;
Failure of the pilot and master to effectively communicate relevant navigational information with each other during the course of the voyage leading up to the casualty;
Failure of the pilot and master to conduct a proper pilot-master exchange prior to getting underway;
Failure of the master to adhere to restricted-visibility procedures in the vessel's safety management system; and
Failure of the pilot and Cosco Busan's crew to employ proper bridge management team principles. [11/03/09]
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