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Confined space entry fatality

The Accident Investigation Board of Norway (AIBN) has published the following safety flash regarding a confined space entry fatality on board a vessel, in which a crew member died during cargo tank cleaning work. The incident occurred when a crewman entered the cargo tank without breathing apparatus to retrieve a cargo sampling device. The crewman collapsed inside the tank. He was rescued, but, despite efforts to save his life, he was later declared dead.

The investigation undertaken by the AIBN noted the following points:

  • The crewman died as a result of oxygen deprivation. At the time of the accident, the oxygen content of the atmosphere at the bottom of the tank was probably less than 7.2%. The nitrogen content was probably over 90%;
  • The crewman was experienced and familiar with the risks involved in entering the tank, and probably thought he could ‘get away with it’ and be able to climb down the ladder, retrieve the equipment and climb back up again without an oxygen supply;
  • The cause of the fatality was probably not due to a lack of knowledge, but a lack of motivation in relation to complying with the procedures in the management system;
  • Non-compliance with company confined space entry procedures was found to be more widespread on the vessel than just the crewman who died.

The report can be downloaded from

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