JAPAN P& I CLUBVol.49 December 2020

P&I Loss Prevention Bulletin
The Japan Ship Owners’Mutual Protection & Indemnity Association Loss Prevention and Ship Inspection Department

T ip s fo r E ffe c tiv e
E n g in e M a n a g e m e n t
a n d M a in te n a n c e

P&I Loss Prevention Bulletin

Contents
Chapter 1 Introduction......................................................................... 2
Chapter 2 T he importance of repair/inspection/maintenance ........ 5
2-1	Building up a trustful relationship among engine team members................. 6
2-2	Why is repair/inspection/maintenance necessary?................................. 112-3	Harmony between technology and human beings:
4M management.............................................................................. 13
2-4

Limitation of human capacity.............................................................. 15

2-5	Error chain: example of an engine accident........................................... 19
2-6	What to careful of with repair/inspection/maintenance............................ 22
2-7	When and what should crewmembers evaluate andjudge on board?............................................................................... 24
2-8

Summary........................................................................................ 27

Chapter 3 P reparing for an emergency situation......................... 31
3-1	Common recognition of the state of loss of propulsion
and loss of power............................................................................. 32
3-2	Cases of loss of propulsion and loss of power....................................... 34
3-2-1	Incident case of loss of propulsion in the US: Incorrect operationof the main engine in the wheelhouse.................................................. 34
3-2-2	Incident case of loss of power in Norway: Inadequate replenishing of systemlubricating oil to diesel generators on an electric propulsion vessel............ 35
3-2-3	Transport Safety Board investigation reports for Japan: Cases of loss of
power............................................................................................. 38
3-3

Response to be taken by a ship in the event of an emergency................. 40

JAPAN P& I CLUB
Chapter 52020 IMO compliant fuel oil ........................................ 65

5-1
IMO 2020 compliant fuel oil concerns.................................................. 66
5-1-1 Production of marine fuel oils.............................................................. 66
5-2	Precautions and countermeasures for safe usage of 2020 IMO
compliant fuel oil............................................................................... 69
5-2-1 ① Compatibility................................................................................ 71
5-2-2 ② Low viscosity............................................................................... 75
5-2-3 ③ Cold flow properties...................................................................... 82
5-2-4 ④ Cat-fines (FCC catalyst particles)..................................................... 88
5-2-5 ⑤ Ignition and combustion quality....................................................... 92
5-3 	Countermeasures for the safe use of cylinder oil.................................... 97
5-4
Onboard check................................................................................ 99
5-4-1 Diagnosis of Compatibility................................................................ 100
5-4-2 Diagnosis of cold flow properties....................................................... 101
5-4-3 Assessment of ignition quality........................................................... 102
5-5
Summary...................................................................................... 103

Chapter 6 Conclusion....................................................................... 104
Reference Materials .......................................................................... 106
Reference Material 01:
Ability diagnosis of onboard work performance: Main Text P. 7......................... 106
Reference Material 02:
Under what circumstances does an error occur?: Main Text P. 16.................... 108
Reference Material 03: Problem Solving Method: Main text P. 21, P. 42............. 111
Reference Material 04: Details of Power Loss Accident in Norway:
Main Text P. 35......................................................................................... 116
Reference Material 05:
The investigation reports of the Japan Transport Safety Board: cases of loss of

3-3-2 Analysis of loss of propulsion.............................................................. 41

power: Main Text P. 39............................................................................. 119
Reference Material 06:
Emergency response checklist immediately after loss of propulsion and loss of

3-3-3 Emergency response when loss of power occurs (blackout).................... 43

power: Main Text P. 45.............................................................................. 125

Summary........................................................................................ 55

Reference Material 07: How to prevent panic: Main text P. 55.......................... 127

3-3-1 Diesel Engine Plant System................................................................ 40

3-4

Chapter 4 P
 repare for Bunker Trouble(Engine accident due to poor fuel oil quality) ............ 56
4-1

Importance of preserving evidence in time of bunker trouble.................... 56

4-2

Summary........................................................................................ 63= References = ....................................................................................... 131
Author .................................................................................................... 140

1

P&I Loss Prevention BulletinJAPAN P& I CLUBRecommended measures to prevent a reoccurrence:

Chapter1

We need to analyze the human behavior characteristics of the person who caused

Introduction

such errors: the root cause, the psychological factors, and human capability/
limitation, to establish an environment that eliminates them.
When focusing on the root causes of a ship’s machinery failure and incidents, it

In previous seminars and loss prevention bulletins, we introduced the following themes:

appears that most cases are the result of management problems regarding oils (fuel・the causes of marine casualties/incidents,

oil and lubricating oil) and inspection/repair/maintenance work that was not properly

・the reasons why similar types of marine accidents continue, andperformed. However, the engineers and their crewmembers in the engine department

・the recommended measures needed to prevent a reoccurrence.

tend to pursue the cause as to whether there is any abnormality regarding mechanical/
electrical engineering integrity and soundness in design/manufacturing, such as

A brief outline of each is given below.

whether the engine machinery/equipment itself is working and running normally or not.
Regrettably, it is often the case that reoccurrence preventive measures, such as those

The root cause of marine casualties/incidents:
A Chain of Human Errors.

The reasons why similar types of marine casualties/incidents continue:

mentioned above, tend to get neglected or forgotten.
In this guide “Tips for Effective Engine Management and Maintenance” we haveincluded all of the key elements taken from our open seminars that were held in Japan in
2019.

While it is impossible to prevent human errors completely, in the past, those involved

Mr. Osamu Hayashi, a yobikō (university prep. school) lecturer, known for his famousin safety management and many shipowners/management companies have takenphrase “Ima desho! (Do it now!)” explains that the common causes of historical failures

measures to prevent recurrence from a technical perspective because they assumed

and defeats are “conceit, preconception, and a lack of information”. We should viewthat the cause of casualties/incidents was mainly due to the chain of errors thatthem as human behavioral characteristics. Therefore, we recommend that ship owners/

surfaced as a result of technical issues. Previously, the parties who were directly

ship management companies, in particular, recognize human behavioral characteristics

related to the casualties/incidents were punished and the case was closed.

as a threat. We wish to emphasize the importance of ① “supporting human resources”

However, with this method, the possibility of the same kind of accident reoccurring

andis apparent, since we have not analyzed the root cause as to why experienced

man them more effectively will lead to successful teamwork. It is hoped that the key

crewmembers and marine engineers generated human errors that could lead topoints raised in this bulletin will assist and promote prevention and the reoccurrence of

casualties/incidents.

casualties/accidents.

② “being prepared for panic”. By cooperating with the vessels and those who

Please refer to the following loss prevention bulletins on human behavioral

2

3

P&I Loss Prevention BulletinJAPAN P& I CLUBcharacteristics, psychological factors, and human capability/limitation that contribute to
the root causes.

Chapter

UB

P&I Loss Prevention Bulletin Vol.35

revention BulletinJAPAN P& I CLUB2

The importance of repair/inspection/maintenanceVol.35 July 2015

P&I Loss Prevention Bulletin
The Japan Ship Owners’
Mutual Protection & Indemnity Association Loss Prevention and Ship Inspection Department

Thinking Safety
Bridge Resource Management and Engine Room Resource Management

Vol. 35

The author

Ship Inspection Dept.
rs’ Mutual Protection & Indemnity Association

Thinking Safety – Bridge Resource Management andEngine Room Resource Management

UB
Websitehttp://www.piclub.or.jp

橋人形町 2 丁目 15 番 14 号 ………… Tel：03-3662-7229 Fax：03-3662-7107

shi-Ningyocho Chuoh-ku, Tokyo 103-0013, Japan

区海岸通 5 番地 商船三井ビル 6 階…… Tel：078-321-6886 Fax：078-332-6519

Mitsui Bldg. 5, Kaigandori Chuoh-ku, Kobe, Hyogo 650-0024, Japan

端町 1 番 1 号 明治通りビジネスセンター 6 階 … Tel：092-272-1215 Fax：092-281-3317

The following are the fundamentals of repair/inspection/maintenance and are
empirically said to be the lifelines of the engine department.

Business Center 1-1, Shimokawabata-machi, Hakata-ku, Fukuoka 812-0027, Japan

来町 2 丁目 2 番地 1 ………………… Tel：0898-33-1117 Fax：0898-33-1251

o, Imabari, Ehime 794-0028, Japan(Issued in July 2015)#14-01B SINGAPORE 068898 …… Tel：65-6224-6451 Fax：65-6224-1476

eet, London EC3V 9BS U.K. ……… Tel：44-20-7929-3633 Fax：44-20-7929-7557

The management of Oils (fuel oil and lubricating oil)The grasping of machinery working status/appropriate maintenanceJAPAN P& I CLUB(especially the fuel supply system)

Vol.46 November 2019

P&I Loss Prevention Bulletin
The Japan Ship Owners’Mutual Protection & Indemnity Association Loss Prevention and Ship Inspection Department

A Psychological Approach
to Safety Behaviour

ERM (Engine Room Resource Management) was stipulated as a requirement
Vol.46

following the revision of the STCW Convention (International Convention

A Psychological Approach to Safety Behaviouron Standards of Training, Certification and Watchkeeping for Seafarers) in(Issued in September 2019)2010. The requirement specifies the standards of navigational watchkeeping
needed in accordance with the Mariners Act in Japan. The standard goes on toJAPAN P& I CLUB

explain that crewmembers must surely implement what has been traditionallyVol.47 March 2020

P&I Loss Prevention Bulletin
The Japan Ship Owners’Mutual Protection & Indemnity Association Loss Prevention and Ship Inspection Department

important/necessary regarding technical knowledge and maintenance methods

A Psychological Approach
to Safety Behaviour
Continued...

that are the fundamentals of engine management. To reliably realize this, crew
Vol.47

A Psychological Approach to Safety Behaviour Continued(Issued in March 2020)

members must utilize all of the engine department’s resources and cooperatewith one another, communicate with the engine team effectively, and makesure that work on planned maintenance is carried out along with continuous
condition monitoring while keeping up to date with training. Therefore, repair/inspection/maintenance is closely linked to ERM.

4

5

P&I Loss Prevention BulletinJAPAN P& I CLUBIt is also recommended that not only the crewmembers on-board, but also thatthe shipowner/ship management company consider the following to achieveeffective engine management in addition to mechanical/electrical engineering
technical theory:
It is essential to respect the “positiveness and faithfulness” of humans.
It is necessary to be mindful of “supporting human resources” paying particularattention to the fact that “people have limitations”.

war II, the collapse of the bubble boom economy in 1991 in Japan, and the 2008 Global
Financial Crisis. As a result, while our freedom to think and diversity, and ability tochoose are respected, there is the concern that humans have become vulnerable to stressin social situations due to such respect and sensitivity towards individual rights.
However, life onboard a ship is still sometimes considered backward with a system thatremains straitjacketed and hierarchical. If experienced crewmembers teach younger
crewmembers in an old-fashioned manner with conceit and preconception, it may be
too overwhelming for younger crew members. This may scar them mentally and it
may take some time for them to recover. Therefore, to create a sustainable workplace,experienced crewmembers should be aware of the fact that younger crewmembers are

2-1 Building up a trustful relationship among
engine team members

more vulnerable to a stressful environment, particularly when under the supervision ofexperienced crewmembers. Given these circumstances, experienced crewmembers alsoneed to acknowledge this and take a more flexible approach, for example:

Figure 2-1 is one of the posters that we① To compliment younger crewmembers whenever possible

issued in early 2019 to promote safety.

② To not give ambiguous instructions to younger crewmembers
 o create a safe space and environment where younger crewmembers can③ T

There may be a gap between what

concentrate

the “boss” expects (conceit and the④ In order to support younger crewmembers, experienced crewmembers

preconception) and what the “younger

need to be aware of what they need to know, and not pressure them

crewmember” may understand (a lackof information). The poster reminded
the author of one day when he was

It is recommended that the senior engineers conduct an extensive and comprehensive

looking around the engine room fordiagnosis of each crewmember in the engine department as early as possible, so as tosomething, about 30 years ago whenbe able to approach younger crewmembers appropriately. Please refer to “Reference

he first boarded a ship. Have you evermaterial 01: Ability diagnosis of onboard work performance” (Page 106).

experienced something similar to thescene in this poster?

It is difficult to build up a trustful relationship in the engine team under vague
Social and economic development

circumstances, i.e. an attitude of conceit, preconceptions, and a lack of information

is now stable following a period ofwill hinder a trustful relationship. To prevent this, as shown in Figure 2-2, experienced

rapid economic growth after world

6

Figure 2-1 4th Engineer gets lost and struggles

crewmembers and younger crewmembers should establish a sense of unity.

7

P&I Loss Prevention BulletinJAPAN P& I CLUB・    ・        ・  
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

    
          
  

       


   

Therefore, the experienced crewmembers need to utilize 6 capabilities effectively tobuild a trustful relationship with younger crewmembers who have a diverse way of
thinking, especially when they work on onboard operations that require organizational
control and discipline.
The 6 capabilities are “trustworthiness, principles, ability to evaluate, ability tocommunicate, achievement, and autonomy”.

8   



   
    Dbedismissive.
    on’t

     

 makes for a weak leader.
：Self-protection   

         Figure 2-2 On building a better team    

 

Supportthose under
 your leadership.

 Be true to your word.    ：Rules that follow a vision are strong.

ave a clear vision.
  H

Decide how the team should be.


 the rules is a joint responsibility.
Breaking
Create rules to prevent mistakes and gaps.
Eliminate the contradiction between words and actions.

9



P&I Loss Prevention Bulletin    


JAPAN P& I CLUB    ：An absolute  
 appreciation 
of roles is motivating.

If you try to control your those under your charge by downplaying them, you will likely be respect those working for you, they may never listen to you and may never cooperate.

It

 kind).
is not
necessary to be biased(unfairly

It is important that everyone develop strong resilience.





It
is necessary that everyone be aware of their role.

