Location of Fire

December 15, 2004

Singapore yard faces prosecution in fire case

Singapore's Ministry of Manpower (MOM) has completed its investigations into a flash fire that broke out in the No. 3 Starboard Cargo Oil Tank of the vessel Almudaina on May 29 2004, at Keppel Shipyard Ltd (KSL), killing seven workers.

The Ministry says it will bring prosecutions against Keppel Shipyard and the company's Safety Assessor under Singapore's Factories (Shipbuilding and Ship-repairing) Regulations.

On the day of the accident, says the Ministry, seven workers were carrying out hot-work to replace some structural steel brackets inside the No. 3 Starboard Cargo Oil Tank. At about 1.00 pm, sludge at the tank's bottom at the aft of the No. 3S COT was ignited by sparks or molten metal from the hot-work being carried out above.  The sludge was residue from the cargo previously held in the tank. It should have been cleared before hot-work was carried out. The fire spread from the aft of the tank and subsequently led to a flash fire inside the tank.

Key Investigation Findings

Prior to the accident, on May 24, 2004, cleaning to remove sludge was carried out in No. 3S COT at areas where hot-work was to be carried out. The area to be cleaned included the entire bottom of the tank.

On May 27, 2004, an application for a hot-work permit was submitted by the company's Steel Foreman after initial cleaning was completed.  This was followed by a hot-work assessment conducted by the Safety Assessor in No. 3S COT. During the inspection, the Safety Assessor instructed further cleaning to be done.

Under the Permit-To-Work system of Singapore's Factories (Shipbuilding and Ship-repairing) Regulations, the Safety Assessor is required to make a physical inspection of the site of the intended work and its surrounding areas to ensure that there are no hazards or dangers present. He should only endorse the hot-work permit application after he is satisfied with the results of his inspection. 

However, in this case, says the Ministry, the Safety Assessor endorsed the hot-work permit without re-inspecting No. 3S COT to ensure that the areas that required further cleaning had in fact been cleaned. The hot-work permit was then submitted to and approved by the Project Manager.

Consequently, the residual sludge was ignited by sparks or molten metal from hot-work being carried out. The fire spread from the aft of the tank and subsequently led to a flash fire inside the tank, killing seven people.

The Ministrt notes that the Permit-To-Work system for the shipbuilding and ship-repairing industry was legislated in 1994 under the Factories (Shipbuilding and Ship-repairing) Regulations.  Since then, the number of reported accidents in the shipbuilding and repairing industry has dropped from 829 cases in 1994 by about 52% to 394 in 2003. The frequency rate has also decreased significantly (about 64%) from 9.6 cases per million man-hours worked in 1994 to 3.4 in 2003.

Following the incident at Keppel, the Ministry has sent two circulars to the industry in June and August 2004 reminding them of safety measures for the carrying out of hot-work onboard oil tankers and petroleum products or chemical carriers, and also the safety measures for work in confined spaces.  The Ministry also met the safety officers in the shipbuilding and ship-repairing industry on November 4, 2004 to reiterate the importance of effective implementation of the Permit-To-Work system at the shipyards.  In the period of June to October 2004, Ministry inspectors had carried out 266 inspections in shipyards.  Arising from these inspections, 13 fines amounting to a sum of Singapore $8,250 were issued to shipyards for violations relating to the Permit-To-Work system.

The Ministry is reminding all occupiers of shipyards and their contractors that the Permit-To-Work system and other mandatory safety measures must be effectively put in place to ensure that workers are provided a safe working environment. The Ministry says it will not hesitate to take legal action against any company or person found flouting safety rules and regulations.


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