HUMAN FACTORS ANALYSIS OF FATAL FERRY COLLISION

BACKGROUND

On 28 March 2007 the Sydney Ferries Harbourcat , Pam Burridge , collided with the recreational motor cruiser the Merinda resulting into the deaths of 4 passengers aboard the Merinda . Dr Graham Edkins, from Leading Edge Safety Systems Pty Ltd, was provided with instructions to conduct an independent human factors analysis of the incident for Sydney Ferries in relation to the Coronial Inquest. The independent hu man factors analysis included an examination of the visibility of both vessels; workload and distraction factors that may have impacted on the sit uat ional awareness of both crews involved; the adequacy and use of a lookout based on ‘see and avoid’ principles; and operational risk management i ssu es utilised by both crews to maintain safety.

THE RESULT

Information was presented as part of the Coronial Inquest supporting the findings of various NSW agency investigations in regard to human factors issues , including the effectiveness of lookouts, cognitive demand on those operating the vessels and the visibility of both ves sels at night.

HUMAN FACTORS ANALYSIS OF FATAL FERRY COLLISION