Investing in the education of younger personnel under your leadership is
ideal.
  

 
  

Use repetition if you want to be understood.

       

Leaders must work harder than anyone else.
Keep going no matter the outcome.

Consider the result an “opportunity to learn” that will strengthen younger
personnel under your charge.

 Face and respect your younger personnel as individuals.
  

Create an updatable and readily accessible manual.

 

  ：Create an environment that encourages those under

your charge to act of their own accord.

2-2 Why is repair / inspection / maintenancenecessary ?
The author attended a seminar on the human factors surrounding aeronautical engineers,which included many hints that could be considered applicable for onboard work in aship’s engine department.

T ips that can be applied to a ship’s engine department
The aviation field considered human characteristics and capabilities carefully in aircraft
design to effectively improve manoeuvring operations. This is where an understanding of
human factors first began. Besides, even in recent years, even though aircraft technology
has advanced to a high degree, it is dependent on humans to a large extent, so it isCreate a safe work environment.

extremely important to understand human behavior characteristics and to align them

Encourage newcomers to emulate others.

with machines to improve overall system safety. The author would like to focus on theReal leaders win over both superiors and those under their charge.

background of a more profound recognition of human factors.

Endurance is key to success.
10

not interfere with the teamwork of the crewmembers.



that allows
a team to exert its
  ：A mechanism
greatest performance.

Management System) as a countermeasure for casualties/accidents. However, it should

Share the best and ultimate achievements.

  and obtain high-quality work results.
Shipowners and ship management companies tend to tighten the SMS (Safetyis absorbed.

everything  Based on this, if the mutual understanding of values between the two parties creates

Don’t communicate with uncertainness.



 

betray their team”. Namely, “do not betray others to save face”.

than simply “transmitted”?

Always encourage them to leave their comfort zone and make sure that

In short, it is important that “one does not lie, does not make excuses, and does notcooperation and empathy, the engine department can build the most robust teamwork

 

  ：Wasthe 
information “understood” rather repulsed and may face difficulties in building a strong team. In other words, if you do not

Figure 2-3 shows the “biggest threat” to aircraft and ships, two main forms of transportation.
11

P&I Loss Prevention BulletinJAPAN P& I CLUBOn an aircraft, if the aircraft gets damaged or there is engine failure due to “human” error

sure that younger crewmembers understand, putting themselves in the shoes of thewith repair/inspection/maintenance or if it is manoeuvred incorrectly, “gravity” will cause it

younger crewmembers.

to crash.
On a ship, if a ship sustains damage to the hull or the main engine stops because of “human”
error similar to the above, a marine casualty/accident occurs because the “water (sea)”causes instability, inconvenience, and isolation.
Therefore, both forms of transportation have the same phenomena in common, that is, thebiggest threat is “human beings”.
Aircraft and ships are inspected before commencement of operation to ensure that they
have been designed and built in accordance with the rules and regulations and that they areoperated correctly. On passing, a certificate is issued. This is then proof that an aircraft is
airworthy or that a ship is seaworthy.

2-3 Harmony between technology andhuman beings: 4M management
In the aircraft field it is said that 4M management, as shown in Figure 2-4, is indispensable
as a guiding principle to properly manage the repair/inspection/maintenance necessary toensure that the aircraft remains “airworthy”.
Man who acquires the Method（necessary knowledge) and who uses the Material, theMachine & the Facility can carry out repair/inspection/maintenance. Those 4 initials
are M. 4M management is the same as ERM (Engine Resource Management), and it isessential for the implementation of quality control.


   （）
 
Figure 2-3 What is the beings threat?



 





（ ）   

The carrying out of repair/inspection/maintenance is to “maintain the inherent
airworthiness and seaworthiness” of an aircraft or ship. Besides, it is just this “essential
positive action” that enables “humans” to discover defects or problems within
machinery. However, because “humans” work on this machinery directly, and let us
remember that “humans” pose the greatest threat, it is recommended that experienced
crewmembers always reconfirm just what “repair/inspection/maintenance” is and make12

Figure 2-4 Management of 4M

13

P&I Loss Prevention BulletinJAPAN P& I CLUB

4M is compromised when the following examples occur:(1) Machine&Facility: the maintenance personnel judges the deterioration ofparts by measuring with a “faulty measuring scale”.
(2) Machine&Facility: the maintenance personnel tightens bolts using an“uncalibrated torque wrench that has a deteriorated spring”.
(3) Material: the maintenance personnel installs non-genuine parts.
In Table 2-5, aircraft and ships can be compared using 4M.
It is clear to see that 4M can be applied to ships also, therefore, please take some time toreview this and use it onboard whenever possible.

2-4 Limitation of human capacity
Factors that cause human error include the following recognition processes.
Error when registering information
Example: C rewmembers sometimes overlook parameter information of engine
room machinery dials etc. (change of pressure, temperature, vibration,and so on) during engine room rounds, etc.
E rrors in the memory process (errors due to limitations of short-term
memory, long-term memory) (lapse)
Example: T he technical personnel forgot what he planned to do.
The technical personnel believed that he completed his work eventhough he did not finish it, and so on.

Industry

Aircraft

Ship

Important points

Gravity
Human beings

Water (Sea)
Human beings

Knowledge, Repair/
Inspection/Maintenance,
Instruction Manual, Procedure,
Training, Education

Knowledge, Operation, Repair/
Inspection/Maintenance,
Instruction Manual, Procedure,
Training, Education

Example: T he technical personnel believed the action was correct without any
doubt.
The technical personnel worked according to procedures that do not
apply, and so on.

Engine Department Crew
(Supervisor, Subordinate,
Senior, Junior)

Examples: T he technical personnel unavoidably used a tool not specified for thetask.
The technical personnel believed it was safe and didn't wear theprescribed protective goggles, and so on.

MethodE rror in the judgment process (mistake)T emptation to deviate (violation)Man

Airline Mechanic(Supervisor, Subordinate,
Senior, Junior)

4M

Error in the output process (slip)

Material(Materials, Parts,
Consumables, etc.)

Machine & facility(Facilities, Plant andEquipment etc.)

Repair/Maintenance Parts,
Fittings

Repair/Maintenance parts,
Ship Supplies, Chemicals,
Lubricating Oil

Facility, Equipment,
Equipment, Tools,
Maintenance Hangar

Facilities, Equipment, Measure,Tools, Dry Dock

Table 2-5 Comparison of 4M

14

Example: T he technical personnel hit the next key on the keyboard for operating
the remote monitoring system,
The technical personnel skipped the items on the check sheet andproceeded, Captain inadvertently pressed the main engine “manualemergency stop button,” which was identically shaped and locatedimmediately adjacent to the “program by-pass button,” and the main
engine stopped in an emergency in the center of the canal (Pleaserefer to “3-2-1 Incident case of loss of propulsion in the US: Incorrect
operation of the main engine in the wheelhouse”) , etc.

Among the above factors, let’s look at errors that occur when registering information.
15

P&I Loss Prevention BulletinJAPAN P& I CLUB
Humans collect information by taking advantage of their five senses when making

Errors when registering information
Table 2-6 shows, “Errors when registering information”. Let us imagine your vision
during taking a round in the engine room when “Focusing on one thing,” “Checking

decisions and acting on them. Figure 2-7 shows the ratio of the five senses affecting
information collection in general.

aimlessly,” “Thinking about something different,” or “Jumping to the wrong
conclusion,” and so on. The information around you that you recognize with your eyes
such as “color, numerical values, indication on a measuring gauge, quantity, and open/
closed state of switches and valves,” and so on can be perceived as only an image like 
  

some ordinary scenery or landscape. As a result, it cannot enter into your selection/
judgment/decision process accurately and cannot be transmitted to the brain, which       

then leads to an incorrect output (action). Factors such as similar notation, a confusing
display, busyness, fatigue, lack of sleep, aging, your physical condition, and so on also
influence the background processes behind your actions, and if they overlap, the risk oferror increases. Please be aware that a lack of sleep can lead to the same decline in brain
function as when drinking alcohol. Please refer to the errors of each process in “Reference
Material 02: Under what circumstances does an error occur?” (Page108).

   

Errors when registering information

 
 

Focusing on one thing
Information is notregistered.

・Vision/hearing is limited.
・Field of view is limited.
・Visible range is limited.
Checking aimlessly

Information isregistered, but notprocessed.

Information
registered,
but was illuded.

・A lack of interest.
Thinking about something different
Jumping to wrong conclusion
・The information is of interest but
misinterpreted.
(Hasty judgments, misunderstanding,assumptions).

Incorrect
operation&
poor
maintenance




 
 



Figure 2-7 The five senses

Table 2-6 Errors when registering information

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P&I Loss Prevention BulletinJAPAN P& I CLUB

Surprisingly, sight accounts for 83%, and hearing 11%. However, since the brain

2-5 Error chain: example of an engine
accident

cannot process all the information it perceives, it can only see and hear according to
the information that the brain imagined in advance. That is, since humans’ subjectivity
interposes, you will only see what you want to see and will hear only the sounds you
want to hear. Furthermore, these abilities greatly influence the decision of engine
operation and repair/inspection/maintenance.

Most engine accidents are the result of a chain of small errors.

Engine accident error chain example

Humans have the wonderful capability to “see, hear, judge, act,” but these limitations

Figure 2-9 shows an example of an engine accident error chain. The following humancan cause human error. Therefore, it is necessary to harmonize between the goals to beerrors (in red) form the chain.

achieved and machinery/equipment function. If it is impossible to do so, it will result inincorrect operation or faulty engine room machinery maintenance.

       

   
      
      


 

  
     
   
     ­ 

     



For the aviation industry, “human capability and its limitations” are shown in Table
2-8, and are essential items for qualification requirements, maintenance programs,
maintenance training, and so on. Thus, these are incorporated into the basic education
program, and national examinations require proficiency in this area. It is highly
likely that the shipping industry can learn something from these important points thatoriginated in the aviation industry.
POINT

(1) U
 nderstand human capabilities and their limitations.
(2) B ased on these capabilities, we need harmony
amongst humans, machinery systems and theenvironment.
Table 2-8 Human capabilities and limitations        

Figure 2-9 Error chain: example of an engine incident

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P&I Loss Prevention Bulletin

As a countermeasure, according to the principles of ERM and BRM, if one person’s
mistake occurs during teamwork, somebody must notice this as early as possible and“advise, warn, or help out”.

JAPAN P& I CLUB
    


  

The following situations illustrate this:




3rd day onboard. Because he was unfamiliar with the engine-room MO check list
system, he had difficulties completing the checks.



The Chief Engineer boarded after returning from shore service. It had been a longtime.
The Second Engineer was in charge of the generator. He had been on board for 

A
 Third Engineer, boarded a ship for the first time after being promoted. It was his

5 consecutive years and he had the longest ship boarding experience among
the engine crew members. Furthermore, he believed that he had the best
understanding of the engine room.

distinguish between physical abnormalities (strainer blockage) and electricalthey can refer to the 8 inspection items and grasp the whole picture.
As a result, the person in charge can establish a mutual understanding with the Chief
Engineer regarding the 8 inspection items and be on the same page.
Therefore, they could have broken the chain of errors through referring to the 8 items
related to engine operation management, repair/inspection/maintenance work, andtroubleshooting.

  

    
  

When the strainer differential pressure alarm activates, if the crewmembers canabnormalities (signals, wiring, and so on) based on the logic tree shown in Figure 2-10,
     
 
     

  
     
        
     
    

Figure 2-10 Logic Tree: in event of strainer differential pressure alarm

In various jobs other than this example, it is recommended that the person in charge ofeach piece of machinery/equipment prepares such a technical basic chart in cooperation
with the engine department. It helps crewmembers to resolve engine difficulties. And
then, when they build the troubleshooting procedure, it is good to add weak points
peculiar to the ship by taking advantage of the advice of experienced experts. As aresult, it becomes a more persuasive weapon in the fight to resolve trouble.
Therefore, it is recommended that the chief engineer make an effort to establish theabove system that enables the engine department to work as one team in cooperation.
In addition to a logic tree analysis, there is also a “fishbone” analysis method that canbe used for problem-solving. Please refer to “Reference Material 03: Problem Solving
Method” (Page 111).

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P&I Loss Prevention Bulletin

2-6 What to be careful of with repair/inspection/maintenance
Even if the ship management company or the ship prepares an absolutely perfectprocedure/instruction manual in theory, we cannot eliminate human error because
humans apply their five senses, as mentioned above. James Reason said maintenanceaccidents of aircraft occur in an environment as shown in Table 2-11, according to his
book “Managing Maintenance Error”. He is a British psychologist famous for his “Swisscheese” model of accident causation. He worked in the aviation field with the Royal Air
Force Institute of Aviation Medicine and the U.S. Naval Aerospace Medical Institute.
Errors in repair/inspection/maintenance(1) H umans directly implement and rely on their hands for repair/inspection/maintenance work.
(2) T he level of wear and deterioration of each item to be maintained
will vary, making it difficult to formulate routine procedures.
Therefore, the organization, management and awareness all directly
influence this.

JAPAN P& I CLUBThe ship’s crewmembers and the manager/supervisor of the ship managementcompanies might realize that the same things are happening onboard. Repair/inspection/
maintenance errors always occur when maintenance personnel “(1) do not perform thework that must be done at a determined time/timing, or (2) perform work that does notneed to be done”, as shown in Table 2-12.
Example: The crewmembers did not replenish lubricating oil in the generators with the
manufacturer’s recommended amount (Please refer to “3-2-2 Incident case of loss of
power in Norway: Inadequate replenishing of system lubricating oil to diesel generators
on electric propulsion vessel”).
When there are errors in repair/inspection/maintenance(1) W hen maintenance personnel do not perform necessary workrequired during operating conditions or repair/inspection/maintenancerecommended in the instruction manual at the appropriate time.
(2) W hen maintenance personnel perform repair/inspection/maintenancework that is not required or is prohibited.
Table 2-12 When there are errors in repair/inspection/maintenance(3) R eassembly work is more vulnerable to human error than that ofdisassembly, because reassembly imposes a much greater burden
upon limited mental resources (memory and attention), thus greatly
increasing the probability of error.
(4) M any accident causes are as follows: incorrect parts, incorrect

The managers/supervisors of shipowners or ship management companies must
repeatedly remind crewmembers about “errors that occur during inspection/repairs/
maintenance” as shown in Table 2-12 and Table 2-13, also mentioned above in “2-4

installation of components, fitting of wrong parts, electrical wiring

Limitation of human capacity”.

discrepancies, foreign objects (tools, rags, personal items) left

On the other hand, there are times when crewmembers cannot always perform thebehind in the reassembly of machinery, and so on.

important repair/inspection/maintenance.

