MOB fatality: person fell between vessel and jetty

What happened?

The UK Marine Accident Investigation Branch (MAIB) has published Accident Investigation Report 09/2020 into the death of the Master of dredging vessel Cherry Sand when he was crushed between the dredger and the jetty after he fell while attempting to step ashore to assist berthing the vessel in Rosyth, Scotland.

The Master had climbed over Cherry Sand’s bulwark and on to the rubbing band in readiness to step ashore as part of a self-mooring operation. The chief officer was still manoeuvring the dredger towards the berth when the master took a single step towards the quayside. Cherry Sand was too far away from its berth, with the result that the Master’s foot missed the quay, and his upper body struck the chains and quayside with force before he fell between the quay wall and the vessel. He was crushed by the moving dredger before slipping into the water.

The Master was wearing a lifejacket and the ship’s crew were able to recover him onto the quayside, but his injuries were too severe, and he could not be revived.

What were the causes? What went wrong?

The MAIB noted:

  • The method used for self-mooring Cherry Sand was inherently hazardous, and crew routinely stepped ashore/on board when the vessel was not tight alongside;
  • Linesmen were not used, and no measures had been taken to avoid having to place a crew member ashore while the vessel was unmoored;
  • Safety management system audits had not identified that Cherry Sand’s operational practices, and the general safety culture on board, were below the expected level;
  • Of the occupational accidents investigated by the MAIB over the past 5 years, more than 40% of the mariners who lost their lives were over 50 years old. Over the same period, the four persons who lost their lives while attempting to step on/off during mooring operations were between the age of 58 and 72.  UK HSE guidance warns that older workers may experience more slips, trips and falls than younger workers, and recovery following an injury may take longer.


  • The UK Maritime and Coastguard Agency (MCA) were to amend the Code of Safe Working Practices for Seafarers to provide guidance on mooring and unmooring operations, and when it is permissible for vessels to self-moor;
  • A recommendation was made to Associated British Ports (aimed at ensuring a common approach to safety and fleetwide application of company procedures;