(5) T here are several assembly procedures, hence the margin for error
is increased.

There might be several possible reasons behind this:(6) W hen there is a simple and quick work procedure, which violates
the approved procedure. (Black book)(7) O verfatigue, etc.

22

Table 2-11 Errors in repair/inspection/maintenance23

P&I Loss Prevention BulletinJAPAN P& I CLUB
Basic items to check during engine operationT he ship management company does not supply sufficient quality andquantity of spare parts to the ship due to cost-saving.
B ecause of the tight schedule, it will not secure the time for repair/inspection/
maintenance.

Categorymembers on board, the ship management company must analyze what is happening
between those onboard and the management system on the company side. It is
indispensable for the company to establish a system that supports the seafarers onboard
the ship to achieve a higher safety level.

2-7 When and what should crewmembers
evaluate and judge on board?
The basis of engine room watchkeeping is to monitor the condition of the equipment

Prior tostarting ofequipment“when, where, and what they need to pay attention to on board”. Table 2-13 and Table
2-14 show the basic check items needed during engine operation and repair/inspection/
maintenance.

24・Is the scale easy to read?
・Is the lighting around the engine machinery &equipment sufficient?
・Is a pipeline system for lubricating oil, cooling water,fuel oil, etc. in place?
・Are the control switches or control valves set to thecorrect positions?
・Is continuous operation possible?

Starting ofequipment

・Is it normal?
・Will it be necessary to stop the machinery &equipment manually all of a sudden?
・Is it abnormal?

Duringoperation

・Is continuous operation possible?

(unusual, abnormal,
leakage, alarmsounds, vibration,
noise, smell, etc.)

・Will it be necessary to stop the equipment manually allof a sudden?

(recognizing and grasping the current situation).
When monitoring engine operation condition, the crewmembers must always consider

Please increase awareness of the problems,and listen to the noises coming from the machinery.

・Is the glass of instruments and sight glass broken or
dirty?

M a chine O p eration M anag em ent

progress falls behind schedule, instead of leaving everything entirely up to crew

What to Judge/Evaluate?

・Are the pressure gauge, thermometer, and rotating
gauges accurate?

A s a result, the crewmembers onboard lose motivation to carry out repair/inspection/maintenance, and in the worst case, they deteriorate and lose theability to perform repair/inspection/maintenance work onboard.

That is, it is the “collapse” of 4M and ERM. When repair/inspection/maintenanceStatus of
Device or
Machine・Is it normal?

・Is it abnormal?
・Can it be repaired?

Emergency
manual stop・Do you have to leave it?
・Will it be necessary to carry out any additional
inspections/confirmation, including that of related
systems and equipment?

Table 2-13 Basic items to check during engine operation

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P&I Loss Prevention BulletinJAPAN P& I CLUB

Basic items to check during repair/inspection/maintenanceCategory

Status of
Device or
MachineWhat to Judge/Evaluate?
Please increase awareness of the problems,and check attentively.

As mentioned above in “2-4 Limitation of human capacity,” if crewmembers “checkaimlessly,” or “think about something different” during engine room rounds, this is
likely to cause an error.
It is important for younger crewmembers to consciously monitor conditions and predict

Repair / Inspection / Maintenance Managementchanges that may occur during inspection and to keep up to date regarding each piece
Prior torepair/inspection/
maintenanceDuringmaintenance・Did you prepare 4M (Method, Man, Materials, Machine& Facility ), and do you have a risk assessment protocol
in place?

・Must any parts that you removed due to overhauling
be replaced or renewed?
・Are there any abnormalities?
・Is it possible to reuse or refit any of the parts during
overhaul on the machinery?
・Will the maintenance be implemented as scheduled(as planned)?
・Or will the schedule be brought forward?

Regularmaintenance・Will the time of maintenance be extended(postponed)?
・Is the maintenance schedule recommended by the
manufacturer appropriate considering the actual
operation and running of the equipment?
・Is it earlier or later?

of machinery or area where attention should be paid. When monitoring and inspecting,they must also remember the voice of experience from experienced crewmembers/colleagues and information about trouble that occurred on other ships.
In other words:(1) When crewmembers check the engine, they must pay full attention andlisten carefully for abnormal noises coming from the machinery during its
operation.
(2) When crewmembers carry out repair/inspection/maintenance, they mustobserve and evaluate the wear, deterioration, and aging of the machinery
carefully comparing this with the information from each manufacturer
and drawing reference to past similar vessel accidents.
Therefore, crewmembers need to increase their awareness of potential problems, andlook out for and listen carefully with close attention.

・Can own crew on board manage repair, inspection,and overhaul by themselves?
・Will it be necessary to arrange for the repair company
from shore to attend during an emergency?

Repair・Will repair and overhaul need to be carried out at adry dock urgently?
・At present, is it possible to carry out emergency repair
work by the own crew on board and to postpone fullscale repairs until the next regular dry dock?

Table 2-14 Basic items to check during repair/inspection/maintenance

2-8 SummaryEngineers must understand science principles (chemistry and physics) and apply theseto engine room engineering and technology (technical skills). Marine engineers who
have to operate ships with limited technical personnel need to pay attention to this andconsider the psychology (law of behavioral characteristics: human limitations). From
now on, they need to think about how to utilise psychology and ergonomics in order to26

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P&I Loss Prevention Bulletin
mitigate the risk caused by humans.
When planning work instructions for operating machinery, crewmembers should place
human beings at the center of the equation rather than machinery by incorporatingteam members’ wisdom and experience and considering the human capabilities andlimitations (weak points & threats) due to human behavioral characteristics.

JAPAN P& I CLUBteam can be realized.
As mentioned above in “2-5 Error chain: example of an engine accident”, the following
error chain causes engine trouble:(1) When the engine department crew not only lack knowledge andexperience in technical skills, but also make errors when registering

Ultimately, they need to raise the standard of work by applying the above.

information, memory, judgment, deviation, output, etc., they begin

It is also true that experienced crewmembers such as the Chief Engineer and theto overlook small abnormalities in engine operation and repair/First Engineer have high hurdles to negotiate as they support their team in successfulinspection/maintenance.

engine room management. However, to achieve safe operation without engine trouble,(2) If crew members continue to deviate from the original reasons orexperienced crewmembers need to devise ways to bring out the best performance inpurpose of engine operation and repair/inspection/maintenance due

younger crewmembers under their care. This will mean changing their approach toto “conceit, preconceptions, or a lack of information,” the ship cannot

younger crewmembers. Furthermore, the younger crewmembers will also need to have aachieve maintenance as planned in accordance with the SMS (Safety

flexible mindset.

Management System).

However, changing the attitudes of others can be challenging, so experienced

The engine department crew tends to focus on the completeness of their mechanical/

crewmembers need to step outside of their comfort zones if they are to improve theelectrical technical knowledge and tend to focus mainly on dealing with engine

whole team to create a sustainable workplace.

equipment. However, since humans have limitations, it is necessary to consider how thisThen, it is recommended that experienced crewmembers do the following:

will play out in the future as humans remain central to engine room operation. Thus,(1) Prepare an adequate working environment, such as a safe space towork.
(2) Train and mentor (teach, guide, and nurture) next generation younger
crewmembers in basic skills.
(3) O ffer ample support (non-technical skills) to help younger crew
members develop.

when planning work instructions for operating machinery, consideration must be given
to improving work methods with people at the heart of the operation.
Furthermore, the shipowner and the ship management company need to include
awareness building, which harmonizes and aligns technical safety with such limitations,that reinforce repair/inspection/maintenance, as shown in Figure 2-15.

By doing this, younger crewmembers will develop the tools needed to be independent.
Experienced crewmembers and younger crew members need to establish a sense ofunity. We would like to ask the experienced crewmembers to simply demonstrate toyounger crew members the fundamentals, such as to not lie, to not make excuses, and tonot betray their team. Through the mutual understanding of both parties, a truly robust
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P&I Loss Prevention Bulletin  
 
     

JAPAN P& I CLUB  

Chapter
    


3

Preparing foran emergency situation

The engine department’s mission is to “maintain stable ship’s propulsion and secure a           

source of electrical power”. However, there is a risk of an accident occurring if thesecannot be secured.
Loss of propulsion or loss of power can have both primary and secondary impacts on
marine casualties.

1 Primary (direct) impact 
   
           
  

     
     
     
 The following are primary impacts shown in Figure 3-1.

①C ollision withother vessels②D amage to port
facilities

 tranding③S④ Cargo claim, etc.

Figure 2-15 Harmonization between technical safety an human “weak points"
Figure 3-1 P&I accidents that seriously impact the operation

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P&I Loss Prevention BulletinJAPAN P& I CLUB2 Secondary impact
The following are secondary impacts.

Partial and complete loss
（1）Loss of propulsion:①P artially damaged state: reduction of main engine output which inevitably① Personal matter (sickness, injury, and loss of life)

leads to reduced speed operation (damage that lead to speed reduction).

② Consequential environmental influence (pollution, destruction, so on)・During speed deceleration of the main engine.

③ Claims for damage to property and cargo

・When a main engine cylinder is cut off.

④ Economic loss caused by “off-hire”⑤ Reputational damage caused by media reports

Experienced crewmembers and younger crewmembers are engaged in various
operations in accordance with the SMS（Safety Management System) of each company.

・When cutting a main engine turbocharger.
②C
 ompletely damaged state: loss of self-propelling ability (damage requiring
towing).
· When it is impossible to operate the main engine.
·W hen it is impossible to achieve propulsion supply and control of hullstability and manoeuvring due to weather and sea state conditions,So, if they routinely make risk assessments related to the operations concerned withbecause the main engine is partially damaged.

understanding the impact of such casualties as mentioned above, it will be possible to·O perating conditions of the main propulsion plant are not satisfactory.

take the level of safety up a notch.

3-1 Common recognition of the state of loss of
propulsion and loss of power
There are various causes of loss of propulsion and loss of power, but those states canbe defined into two damaged states; partially and completely. If the bridge team on
board and the shore team don’t understand those states accurately, they cannot establish

When the boiler and auxiliary machinery cannot operate due to lack of
power.

（2）Loss of power (blackout ):①P
 artially damaged state: When some power supply units can supply alimited amount of power.
・It is impossible to use/start diesel generator or main switchboard system.
・It is possible to use/start emergency generator ( diesel generator cannot
supply power).
・It is possible to use battery system (neither emergency generator anddiesel generator can supply power).

a system organization structure for recovery. After receiving the first report from theengine department, it is important for both the officer on watch on the bridge and thesuperintendent on shore to confirm the situation simply and accurately. As shown in
Table 3-2, the loss of propulsion power and loss of power can be precisely grasped by
distinguishing between complete losses, such as loss of self-propelling and deadship,
and other partial losses.

32② Completely damaged state: Dead Ship.
・None of the power supply units can supply any power.
・It is impossible to use stored energy such as starting air to start the prime
mover, battery, hydraulic pressure, and so on.
Table 3-2 Partial and complete loss

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P&I Loss Prevention BulletinJAPAN P& I CLUB

3-2 Cases of loss of propulsion and loss ofpower      
    

The following cases are examples of loss of propulsion and loss of power in the USA,
Norway, and Japan.

3-2-1 Incident case of loss of propulsion in the US:
Incorrect operation of the main engine in the wheelhouse
In Texas, USA, a tankship lost its propulsion completely while navigating in a canal(artificial waterway) which resulted in a collision and a cargo (crude oil) spill.
Accident summary
The tankship carrying most of its cargo capacity was behind the scheduled time whilenavigating the canal (artificial waterway), so the captain decided to rapidly raise the main
        

Photo 3-4 Buttons for “manual emergency stop” and “program by-pass”

engine speed according to
the pilot’s instructions. He

The ship dropped an emergency anchor using the starboard anchor because of an

tried to increase the speed

emergency stop to the main engine and loss of ship’s manoeuvrability. However, theof the vessel by pushing theship’s heading bearing became uncontrollable, and the port bow collided with another“program by-pass button”.

ship at berth. After that, the starboard bow collided with another barge that approached

However, he inadvertently

from the front. As a result, the starboard ballast tank and No. 1 center cargo tank werepressed the main engine

breached. An estimated 462,000 gallons (1,756 kl) of crude oil spilled into the water.

“manual emergency
stop button”, which was

3-2-2 Incident case of loss of power in Norway:
Inadequate replenishing of system lubricating oil todiesel generators on an electric propulsion vessel

identically shaped andlocated immediately
adjacent to the “program
by-pass button”, resulting

in a complete loss of
propulsion.

34

This is an accident in which an electric propulsion ship lost its power completely whilecruising in stormy weather causing it to drop an emergency anchor.

Figure 3-3 Maps where the canal accident occurred (artificial waterways)

35

P&I Loss Prevention BulletinJAPAN P& I CLUBtrying to restart the stopped diesel generators, but at 13:58 pm all 3 diesel generators

Accident summary
At 13:50 on March 23, 2019, an electric propulsion passenger ship carrying a total of
1,373 (915 passengers and 458 crew) left Tromsø for Stavanger, southwest, in Norway
running on 3 generators.
One week before the accident, on March 16th, No.3 diesel generator (hereinafter DG3,
Units 1, 2, and 4 being DG1, DG2, and DG4, respectively) was inoperable due to aturbocharger failure. As a result, the manufacturer engineer worked on disassembling
DG3’s turbocharger on board.

stopped completely, and the ship resulted in a loss of propulsion. 2 minutes later, since
the ship started drifting in the direction of the coast (shallows and southeast), a distresssignal “Mayday” was broadcasted. From 8 to 22 minutes later, emergency anchoring(starboard 1st and port 2nd, dropping in that order) was conducted, however the anchors
did not hold, and the ship continued to drift towards the shore. DG1, DG2, and DG4
were replenished with enough lubricating oil, and from 24 to 36 minutes later, thecrew manually restarted DG2 and turned on the main power supply. Then, the electric
propulsion devices on both sides were started, so the ship was able to secure minimum
ship’s propulsion. One hour and 9 minutes later, a passenger rescue by helicopter began.
From 1 hour 26 minutes to 1 hour 48 minutes later, the other two DGs restarted which

Left Tromsø
21 March 2220 GMT
Norwegian Sea

secured half ahead speed. Finally, 26 hours and 29 minutes later, the ship was able toTromsø

arrive at the nearest port of Molde.

PlannedRouteFor details, please refer to “Reference Material 04: Accident details of loss of power in
Norway” (Page 116).

Accident Point
23 March 1400

SwedenFinland

Emergency
port entry

1345'26"
DG4 shuts down

Molde
NorwayOslo

Scheduled toarrive at Stavanger
24 March 1300

Figure 3-5 Maps of navigation route1640 Tug arrives
1345'34"
DG2 shuts down
1400 Mayday

1358’31” DG2 & DG1shut down - Blackout
1406 Stbd anchor let go 10 shackles
1420 Port anchor let go 10 shackles

The weather at that time was strong winds and rough waves (Beaufort wind power 9-10
from the southwest, significant wave height 9-10 meters), and the ship was in rough1422 DG2 back on the MSB but inmanual - Xtie close

1546 DG1
on board in auto
1524 DG4 backon MSB in manualmode, changed
to auto mode shortly
afterward
1505 Help arrives
for pax evacuation
1436

weather. During operation, DG1, DG2, and DG4 had frequent lubricating oil low level
warnings and low lubricating oil pressure warnings for several hours from the earlymorning of the same day.
At 13:37 pm, the diesel generators all stopped in succession, so the crew responded by

36

Shallow Contour = 5m
Safety Contour = 10m
Deep Contour = 20m

Figure 3-6 Map with sequence of events37

P&I Loss Prevention BulletinJAPAN P& I CLUBCause
(1) The engine manufacturer’s recommendation for the amount of system lubricating

Accident 1: Navigating in stormy weather

oil for the ship’s diesel generator is to remain between 68 to 75% of tank capacity.

Accident 2: Activation of over-speed protection device for diesel generator

However, the amount of lubricating oil at the time of the incident was 28-40%. As a

Accident 3: Loss of control power source DC24V

result of pitching and rolling caused by stormy weather, the liquid level of the systemlubricating oil was further lowered, and the suction capability of the lubricating oil
supply pump was lost. As a result, each generator’s lubricating oil pressure dropped,
the safety device was activated automatically, and the generators stopped.
(2) R egarding preparation for heavy weather voyages, there was a lack of risk
assessment based on the safe return to port defined in the SOLAS Convention on thefollowing points.

There was no standby generator
Amount of lubricating oil was insufficient

3-2-3 T ransport Safety Board investigation reports for Japan:
Cases of loss of power
According to the Japan Transport Safety Board’s accident safety database, between
2011 and 2018, there were 8 vessels (5 cases occurred in port areas) that were identified

Accident 4: Cooling fan control circuit failure
Accident 5: During port entry standby, crewmembers set the start switch forstandby diesel generators from “automatic” to “manual” to clean
the lubricating oil strainers of the diesel generators. After a while,
one of two diesel generators in operation stopped suddenly due
to an oil leakage from its load management governor. As a result,the automatic power backup sequence could not be engaged.
Accident 6: A ctivation of ACB safety protection devices of the diesel
generator during operation
Accident 7: Activation of safety protection device for the boiler and stopping
the main engine suddenly due to sensor failure
Accident 8: A fter switching the valve to the middle position to receive
marine diesel oil and heavy fuel oil, this caused heavy fuel oil ofhigher hydraulic head pressure to flow into the marine diesel oiltank. As a result, this caused the diesel generators (supplied by
the marine diesel oil tank) to stop.

as “vessel not under command” due to loss of power or loss of control power source
onboard during navigation (excluding pleasure boats, personal water craft, mini boats,recreational fishing vessels, fishing vessels, tug boats, and push boats, etc.)

For more details, please refer to “Reference Material 05: Details of The investigation reports of the Japan Transport Safety Board; cases of loss of power” (Page
119).

38

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P&I Loss Prevention BulletinJAPAN P& I CLUB

3-3 Response to be taken by a ship in theevent of an emergency

Fuel OilIntake Air/
Scavenging Air

Before going on to talk about how a ship should respond in the case of an emergency,
we will first look at the layout of the engine room’s machinery and how each piece ofequipment is related. The purpose of each piece of machinery in the engine room is as

Diesel Main Engine

 ain engine & shaft system: Generating propulsion
MGenerator: Generating electric power
Boiler: Generating the heating source mainly for fuel oil or cargo
E mergency generator: Generating emergency electric power supply to theminimum critically important backup machinery when the generators cannot
supply electric power.
Emergency battery: Supplying power to the control system and some lighting
when power cannot be supplied from an emergency generator.

Power source
for Control System
Main Generator /Emergency Generator
Power Supply Device

Lubricating
Oilfollows. Below is a Diesel Engine Plant System. Please see Figure 3-7.

(5)・Starting Air
・Battery・Hydraulic Power etc.

Main Generator/
Emergency Generator

3-3-1 D iesel Engine Plant System

(1)
(2)
(3)
(4)

Stored energy for
Starting Prime Mover

Cooling
Water

・Air Circuit Breaker (ACB)・Switchboard
・Power Management System

Diesel Main Engine

Broken lines show the main engine system.

・Remote Control Device
・Speed Control Device

Solid lines show generator and emergency generator system.
Figure 3-8

Basic configuration diagram of diesel engine system

Assuming that fuel oil supplies, lubricating oil, cooling water, intake air/scavenging
air, a control device, a power supply device, or a power source for a control system is

Emergency DC 24V Battery(Control System Power Source & Emergency Lighting)EG
Fuel Oil Tank

EG Start
EG
Start Air HydraulicReservoir System

EG Start
Battery

Emergency
Generator:(EG)

disrupted, in such a case, a diesel engine such as the main engine, diesel generators,

Emergency
Switchboard

Heavy Fuel Oil
Service Tank

Main
Switchboard

Alternator

DieselGenerator

Alternatorand an emergency generator cannot operate in good order as designed. As a result, loss
Boiler

EGE

40

LO Pumpdiagram of a diesel engine system.

Main Air
Reservoir

3-3-2 Analysis of loss of propulsion
M/E
Remote Control
DeviceSPD

TurboCharger

It is necessary to analyze and understand the causes behind a loss of propulsion inorder to consider an appropriate response. Figure 3-9 is a diagram that breaks down theMain Engine(M/E)
CW Pumpof propulsion or loss of power will take place. Figure 3-8 shows a basic configuration

HFO Pump

LO Sump Tank

Figure 3-7 Machinery layout in engine room (Diesel engine plant system)

problems into elements and shows us a causal relationship among the main causes, theirfactors, and their elements in a step by step format. This style of visual representation is
known as the Fishbone analysis.

41

P&I Loss Prevention BulletinJAPAN P& I CLUB

Main Engine Failure

as described in the Japan Transport Safety Board’s investigation reports, we must takeEngine System

extreme care and understand that the failure of the electric power system deeply affects

・Main engine failure whilst
using shaft generator
・Fuel problems
・Human error

・Failure ofControl Devices

・Failure of electric
control devices

the maintenance of propulsion. Therefore, it is recommended that the company and the・Failure of Mechanical system
Loss of Power(Blackout)

Electric Power
System・Other causes

procedure to maintain the reliable operation of the main engine.

3-3-3 E mergency response when loss of power occurs(blackout)

・Failure of Automation system

・Inadequate care of fuel oil changeover procedurewhen entering or leaving SOx Emission Control Area
・Contamination or poor quality of Fuel Oil

Loss of power affects the various operations in the engine room and the entire ship. So,
engine crewmembers need to take this into account and understand & respond with a・Failure to engage compressed air
・Insufﬁcient or ineffective maintenance of control systems(electronic and pneumatic)

Loss ofPropulsion

ship review power supply system maintenance planning and an emergency response

recovery procedure.
It is necessary to work on an emergency response and recovery operation together with・Loss of control air pressure

the cooperation of the entire team on board: not only the engine department alone but

・Loss of Lubricating Oil

also the deck department, the cargo department, the passenger department, the catering
department, and so on. See Figure 3-10 “ Recovery flowchart for loss of power (Blackout)

・Failure of Automatic
Voltage Regulators

・Loss of exciter voltage due
to failure of diodes (rectiﬁers)

・Load share problems

・Lack of Fuel Oil (starvation)・Contamination or poor
quality of Fuel Oil
・Generator Switchboard
Selector Switch not set to“Auto” start position
・Poor condition of Batteries(Diesel Engine Plant System)”.
In particular, close information sharing is required between the deck department andthe engine department that is directly involved in the ship manoeuvring operation. The
crewmembers need to understand that the procedure will differ depending on eachpower supply pattern, such as (a) successful start of diesel generator, (b) successful startof emergency generator only, and (c) only battery.
Furthermore, it is necessary to take action appropriately in accordance with theprocedures specified in the SMS (Safety Management System).

Alternator Failure

Electric Power
SystemFailure of Emergency
Generator

Electric Power
SystemFigure 3-9 Overview of loss of propulsion and power: Fishbone analysis

As can be seen above, engine crewmembers need to manage the fuel oil, lubricating
oil, cooling water, intake air/scavenging air, control devices, power supply devices,
power sources, and so on, in order to maintain main engine propulsion. Furthermore,

42

43

P&I Loss Prevention BulletinJAPAN P& I CLUB

Deck Dept.

Loss of power(blackout)

Take appropriate action to prevent manoeuvringrisk (to ensure safety): Collision/Stranding/Damage to Harbor Facilities and Fishing Facilities

Cargo Dept.

Take appropriate action to protect against cargo damage

Pssenger Dept.

Maintain Passenger Safety

Cater. Dept.

Food Service at an allotted time/manage provisions

Engine Dept.

Recover loss of propulsion and power

Furthermore, it is also important that the crewmembers properly utilize thechecklist, and confirm everything on it using the pointing and calling method toprevent the overlooking of a work procedure. Please refer to “Reference Material
06: Emergency response checklist immediately after loss of propulsion and lossof power” (Page 125).
Please confirm your department’s appropriate response.

Reporting of situation report
to Parties concerned

D/G
Initial Start

E/G
Initial Start

Start machinery “Auto sequence”.
or “Manual sequence” dependingon the situation.

Electriic supply only from ESB.
Start steering gear and Radar.

Change M/E manoeuvring position"W/H->ECR" & M/E manoeuvring
handle "Stop" position.
Start turning "Steam turbine
generators (Other steam driven
devices).

Recover and maintain various
operating orders andconditions step by step.

Battery electric power suppy

Set M/E manoeuvring
position "W/H->ECR" &M/E manoeuvring handle"Stop"position.

Set M/E manoeuvring position"W/H->ECR" & M/E manoeuvring
handle "Stop" position.

Start turning "Steam turbine
generators (Other steam
driven machinery).

Start turning "Steam turbine
generators (Other steam
driven devices).

Investigate start fail of DG& troubleshoot the causes.

D/G
Re-start
Feedback Power

Start Auxiliary Machinery
manually.

・authorities,
・salvage, so on

Investigate start fail of DG& troubleshoot the causes.

Restart "Firing FO burner" mainboiler and steam it up.
Reset "M/E" control system &Restart M/E.

Both onboard and those externally:・ship management company,
・insurance company,

D/G
Re-start<Feedback Power >If possible, supply “Feedback Power”
from ESB to MSB so as to start auxiliarymachinery manually. (Turn off all NFB of
GSP under MSB to avoid “Auto sequence”
start before feedback.)

1

RecoveryR ecovery work in the Deck department= Control action for voyage risk (collision, stranding, etc.)

The first action of manoeuvring in the wheelhouse isto grasp the circumstances surrounding the ship and to
appropriately take collision avoidance actions. The next
thing the officer on watch needs to do is to issue safety
notifications to surrounding areas by VHF and report thesituation to the Maritime Safety Authority and the company. Furthermore, in the caseof loss of propulsion and loss of power in coastal waters, it is necessary to consider
dropping an emergency anchor as appropriate.

  

Investigate start fail of EG& troubleshoot the causes.
E/G Re-start

Secure Boiler

Abbrebiations
M/E: Main Engine D/G: Deisel Generator E/G: Emergency Generator MSB: Main Switch Board
ESB: Emergency Switch Board W/H: Wheel House ECR: Engine Control Room FO: Fuel Oil Dept.: Department
NFB: No Fuse Breaker ◎: Yes ×: No  Photograph 3-11 Chain stopper

Figure 3-10 Recovery flowchart for loss of power (Blackout) (Diesel Engine Plant System)

44

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P&I Loss Prevention Bulletin
In particular, there are set precautions that need to be taken regarding emergency
anchoring. Normally, the anchor chain is stopped using the windlass brake. The anchor
must always be securely held by the force of the brake, and a gap between the chain
stopper and the anchor chain must be provided, so that the chain stopper and the anchor
chain do not come into contact, as shown in Photograph 3-11. If the anchor chain slips
and comes into contact with the stopper, the stopper cannot be removed. In case of lossof power, the ship will not be able to operate the windlass and hence be unable to drop
an emergency anchor.
Therefore, the chief officer and technical superintendent must observe and inspect the
gap as mentioned above as an important item to be confirmed for Chief Officer’s ondeck rounds and the Superintendent’s ship visit.

2

Recovery work in the Engine department

1) Report to the Master
The Chief Engineer should precisely identify the power supply source at that time fromand distribution destination as shown in Table 3-12 “Recovery procedures for engine
department (Diesel engine plant system)”, and report this so that the Master can get acomplete picture of the current situation, when first reporting the loss of power to theship and the company.
Furthermore, it is easy to clarify and understand the relationship between the power
supply source and the power supply destination using the “Schematic diagram of thepower supply system,” as shown in Figure 3-13 as a supportive aid.

JAPAN P& I CLUB
Recovery procedures for the engine department(1) Report power supply source and its destination①D iesel generator:
Nautical instruments, communication equipment, lighting, Main engine(high power device), auxiliary machinery (boiler), fire pump, etc.
②E
 mergency generator:
Nautical instruments, lighting, emergency fire pumps, etc.
③B
 attery only:
DC 24V control system power source, radio communication devices, etc.

(2) Recovery work
① Initial response:
Keep calm, check the current situation, share information with Wheel
House.
②S
 econd:Pay attention to heated steam drain returning to the drain tank.
③S equentially:
Work on fixing the causes and restart the engine plant systemsimultaneously.
1) C hange the manoeuvring position "W/H->ECR" of the main engine's
remote control system, and set the maneuvering handle to the "Stop"
position.
2) S tart turning steam turbine driven machinery such as steam turbine
generators if necessary.
3) C onfirm that the emergency generator started and that ACB closed
automatically.
4) C onfirm the direct cause.
Check whether each ACB can close in order to restart the generators.
5) A utomatically or manually start the standby generator and close its ACB.
Alternatively, restart the generator that was running and re-close ACB.
6) P ay attention to the electric load. Start important auxiliary machinery with
"Auto sequence," or "Manual sequence "depending on the situation.
7) S tart up other auxiliary machinery.
8) R estart the main engine and check that each operation is fully functional
step by step.
9) Investigate the root cause and establish preventive countermeasures.

Table 3-12 Recovery procedures for engine department (Diesel engine plant system)

46

47

P&I Loss Prevention BulletinJAPAN P& I CLUB〈 Schematic diagram of power supply system 〉
#1 DG

#2 DG

#3 DG

#4 DG

G

G

G

G

Figure 3-14 shows the recovery work cycle. Recovery work in the engine department
consists of repeating the following: “investigating causes in the engine room”,“establishing common understanding and recognition of the situation”, “repairing

ACB

ACB

ACB

damage”, “trialing a test run for restart”, “understanding the stoppage/failure”, and“investigating causes”. If the recovery work is deemed to take a long time, from theACB

perspective of fatigue, the Chief Engineer may need to consider shifting from an all-out
staffing arrangement to the mobilization of a split work rotation with a second shift or a

MSB 440V

MSB
NC

EG

〈 Recovery work cycle 〉
440V/110V

440V/110V

G

440V

ACB

GSP

third shift and arrange for shore support if necessary.

Establish common understanding
and recognition of the situation
GSP

Report progress/ request support

Investigate causes
DB

DB
M

M

ESB

M

FP

GSP
Each most important
auxiliary machines

Abbreviations
DG: Diesel Generator
EG: Emergency Generator
ACB: Air Circuit Breaker
MSB: Main Switch Board
ESB: Emergency Switch Board
GSP: Group Starter Panel
DB: Distribution Board
FP: Feeder Panel
NC: Normally Closed (Connected)
M: Motor-driven Auxiliary Machinery
G: Alternator

440V/110V

Each general device

FP

M

M

DC 24V system(Control System Power
Source & Emergency Lighting)

Each general device

110V/24V

Stoppage / Failure
BatteryFP
Each most importantdeviceThe most important device and auxiliarymachines that feed from emergency
generators
Lighting, steering gear, emergency ﬁre pump,navigation equipment (gyro compass, radarand others), battery charger, so on.

Figure 3-13 Schematic diagram of power supply system

・Clarify recovery target
・Allot roles

M

Recovery damage

Trial test run for restart

Recovery / SuccessFigure 3-14 Recovery work cycle2) Precautions for recovery work
Regarding “②Second” in “(2) Recovery work” shown in Table 3-12, even if the boiler
or pump is stopped due to loss of power, the liquid (steam) may flow downstream (lowpressure) due to its physical properties. Therefore please pay close attention to the water48

49

P&I Loss Prevention BulletinJAPAN P& I CLUBlevel and temperature in the atmospheric drain tank.
Regarding the recovery response pattern, in Figure “3-10 Recovery flowchart for lossof power (Blackout) (Diesel Engine Plant System)”, “blue” represents the successful
start of the diesel generator, “yellow” is the successful start of the emergency generator
only, and “red” is battery only. The recovery procedure differs depending on thecircumstances of each power supply source.
Especially when it takes a considerable amount of time to restart the diesel generator, if
the ship is equipped with a switching system that allows feedback power supply fromthe emergency generator to the main switchboard, the ship may take advantage of it.
However, caution must be exercised when using the feedback power supply, if engine
crewmembers do not have such dry docking experience, they will be unfamiliar withthe operation of switching from the emergency switchboard to the main switchboard
using the feedback power supply, which may lead to an insufficient emergency response.
Therefore, it is recommended that the engine department carry out onboard training of
the feedback power supply system when time permits, along with opportunities suchEngine System(1) Engine failure① Diesel Generator(a) Fuel issue
・Blocked strainer
・Blocked fuel oil supply systembecause of Vapor Lock(b) Overspeed trip
・Malfunction of speed sensor(c) Trip due to Loss of Lubricating
Oil Pressure
・Blocked strainer
・Malfunction of a Pressure switch(d) Trip due to Overtemperature of
Cooling fresh water
・Malfunction of a Temperature control
valve or a thermocouple sensor② Steam turbine generator(a) Excessive shaft vibration,
movement of shaft position,
High exhaust pressure, Overspeed,
Loss of Lubricating Oil Pressure, etc.

as any drills necessary for an emergency response and start-up test/load test run of theElectric Power System(2) Electrical failure① Air Circuit Breaker(ACB: Circuit breaker between
generator and bus)
・Over current
・Under voltage
・Reverse power trip・Mechanical defect② Switchboard bus
・Voltage: Over or under・Frequency: Over or under③ Control power supply
・Voltage drop・Fuse blown, etc.

Past Cases(3) Check and study "Analysis and Lessons
learned" of past accident cases
encountered.

Table 3-15 Possible loss of power causes

emergency generator.

3) Elimination of causes
Table 3-15 shows the typical causes behind the failure of an engine system and electrical
power system. Past cases from the current ship and from other similar ships will be
indispensable in investigating any future cause and help build countermeasures. Engine
department crewmembers must utilize such information to promptly establish theabnormality and eliminate causes during the recovery process.

504) Daily operation management as preventive measures
The Chief Engineer needs to encourage crewmembers in the engine department to carryout the management of preventive measures on a daily basis, as shown in Table 3-16, inorder to ensure safe and secure operation management.
In particular, it is recommended that crewmembers satisfy the following minimum
requirements.
① With reference to the countermeasures of cleaning a strainer in Accident 5 shownin Table: Reference 11 “Reference Material 05: The investigation reports of the Japan
Transport Safety Board; cases of loss of power”, crewmembers must never carryout maintenance of equipment on a fuel oil supply pipeline during manoeuvring
standby station.

51

P&I Loss Prevention Bulletin② Engine crewmembers must secure adequate electrical capacity available before
starting large electric motors such as bow thrusters.

This is because the starting current of electric motors may be several times the fullamount of an “on load” current.
Furthermore, regarding engine operation management and emergency generator

JAPAN P& I CLUB
(2) Sharing of power load and related training
All watchkeeping engineers must have training in manually operating load
share, putting generators on board, and taking generators off board.
(3) Engine operation management① All
 engineers must be fully familiar with all engine room systems andtheir pipelines.

management, assuming that the standby generating machinery cannot be started, the・They must know how to isolate one cylinder of the main engine when it

engine department must regularly carry out a start-up test/load test run of the standby

fails so that the main engine can at least continue running until repair

diesel generators and emergency generator.

has been completed.
・They must know all operation methods of the Main engine plant system.

Daily operation management for preventive measures(1) During manoeuvring operation on standby①E ngine crewmembers must not carry out cleaning and maintenance ofstrainers or fuel supply systems.
②T he watchkeeping engineers must monitor the starting air pressure.

preventive measures.
・Fuel pressure control valve condition, a clogging strainer, damage tofuel supply piping, a lack of cooling water supply, etc.
③E
 ngine department must regularly carry out a start-up test/load test

The deck department's bridge team must know the limitations of

run of the standby diesel generators under the following conditions.

starting air availability and operate the main engine appropriately. (12・Weekly start-up test runs: prior to port arrival and narrow channel

times for Single screw ships: Class Rule ).
③E
 ngine crewmembers must switch power supply from shaft generators
to Diesel generators well before entering restricted waters and wellbefore initiating a critical manoeuvring operation. They must follow the
manufacturer's guidelines.
④T he ship must test the astern operation of the main engine prior toboarding of pilot and before approaching berth.
⑤E ngine crewmembers must establish that there is sufficient electrical
capacity available before starting up the lateral thrusters, mooringmachinery, or other heavy load equipment. They must pay special
attention to the simultaneous starting of large electric motors that willlead to a large power surge and risk of overload.
⑥T he ship must test the lateral thrusters and mooring machinery well inadvance of entering restricted waters and starting critical manoeuvring
operations.
⑦T he ship runs two (or more) generators in parallel because Engine

52②E
 ngine crewmembers must know the cause of power loss and takeentry.
・Load test: supply heavy fuel oil, and regular loads, for 30 minutes.
(4) Planned Maintenance System (PMS)① The ship carries out repair/inspection/maintenance regularly.
(5) Fuel oil management①E ngine crewmembers must strictly ensure that the fuel oil viscosity andtemperature control devices work accurately.
②T hey must drain water regularly from fuel oil tanks because they must
prevent water build-up and carryover in the fuel and lower the risk ofbacterial contamination/microbial infestation.
(6) Emergency response①E ngine Department must make manuals/procedures/checklists/work
instructions for emergency responses such as "standby machinery
failing to start".
・Engine Department must regularly conduct "Loss of Propulsion" andcrewmembers must ensure sufficient power availability even if one of"Loss of Power" drills by carrying out simulations of the situations onthem stops or trips.

board.

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P&I Loss Prevention BulletinJAPAN P& I CLUB・Additionally, they need to study and include them in the procedure

3-4 Summary

for supplying power via the feedback method from the emergency
switchboard to the main switchboard.
(7) Emergency generator management①E ngine Crewmembers must disconnect the battery charger from themains when carrying out weekly tests for emergency generator with a

According to the accident investigation report of the Maritime Safety Authorities, thefollowing points of caution are often introduced because accidents, such as loss of
propulsion and loss of power, have occurred in the world.

battery charger.
②E
 ngine department must also regularly carry out start-up tests/load test
runs on the emergency generator under the following conditions.
・Start-up test run: weekly.
・Load test: supplying on load as close to the maximum capacity as
possible, for 30 minutes.
・The Marine Safety Agency of the UK recommends weekly tests in the
Marine Guidance Note (MGN) 52, 1998.
(8) Others and incident investigations①P
 roperly trained personnel must investigate any loss of propulsion orloss of power and determine the root cause.

(1) What daily operation management of preventive measures are
required onboard?
(2) H ow effective is the sharing of information and collaboration
among related parties when a recovery operation is to be carriedout together as one team on board, following the occurrence ofan accident?
(3) How should the engine department establish causes, eliminate
them, and work on recovery procedures, taking into account otherdepartments’ work?

②A fter analysing the incident and specifying the countermeasures, theship must work on them effectively by comprehensively evaluating andprioritizing depending on their level of importance.
Table 3-16 Daily operation management for preventive measures

While these may be understood in theory, in practice it is difficult for many to take
immediate action appropriately right after a marine casualty has occurred.
Therefore, parties concerned need to prepare measures on a regular basis that deal withboth the soft aspects and hard aspects of engine room management in preparation for
an actual situation. It is recommended that crewmembers properly prepare and repeat
practical training onboard. Please refer to “Reference Material 07: How to prevent
panic” (Page 127).

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P&I Loss Prevention Bulletin

Chapter

4JAPAN P& I CLUB

Prepare for Bunker Trouble(Engine accident due to poor fueloil quality)

When engine troubles occur due to the properties of fuel oil, the causal relationshipbetween the cause and the result becomes a moot point when it comes to claims. The

HFO separator damaged gear due tooverload caused by heavy sludge
HFO separator after one hour of operation: blocked by heavy, hard sludge

ship summarizes the facts recognized as phenomena related to troubles in chronologicalorder and prepares a statement of facts. Its purpose is to explain the situation
surrounding the trouble and where the problems lie to relevant parties such as charterers.
Furthermore, the ship also needs to thoroughly collect supporting documentation
simultaneously.
For continued safe operation, it is essential to secure fuel oil of stable quality. However,Fuel injection pump :the plunger was found completely seized in the barrel

Fuel booster plunger stuck in the barrel

Photograph 4-1 (a) An INTERTANKO Critical Review（An INTERTANKO Critical Review）

the ship sometimes faces bunker trouble (engine accidents caused by bunkering fuel

HFO separator :completely blocked by heavy, hard sludgeoil). Therefore, in order to take precautions against bunker trouble, it is also necessary
to reconfirm the preventive measures that engine crew members must adhere to daily
and be well versed in methods for preserving evidence, a must when it comes to bunker
trouble.
Sludge particles

4-1 Importance of preserving evidence intime of bunker trouble
In 2018, hundreds of accidents related to severe technical problems and mechanicaldamage on ships due to contaminated fuel oils delivered in the Houston (USA) area andCaribbean ports such as Panama occurred.
Fuel ﬁlter: visible heavy sludge,
which blocked the ﬁlter completely
Photograph 4-1 (b) An INTERTANKO Critical Review（An INTERTANKO Critical Review）

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P&I Loss Prevention BulletinJAPAN P& I CLUBThe statement that the international association of independent tanker ownersa) The poor handling of damaged parts and extracted fuel oil/sludge etc.

(INTERTANKO) issued concerning issues that the industry needs to be aware ofb) The disposal of a piece of important evidence in error.

includes Photographs 4-1 (a) and (b).

c) To put off reporting on the facts surrounding bunker trouble until later.

Typical situations related to engine accidents are as follows.

As a result, this only increases the risk of evidence getting misplaced or lost.

① The fuel injection pump’s plunger was seized due to chemical contaminants,
which made the main engine and generator inoperable.

③ There have been many cases whereby evidence on board has been misplaced or
lost. (Engine crewmembers are likely to discard sludge and replaced parts during
onboard work.)
When engine crewmembers concentrate on their daily onboard② The oil purifier became blocked due to the accumulation of a large amountof sludge, thus becoming inoperable.

work, they are prone to forget many record-keeping tasks. As
Pointa countermeasure, if they become accustomed to recording,including date and time, work details, confirmation, and repair/

When an engine accident occurs on board, engine crewmembers rush to respond to theinspection/maintenance, they can safeguard themselves.

recovery on site. So evidence of bunker trouble is prone to being misplaced or even lost.
However, it is difficult to establish a causal relationship if there is insufficient evidence
in the subsequent stakeholder dispute. Focusing on the seriousness of the accident, Law
Offices of Toda & Co. (experts in various shipping cases) proposed the following issues
and countermeasures to legally resolve an engine accident caused by bunkering fuel oil.

1.Issues:① W hen the ship (shipowner) disputes the claim

2.Countermeasures:① To be able to take appropriate measures (following “3.Guidelines for thepreservation of evidence:”) in the event of an accident, the ship managementcompany must provide regular guidance to engine crewmembers based on theimportance of preserving evidence.
Point

Repeated “training”.

caused by poor quality bunkering fuel oil, thebackground of repair/inspection/maintenance,machinery operation, defective design, andso on is also an issue to be disputed. Since itis difficult to establish a causal relationship,
the timing of fuel oil switching, the history ofabnormal occurrence, and the preservation of evidence are extremely important.

② W hen there is a problem reported from a ship, the ship management company
must promptly contact the charterer to cooperate with protesting against the fueloil supplier.
Point

Based on the designated response flow, parties perform “Report,
Inform, and Consult”.

② O n the other hand, unfortunately, in quite a few cases, engine crewmembers
always give the highest priority to inspection/repair/maintenance work on board,
so they are prone to overlook the following:
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P&I Loss Prevention BulletinJAPAN P& I CLUB
3.Guidelines for the preservation of evidence:
Table 4-3 shows the steps for countermeasures in order to preserve evidence.
Procedure for preservation of evidence（1）Preservation of evidence to be carried out by ship/ship managementcompany (owner)①E
 ngine crewmembers must precisely recordand retain Tank Sounding Records, the Oil
Record Book, and the Engine Log Book in casethe ship needs to ascertain if/when it started
using suspect bunker oil.

Photograph 4-2(a) Bunkering work: Sounding tank level②E ngine crewmembers must take photographsof unusual sludge with Date/Time taken, andsecurely retain them.
③E
 ngine crewmembers must take photographsof damaged parts with Date/Time taken, andsecurely retain them.
④E
 ngine crewmembers must report in detail on
Engine trouble and the sequence of events that
led to it.
T hey must also report any trouble and how it
was handled to the ship management company.
This goes especially for HFO.
⑤T he owner/ship management company must
prepare the Crewmembers’Statement（Thismust include succinct details about theprocess leading up to the use of suspectbunker oil, damage status, and how to respondto trouble.)

Photograph 4-2(b) Bunkering work: Calculating tank volume

60⑥E
 ngine crewmembers and ship managementcompany must check the accuracy of therecords of the Bunker Delivery Note (BDN)
every time( to especially, check the serial number ofsample bottles and the remarks.
S ome supply barges try to avoid taking a
bunker sample at the vessel’s manifold.)・Remarks must include the following

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P&I Loss Prevention Bulletin
information:
・Where to take samples: from manifold?
・How to take samples: by way of continuous drips?
・How to witness sampling: attend bunker delivery?
※ 1 If there are inaccuracies or a lack of information in the BDN, correct it
and record the remarks into the BDN.
In case the crewmembers fail to correct the records in the BDN, please
immediately prepare the crewmembers’statement for future reference.
※ 2 In case of inconsistency between the serial number of the sample bottle
and the record in the BDN, the sample’s testing result may not be
trusted or ruled out due to it not being representative. In such a case,collect/keep the materials to prove that it is representative, such as
Landing Pass, Fuel Information Sheet of the bottle, Fuel analysis report,
etc.
⑦E ngine crewmembers are to safely retain the sample bottle after having
taken a sample of bunker.
T hey must also take/safely retain a sample bottle of suspect bunker oil in
the fuel tank before de-bunkering operation.
（Please pay attention not to take a biased sample when taking thesample.）JAPAN P& I CLUBout jointly by an independent and neutral laboratory with theattendance of surveyors appointed by multiple parties.
(b) P lease arrange a joint survey for the testing.
(c) B efore testing, please inform the parties, including Suppliers of thedetailed information.
(Regarding the collection of the damaged parts, sludge, and the debunkered oil, it is desirable to appoint each party’s surveyor toattend.)（3）Preservation of evidence to be carried out by the charterer⑨T he owner (ship management company) needs the Charterer's fullcooperation and support to immediately collect information relating to
the Supply chain (Who is the seller of the physical supplier? Who is therefinery?, etc.) of suspect bunker oil.
*3 S
 ince it is difficult for the ship management company（owner) to
pursue the supply chain where the real fuel supplier procured thefuel oil from, we recommend the ship management company（owner)
ask of the Charterer's investigative cooperation to enable early
settlement.
Table 4-3 Procedure for preservation of evidence（2）Preservation of evidence to be carried out by the owner (shipmanagement company) and charterer⑤T he owner/ship management company must
prepare the Crewmembers’Statement as an
official document. (same as above (1) ⑤ )4-2 Summary（This must include succinct details about theprocess leading up to the use of suspectbunker oil, damage status, and how to
respond to trouble.)

Fuel oil is supplied from the charterer to the owner (the ship) under the charter party.

⑧T he owner (ship management company) andcharterer must consider carrying out detailed
testing such as GC-MS analysis as soon as
possible. (CG-MS: Gas ChromatographyMass Spectrometry)(If necessary, they may consider ametallurgical analysis, too.)safety of the ship or that which adversely affects the performance of the machinery”,

Safe navigation will always be guided by mutual trust which must be kept under thepromise of “Quality of Fuel Oil: the fuel oil shall not include that which jeopardizes theRegulation 18 of Annex VI of “The International Convention for the Prevention of
Pollution from Ships (IMO MARPOL)”.

(a) T he detailed testing shall be carried

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P&I Loss Prevention BulletinJAPAN P& I CLUB

Example of records related to safety management
and repair/inspection/maintenance（1）Entries in Engine Log Book, and record books, etc.
（2）Maintenance of documents and files in accordance with the SMS manual

Chapter

5 2020 IMO compliant fuel oil（3）Storage of replaced damaged parts as evidence（4）Monitoring records of machinery status related to running hours（5）R ecords of damaged machinery, operating and running history,
lubricant management history, planned maintenance system (PMS)
documents, and inspection/repair/maintenance records

In order to prevent any adverse effects on human health and air pollution caused by ship
exhaust gas, worldwide controls were put in place to reduce the emission of Sulphur（6）Ship-shore communication records (FAX, e-mail, etc.) about onboard
work management concerns

Oxides (SOx) and Particulate Matter (PM) from ships in accordance with Regulation14,（7）Memorandums of onboard discussions between the ship (Master &Chief Engineer) and the shoreside (person in charge at the company)(IMO MARPOL)”.

Table 4-4

Annex VI of the “International Convention for the Prevention of Pollution from Ships
Since January 1st, 2020, sulphur concentrations of any fuel oil used onboard have been
curtailed from 3.50% m/m to the current requirement of 0.50% m/m in open sea areas
outside Emission Control Areas (ECAs).

On the other hand, it is difficult for insurance companies to confirm the accident’s

This chapter explains the precautions that crew members need to be aware of when

history and details even if insurance companies try to handle the claim unless records

handling low sulphur compliant fuel oil with a 0.5% m/m sulphur limit.

such as the repair/inspection/maintenance shown in Table 4-4 are retained on the ship.
Please understand that the daily onboard work records are always important pieces ofMarine sulphur Emission Control Areas

evidence or records.

International Marine Organization Emission Control Areas
European Union Sulfur Directive

Chinese Emission Control Areas

Figure 5-1 Marine sulphur Emission Control Areas

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P&I Loss Prevention Bulletin
Jul,2010

Open Sea Area

JAPAN P& I CLUBGlobal sulphur content limit of 0.50% set
by MEPC 70 (under remit of IMO) in October, 2016.
Jan, 2012

4.5%

Jan,2015

Jan,2020

3.5% (HSHFO)

0.5%(Low Sulphur Fuel Oil)

Designated Emission
Control Areas (ECA)
Abbreviations

1.0％ (MGO)

0.1％ (ULSFO)

HSHFO: High Sulphur Heavy Fuel Oil, MGO: Marine Gas Oil, ULSFO: Ultra-Low Sulphur Fuel Oil

Figure 5-2 Timeline of sulphur emission restrictions, prescribed under Annex VI of the MARPOL Convention(under remit of IMO)

Unit (ADU) to distill it into light fractions. The residual oil then goes through a Vacuum
Distillation Unit (VDU) under vacuum (31-38 kPa) and is fractionated into a lightfraction (350°C to 550°C at equivalent atmospheric pressure) and a heavy fraction (550°C
or higher at equivalent atmospheric pressure).
The light fraction sulphur content is reduced through an Indirect Desulphurization Unit,
and then desulphurized Vacuum Gas Oils (VGO) are converted through a Fluid Catalytic
Cracking Unit (FCCU) into higher-value gasoline and middle distillates such as lightcycle oil (LCO) and clarified oil (CLO).

《Blending process of compliant fuel oil》

Compliant Fuel Oil with Sox regulation from 2020”, at its
technical seminar held in June 2019.
This document is an amalgamation of material and guidelines
mainly taken from this seminar, and additional referencematerial taken from a variety of other technical documentsfrom the marine shipping industry.

Diesel fraction
Vacuum Light Distillate（VGO）
Desulphurized VGO

Fluid catalytic
cracking unit
（FCC)

LCO

CLO

Blending“March 2019, ClassNK Guidance for onboard use of

Kerosene fraction

Indirect
Desulphurization
unit

about IMO 2020 compliant fuel oil in its publication the

Crude oilDirectDesulphurization
unit

Nippon Kaiji Kyokai (ClassNK) summarized the concerns

Gasoline fraction

Vacuum Distillation Unit

5-1 IMO 2020 compliant fuel oil concerns

Atmospheric Distillation Unit

For consistent supply and cost effectiveness, residual oil with a sulphur content of 0.50%
or less is commonplace.

Vacuum Heavy Distillate

VGO：Blendstock with good ignition quality, not directly blended with bunker heavy oil,and used as a raw oil for cracking unit (VGO：Vacuum Gas Oil)

5-1-1 Production of marine fuel oils
Figure 5-3 shows the manufacturing process at a typical petroleum refinery, and the

LCO (Light Cycle oil)sulphur blendstock, low kinematic viscosity
CLO (Clariﬁed Oil) ：Low
Figure 5-3 Manufacturing process at a typical petroleum refinery

blending process required to produce marine fuel oils.
Crude oil is heated to 350°C or below and passed through an Atmospheric Distillation
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P&I Loss Prevention BulletinJAPAN P& I CLUB

According to current oil refinery technology, there are said to be five production

Figure 5-4 shows sulphur content by crude oil production area. Low sulphur oil is

methods of compliant fuel oil:essential as a blendstock for compliant fuel oil. Due to financial considerations, it is①

Blending of various low-sulphur blendstocks which have been produced at therefinery,

not possible to supply a sufficient amount of compliant fuel oil using only distillate oil②

Desulphurization of residual oil from high sulphur crude oil,③

Blending of light oil and high-sulphur heavy oil(e.g., crude oil from the Gulf of Mexico, see Figure 5-4),

limit, it is necessary to blend various blendstocks together. This leads to an increase of④

Use of MGO ( Marine Gas Oil, lighter distillate oil) or MDO (Marine Diesel Oil, blend of
distillates and heavy oil but with very low content)

fuel oils for open sea areas outside ECAs (HSHFO: High Sulphur Heavy Fuel Oil with⑤

Use of low-sulphur crude oil residue (e.g., crude oil from the North Sea oilfields, see
Figure 5-4).

and desulphurised residual oil. The above mentioned production method ① is the mostpromising way to secure a stable supply of compliant fuel oil.
In order to keep the sulphur content of compliant fuel below the new 0.50% sulphur
various fuel oil properties other than sulphur content when compared to conventionalsulphur content of less than 3.5%).
 se various low-sulphur blendstocks other than light distillate oils which①U
have been obtained by repeatedly refining, distilling, fractionating, andcracking from crude oil.
 ince crude oil properties vary depending on the region of production②S(see Figure 5-4) and each refinery's capabilities, the ratio of blendstocks incompliant fuel oil may vary widely from region to region when compared toconventional fuel oil.

５－２ Precautions and countermeasures for safe
usage of 2020 IMO compliant fuel oil
Safe use of VLSFO requires an essential understanding of the various properties foundin blendstocks (‘VLSFO’ Very Low Sulphur Fuel Oil: fuel oil compliant with 0.50%
sulphur limit required in open sea areas outside of ECAs. It is further sub-classified
into VLSFO-RM (Residual Marine Fuels) and VLSFO-DM (Distillate Marine Fuels)
depending on the production process. Hereinafter, the compliant VLSFO-RM is referredFigure 5-4 Density and sulphur contentof selected crude oils

68

to as VLSFO)

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P&I Loss Prevention BulletinJAPAN P& I CLUB

Safe use of VLSFO requires essential awareness of the following 5 properties:① Compatibility② Low viscosity

5-2-1 ① Compatibility
When two different fuel oils are mixed, the stability of that fuel will decline, and③ Cold flow properties

asphaltene sludge and/or other substances contained in either of the original fuel oils

④ Cat-fines

may deposit/precipitate. The capacity of fuel oil to resist this deposition/precipitation is⑤ Ignition and combustion quality

generally referred to as fuel compatibility.

Using the points outlined in ‘Problems of conventional High-Sulphur Heavy Fuel Oil

Dispersed and diffused in whole(HSHFO) and Distillate Marine Fuels (MDO: marine diesel oil & MGO: marine gas
oil’, and based on previous experience and knowledge of fuel oil properties, this chapter
aims to identify the various ‘precautions’ and ‘countermeasures’ required for each
property. Please also refer to “Loss Prevention Bulletin Vol.30, Bunkers – Quantity andQuality Disputes” to review fuel quality fundamentals.

Deposition / precipitation
sinking to the bottom

Asphaltene micelle

Photograph 5-6 Deposition/precipitation
Photograph: ClassNK GuidanceAsphaltene (highest C/H ratio)

Resin (C/H ratio decreases
the further it is locatedfrom the centre)
C/H ratio is equivalent
to maltene
Continuous phase (Maltene)

Depositing and precipitating Sludge
Asphaltene in heavy fuel oil forms stable micelle structures in maltene, as shown in
Figure 5-5. They are dispersed and remain in a suspended state (colloidal) and do not
deposit/precipitate.
However, when the fuel is mixed with other fuel oils, or undergoes thermal shock orwhen the fuel is oxidized, the micelle structure becomes unstable and the colloidal stateis lost. Asphaltene will then start to aggregate, and its particles grow in size. It is finallydeposited/precipitated as asphaltene sludge (See Photograph 5-6).
Generally, when a fuel containing a large amount of aromatic hydrocarbon is mixed with

Figure 5-5

Structure of asphaltene micelleanother fuel containing a large amount of paraffinic hydrocarbon, maltene containing theasphaltene reaches a point of discontinuity and asphaltene begins to aggregate.

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P&I Loss Prevention BulletinJAPAN P& I CLUBP
 otential issues and countermeasures for machinery/plant systems affectedby fuel oil sludge
Table 5-7 shows a summary of compatibility issues and countermeasures.

Machinery/plant system issues in the engine room
Please see the Fuel oil piping system (1) in Figure 5-8 and sludge depositionand precipitation in Photographs 5-9 and 10.
1Countermeasures
The following countermeasures are required:Caution：Do not mix fuel oil in the hull storage tank or pipeline, or at the very
least keep the mixing ratio as low as possible.
1①D
 o not change oil in areas of high operational risk such as congested
sea areas.
②K eep the duration of fuel oil mixing to a minimum. Change fuel oil after
a calculated estimation of fuel consumption in the main engine.

A sphaltene sludge deposition clogs pipes and prevents the transferalof fuel oil.
Reason: F uel oils are a mixture of different compositions and this leads todeposition of asphaltene in the following areas:① In the hull storage tank when bunkering.

2① Add sludge dispersants or solubilizers to the hull storage tanks.
② Clean strainers frequently.
③R egarding oil purifier operating management, reduce the flow rate ofoil purifiers, shorten interval of sludge discharge, raise oil treatment
temperature, and reduce overhaul interval of the separating disc for
inspections and maintenance.

the crew switch fuel oil used for onboard machinery to acompatible oil.
L ow fuel oil supply, or in the worst case scenario, main engine shut
down (loss of propulsion), or generator shut down (loss of power)
Reason: T he strainer on the fuel oil supply pipeline clogs with sludge inthe following situations:①W hen asphaltene sludge deposition generated in the hull tankis transferred.
② When fuel oils of different composition are mixed in the piping.
3D uring the discharge of sludge, the oil purifier may be damaged orT he following measures should be adopted in the event of sludge
accumulation:② In either the settling tank/service tank or piping when2T he following measures should be adopted to avoid any adverse effecton shipping operations:

3In case of emergency, it is advisable to keep a reserve stock of sludge
dispersant on board.

Table 5-7 Compatibility issues and countermeasuresabnormal vibrations may occur in the case of any imbalance in the
purifier's rotation unit.
Reason: A ccumulation of sludge on the separating disc in the rotatingbowl of the oil purifier which may occur in the following situation:
When filters in the fuel oil supply pipeline become clogged,
sludge spreads throughout the entire fuel oil supply system. At
the same time, asphaltene sludge deposition increases in the oil
purifier.

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P&I Loss Prevention Bulletin
Bunker barge

JAPAN P& I CLUB

① Sludge precipitation on residual"X: Conventional HSHFO (Aromatic)" when topping
up with "C: Compliant Fuel oil (Parafﬁnic)"③ Accumulation of sludge

P

BunkerFuel oil
puriﬁersystemHeaterOil puriﬁer
supply pump

Oil Puriﬁer

Settling Tank

Service Tank

Hull storage tank
C: Compliant Fuel oil(Parafﬁnic)

Fuel oiltransfer system

Sludge precipitation
X: Conventional HSHFO (Aromatic)② Clogging with sludge

SludgePhotograph: ClassNK Guidance

5-2-2 ② Low viscosity

Fuel oil
Deaeration
Chamber

Switchingfuel oil

Courtesy of 提供
NipponKaiji Kentei Kyokai：日本海事検定協会

Photograph 5-10 Sludge deposition and precipitation in fuel oil filters

Fuel oil supply
systemHull storage tank

A: Compliant Fuel oil(Aromatic)

Source:Guide for use of 2020 SOx regulation
2020年Sox規制適合舶用燃料使用手引書
compliantfuel oils（国土交通省海事局）(Maritime Bureau of the Ministry of Land,
Infrastructure, Transport and Tourism)

P

Transfer Pump

In order to produce VLSFO compliant fuel oil with a sulphur content of 0.50% or less,Main Engine/
Diesel Generator

HeaterHull storage tankP

P

Circulating
pumpSupplypump

B: Compliant Fuel oil(Parafﬁnic)

the blending ratio of the following low sulphur blendstocks will rise above that ofconventional fuel oil (HSHFO):(1) D esulphurized Vacuum Gas Oils (vacuum residue which① Sludge precipitation when switchingfrom "A: Compliant Fuel oil (Aromatic)"
to "B: Compliant Fuel oil (Parafﬁnic) "Figure 5-8 Fuel oil piping system (1)has passed through an Indirect Desulphurization Unit)(2) L CO (Light Cycle Oil) and CLO (Clarified Oil)Cracking reaction in the desulphurization units and cracking units will cause blendstock
viscosity to be reduced.
Therefore, the viscosity of the blendstocks mentioned above is much lower than thatof conventional blendstocks which have not passed through direct desulphurization(Vacuum Heavy Distillate) and been blended with conventional heavy fuel oil (HSHFO).
The viscosity of VLSFO supplied from 2020 is lower than that of conventional fuel oil(HSHFO).

Photograph 5-9 Sludge deposition and precipitation within the rotating bowl of the oil purifier

74

According to two research reports “Assessment of Fuel Oil Availability - final report,
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P&I Loss Prevention BulletinJAPAN P& I CLUBMEPC70/5/3 and MEPC 70/INF.6.” (see right side

leakage of the internal sliding parts.
( As reported in the“Summary of damage”published in the ClassNK
Technical Review (Kaishi) (No312, No316): following enactment in 2015 ofSOx regulations which restrict the sulphur content in fuel oils in overseas
SOx Emission Control Areas, some Class NK registered ships reported
damage to fuel injection devices).

Photograph) presented at the 70th Marine Environment
Protection Committee IMO, held in 2016, the futureof marine fuel oils was described as follows: “Low
Sulphur crude oil is available in certain regions such as
the North Sea Oil Fields. However, it is also envisaged
that a VLSFO compliant fuel oil, mainly composedof atmospheric residue or vacuum residue, can beproduced and supplied and which is broadly similar
to conventional HSHFO fuel oil. Sulphur content
of residues exceeding 0.5% can be adjusted when②D ifficulty in increasing rotation speed (load) because of an insufficient fuelsupply from the fuel supply pump (due to decreased kinematic viscosity).
Internal leakage from the clearance between the rotating body and thecasing occurs, and the fuel supply is insufficient.
③ Low-temperature corrosion of fuel valves and related components.
( This occurs when the fuel injection valve on engines using heated HSHFO
is cooled excessively. This often happens in 4-stroke engines).

necessary by blending with an appropriate amount of low sulphur heavy oil or distillate

2oil. In some regions such as the North Sea oil field where low sulphur crude oil is① Sticking, gear wear, reduction of bearing life (due to decreased lubricity).

available, it is also predicted that compliant fuel oil VLSFO which mainly is composedof atmospheric residue or vacuum residue can be produced and supplied, similar to② Insufficient fuel oil supply (due to leakage of the sliding parts inside thepump, and decreased kinematic viscosity).

conventional fuel oil HSHFO. And if the sulphur content of residue is higher than 0.5%,③ Leakage from pump seal (due to decreased kinematic viscosity).

Fuel supply pump / Fuel transfer pump / Oil purifier supply pump

the appropriate amount of low sulphur heavy oil or distillate oil will be blended to adjust
it as necessary. This will bring VLSFO viscosity to an equivalent level as that of current

Countermeasures

HSHFO.”

The following countermeasures are required:P otential issues and countermeasures for machinery/plant systems
affected by low viscosity oil
Table 5-11 shows a summary of issues and countermeasures.

Machinery and plant system issues in the engine room
Refer to images of damaged parts in Photographs 5-12,13 and 14
1

Diesel engine①S
 ticking of the fuel injection pump (due to decreased lubricity), failure to
start-up, and difficulty in increasing rotation speed (load) due to increased76

It is essential to comply with the manufacturer's manuals and instructions forsafe use of ECA (Emission Control Areas) compliant fuel oil, even when using
VLSFO.
1C onfirmation of engine and fuel pump specifications before use ofcompliant fuel.

①M easures to be implemented when replacing or modifying machinery:1）When the minimum viscosity of the fuel in use is lower than 20 cSt@50℃ at the engine inlet, it is necessary to install a fuel oil cooler infront of the inlet to ensure the manufacturer's recommended viscosity.
2）For fuel supply pumps, if the minimum viscosity of the VLSFO in use
is not within the manufacturer's recommended range of viscosity, thefollowing countermeasures should be implemented:

77

P&I Loss Prevention BulletinJAPAN P& I CLUB(a) U se a fuel supply pump with specifications compatible with low
viscosity.
(b) R eplace the pump seal.
(c) Install a fuel oil cooler (viscosity can be adjusted provided it is done
upstream from the supply pump).
② Overhauls and maintenanceS ome VLSFOs have a high kinematic viscosity and a large amount ofresidue. The clearance between the sliding parts of the fuel supply pumpand the fuel injection system can increase due to wear.
If the kinematic viscosity of fuel oil is significantly lower than that which
has just recently been used, it is necessary to carry out an overhaul
before use.

Photograph 5-12

Scratches on the plunger and barrel of the fuel injection pump
Photograph: ClassNK Guidance

2 Countermeasures at sea①K inematic viscosity varies greatly with changes in temperature. Make sure
to maintain thorough control of fuel oil temperature.
W hen there is no risk of wax precipitation (see next section) at the pourpoint, cease steam tracing and avoid raising the temperature of the fuel oil
as much as possible.
②M onitor fuel oil temperature so that viscosity remains within therecommended range of the manufacturer.
K inematic viscosity can be controlled if the fuel oil is 100 cSt @50℃ or
higher. However, if kinematic viscosity is low, crew should be aware that it
may be difficult to adjust onboard by steam heating.
③F or fuel oils with low kinematic viscosity 20cSt @50℃ or less that areprone to wax at a high pour point, there is a risk of wax formation when
adjusting kinematic viscosity by cooling. Be aware that there is a narrowtemperature range of acceptable cooling to adjust kinematic viscosity.
④W
 here there is concern about the lubricity of VLSFO, a lubricity improver
should be added to the fuel oil.
( Lubricity improvers should be added to the fuel tank in advance.)⑤ It is recommended to keep a reserve of lubricity improvers onboard.

Photograph 5-13 Abnormal wear of plunger and barrel in the fuel injection pump
Photograph: ClassNK Guidance

Table 5-11 Low viscosity issues and countermeasures

Photograph 5-14

Scratches on the fuel injection valve
Photograph: ClassNK Guidance

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P&I Loss Prevention BulletinJAPAN P& I CLUB

Importance of viscosity control

Q

Manufacturers provide a recommended kinematic viscosity of fuel oil at the engine
inlet, and to ensure safe and efficient operation of the engine, the fuel oil supply pipeline
is equipped with an onboard viscosity control device (see table 5-11). Precautions for

The role of the Engineer
Consider:M/E inlet viscosity Manufacturer's
recommended viscosity Corresponding
temperature Steam Heating Valve aperture
THEN
Monitor, think, analyse, judge and act!

the handling of fuel oil are also explained in the manufacturer’s instruction manual.
Each manufacturer has a recommended range of approximately between 2 cSt and 20
cSt.
As shown in Figure 5-15, kinematic viscosity is inversely proportional to increases infuel oil temperature. Conventional fuel oil (HSHFO) has a relatively high viscosity of
180cSt@50℃ or 380cSt@50℃, and so a virtually consistent quality could be obtained.

Understand the technology

Adjusting it to fall within the recommended viscosity range was therefore just a matter 

of steam heating. However, after 2020, trade of VLSFO with a wider range of kinematic
viscosity is expected. When kinematic viscosity is lower than recommended levels,
it will be necessary for crew to increase viscosity by cooling. Moreover, regarding
oil purifiers, from the viewpoint of economy and safe operation, the manufacturer⇒     

Understand the science⇒  

線 図

LSHFO
Service
Tank

Te
Fuel Oil Heater

P
Drain

Vi
sc
let

m
pe

viscosity.

os

Heating Steam

M

In

ＭＧＯ
Service
Tank

Control Box

ramanufacturer’s instruction manual and to take appropriate measures to manage fuel oil

Valve

It is therefore essential for crew members to familiarize themselves with theityControl PaneltureS y s t e m D ia g r a m

ap

purifier to its relative (corresponding) temperature.

ertuSo, crewmembers must take care to set the treatment (feeding) temperature of the oil参照

rerecommends that optimum viscosity be set at, for example, 24cSt for the treatment oil.

Viscosity
sensorStrainerLow kinematic viscosity: Beware! It may require cooling.

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P&I Loss Prevention Bulletin

D ia g ra m

JAPAN P& I CLUB

9000

Kinematic Viscosity（cSt @50℃）

7000
5000
4000
3000

10
9
8

1000
800
600
500
400
300
250
200
150

7
6

1
2
3
4
5
6
7
8
9
10
11

ＭGO
MDF
TFO
〃
〃
〃
〃
〃
MFO
〃
〃

3
6.2
30
60
80
120
180
280
380
500
700

cSt @50℃
〃
〃
〃
〃
〃
〃
〃
〃
〃
〃
〃
〃
〃
〃
〃
〃
〃
〃
〃
〃

5

temperature at which the crystals in the fuel grow even larger to the extent that the entire
fuel oil becomes gelled and loses its ability to flow (see Photographs 5-17 and Figure5-18).
According to “01 | 2015 CIMAC Guideline, Cold flow properties of marine fuel oils “
issued by CIMAC (The International Council on Combustion Engines), the temperature
difference between each of the above stages will be between 2 and 5 ℃ for untreated

4

100
80
60
50
40
30
25
22
15

fuels. In order to ensure efficient management of fuel fluidity at low temperature, the3crew should endeavour to maintain a temperature of at least 10°C higher than the Pour
2

10
8
6
5
4
3
2
1

Curb
〃
〃
〃
〃
〃
〃
〃
〃
〃
〃

11

2000
1500

grow into larger plate shapes and begin to plug the filter. Pour Point (PP) is the lowest

Ｍarine Gas Oil

50℃

Point. From a practical point of view, fuel with a low pour point is preferable.

Recommendation viscosity for Fuel Injection of Diesel Engine(Depending on Engine design and Type)

Typical Δtemp（℃）（Untreated fuel）

1

－10

0

10

20

30

40

50

60

70

80

90

100

110

120

130

140

Cloud Point (CP)150

Temperature（℃）

2 ～ 5℃

Figure 5-15 Viscosity controller

5-2-3 ③ Cold flow properties

Cold Filter Plugging Point (CFPP)

Cold flow properties indicate the lowest temperature at

2 ～ 5℃

which fuel can continue to flow when it is cooled. The
Pour Point (PP) is the temperature below which thefuel loses its flow characteristics.

01 | 2015
CIMAC Guideline

Pour Point (PP)Cold flow properties of marine fuel oils
By CIMAC WG7 Fuels

Photograph 5-17 Wax formation process

Figure 5-18 Definition of cold flow properties

During the process of wax crystal formation as fuelbegins to cool, Cloud Point (CP) is the temperature atwhich wax crystals start to grow and visibly form in
the fuel. Crystal size is still small, and transparent fuelbecomes cloudy. Cold Filter Plugging Point (CFPP)
is the lowest temperature at which these crystals

82

This publication is for guidance and gives an overview regarding the assessment of risks associatedwith operating on fuels with poor cold flow properties. The publication and its contents have been
provided for informational purposes only and is not advice on or a recommendation of any of thematters described herein. CIMAC makes no representations or warranties express or implied, regarding
the accuracy, adequacy, reasonableness or completeness of the information, assumptions or analysis
contained herein or in any supplemental materials, and CIMAC accepts no liability in connection
therewith.
The first edition of this CIMAC Guideline was approved by the members of the CIMAC WG7 Fuels
in January 2015.

Figure 5-16
01| 2015 CIMAC Guideline Cold flow
properties of marine fuel oils

83

P&I Loss Prevention BulletinJAPAN P& I CLUB otential issues and countermeasures for machinery/plant systems
P
affected by cold flow properties
Table 5-19 shows a summary of issues and countermeasures.

Countermeasures
The following countermeasures are required:Caution：Maintain, or if necessary, heat the fuel oil temperature to at least
10℃ above the cold filter plugging point (CFPP+10℃ ).

Machinery and plant system issues in the engine room1W
 hen using fuel oil without a heating device, ensure that the operating
environment (*) is PP+10°
C or above, taking into consideration thenavigation route and season.
When fuel oil cannot be used, employ wax suppresants to control wax
formation.
＊O perating environment: Conditions which affect fuel oil management
include: seawater temperature, surrounding temperature of pipeline,
engine room temperature, and ambient temperature.

2

If wax crystals frequently form on the strainer in front of the purifier,make the following changes to the oil purifier operating settings:r educe the flow rate of oil purifiers, shorten interval of sludge
discharge, raise oil treatment temperature, and reduce overhaulinterval of the separating disc for inspections and maintenance.
If necessary, clean the strainer more frequently than usual.

3In case of emergency, it is advisable to keep a reserve stock ofadditives to mitigate any wax crystal formation on board.

4

When the kinematic viscosity of fuel oil is low
(less than 20 cSt @ 50°C), heating is basically unnecessary.
H owever, if the pour point is high, fuel oil requires appropriate
heating. Be aware though that careful fuel oil management is requiredsince the range of acceptable temperature variation is narrow.

See“Fuel oil piping system (2)”in Figure 5-21 and wax crystal formation
images in Photographs 5-20, 22, and 23.
1Inability to transfer fuel oil from hull storage tank by fuel oil transfer
pump.
Reason：Fuel oil temperature has fallen below the pour point (PP) in
the hull storage tank, and the entire fuel oil gels, losing its
flowability. It is impossible to transfer from the hull storage tankto the settling tank in the engine room.

2L ow fuel oil supply, or in the worst case scenario, main engine
shut down (loss of propulsion), or generator shut down (loss of
power).
Reason：Wax crystals can form and clog the strainer in the fuel oil
supply pipeline under the following conditions:
Even if fuel oil temperature exceeds PP, if it falls below CFPP,
wax crystals can form in larger plate-shapes. In this instance,
any wax formed in the hull storage tank will be transferred andlead to potential clogging of filters in the fuel supply pipeline(Cold Filter Plugging Point (CFPP): please see Photographs
5-17 and18).

3P oor sludge treatment.
When discharging sludge, any imbalance of the oil purifier can lead toabnormal vibrations and may damage the purifier.
Reason：W hen fuel oil containing wax crystal formations passes
through the oil purifier, the following occurs:

Table 5-19 Cold flow property issues and countermeasures①W ax adheres to the separating disc and reduces the separation
efficiency.
②W ax accumulates on the separating disc in the rotating bowl of
the oil purifier.

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Filter blocked due to wax deposit

Source: Guide for use of 2020 SOx regulation
compliant fuel oils (Maritime Bureau of the Ministryof Land, Infrastructure, Transport and Tourism)

Source:01 2015 CIMAC Guideline

Photograph: ClassNK Guidance

Photograph 5-20 Wax crystal formation in fuel oil
Photograph 5-22 Wax crystal formation in the fuel oil tank

Bunker barge③Accumulation of wax crystals

P

BunkerOil Puriﬁer

Settling Tank

Hull storage tank

C: Compliant Fuel oil(Parafﬁnic)

Fuel oil
puriﬁersystemHeaterOil puriﬁer
supply pump

Service Tank

Fuel oiltransfer system

Sludge precipitation
X: Conventional HSHFO(Aromatic)②Clogging with wax crystals

Hull storage tank

Fuel oil supply
systemFuel oil
Deaeration
Chamber

A: Compliant Fuel oil(Aromatic)

At lower
temperatureon the operating
environment

Main Engine/
Diesel Generator

HeaterHull storage tankP
Transfer Pump

P

P

Circulating
pumpSupplypumpab

B: Compliant Fuel oil(Parafﬁnic)

Wax crystal formation①Wax crystals form when the temperature of
the operating environment falls below pour point.

Figure 5-21 Fuel oil piping system (2)86(a) Clear sample at 28°C(b) Wax crystals formed at 24°C

Photograph 5-23 Wax crystal formation in the diesel oil purifier where the distillate fuel temperature
is below the CFPP of fuel in the oil purifier87

P&I Loss Prevention BulletinJAPAN P& I CLUB(4) E xcessive wear, scuffing and excessive leakage of the piston rod andgland packing

5-2-4 ④ Cat-fines (FCC catalyst particles)(5) W ear and blow-by in valve seat on exhaust valve

Cat-fines originate from catalyst particles used in the fluid catalytic cracking (FCC)(6) D amage to exhaust gas passage on T/C nozzle and turbine blade

process. During the FCC process, these catalyst particles break up into smaller particles
and remain in the fuel oil as cat-fines. They are very hard particles composed of alumina(Al2O3) and silica (SiO2).

Countermeasures

The catalyst particles are continuously used and recycled during the FCC process.
However, some of the cat-fines catalyst particles still remain in the low sulphur
blendstocks (CLO: Clarified Oil). The presence of cat-fines is evaluated according to thetotal amount of aluminum (Al) + silicon (Si) content.

P otential issues and countermeasures for machinery/plant systems affectedby Cat-fines
Table 5-24 shows a summary of issues and countermeasures

The oil purifier uses centrifugal force to separate the different densities offuel oil and cat-fines/sludge. If the Al+Si content of fuel oil falls within thevalue specified by ISO 8217 ISO, it is possible to reduce Al+Si content,
before the engine inlet, to the engine manufacturer's recommended value.
To this end, it is necessary for the crew to conduct pre-treatment in thesettling tank, and ensure proper function of the oil purifier by carrying out
the necessary repairs, inspections and maintenance.
The following countermeasures are required:Caution：E nsure the proper operation of the oil purifier and conduct
appropriate pre-treatment of VLSFO in the settling tank asfollows:

Machinery and plant system issues in the engine roomCat-fines problems (Photograph 5-25) have also occurred on ships using
conventional oil in the past. VLSFO which is rich in CLO has an Al and Si
content approaching the upper limits specified in the international standard"ISO 8217:2017 Petroleum products — Fuels (class F) — Specificationsof Marine Fuels". When using such VLSFO, any cat-fines which have notbeen properly removed onboard from fuel oil will enter into the engines
and machinery. As a result, if the particle mass of cat fines is large andtheir diameter outstrips oil film thickness, engines and equipment may bedamaged, especially sliding parts, such as the fuel injection valve or piston
ring (refer to Figure 5-26, and Photograph 5-27). Potential problems include:（1) S ticking and wear of fuel injection parts / Sticking, wear and nozzle
hole defects of the fuel injection valve(2) E xcessive wear and breaking of piston ring / Excessive wear ofpiston ring groove(3) E xcessive wear and scuffing of cylinder liner

881In order to maintain and improve the separation efficiency of theoil purifier, operation settings should include maintenance of an
appropriate oil treatment temperature, and reduction of the flow rate tojust a little more than expected fuel consumption. Use of two or more oil
purifiers in parallel operation can increase purification efficiency.

2W henever bunkering, confirm that oil purifiers are functioning correctly
by regularly taking fuel oil samples to a laboratory in order to have Al+ Si content measured. Samples should be taken from (i) ship manifold(inlet of hull storage tank), (ii) before and after the oil purifier, and (iii) atthe engine inlet.

3It is important to keep the fuel oil level of the settling tank within an
appropriate range.

4

 rain water and sludge from the settling tank should be removed becauseD
cat-fines deposited in the settling tank are also removed.

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P&I Loss Prevention Bulletin

5JAPAN P& I CLUBW
 hen cat-fines are captured by emulsified matter, apparent specificgravity is reduced, and this means a reduction of removal efficiency atthe oil purifier during the pre-treatment process. To prevent this, thewater content of fuel oil should be removed as much as possible andemulsification preserved. The following methods are effective:①P
 revent the mixing of water with fuel oil.
②H eat the fuel oil settling tank (around 70℃ ), allow sufficient settling bygravity, and enhance separation of water content.
③B e careful not to stir fuel oil upstream of the oil purifier.

6B ackwash oil from the automatic backwash secondary filter should be
consumed outside the diesel engine and not returned to the settling
tank.

7

O
 perate the filter in front of the engine inlet in accordance with theengine manufacturer's operating manual. Pay particular attention to thefollowing:

Photograph 5-25 Cat-fines particles“Cat-fines particles vary in size and shape”① In principle, use the automatic backwashing filter side.
②E
 nsure that the fine filter in front of the engine inlet and the by-passfilter are of the same mesh size. Inspect and maintain the fine filter
regularly to ensure it is not perforated.

Excessive wear occurs on sliding surface
between piston rings and cylinder liners.

③F ine filter cleaning schedules should be logged daily. If cleaning
frequency increases, be sure to improve the fuel separation efficiencyof the oil purifier (refer to the countermeasures for compatibility andcold flow properties).

Table 5-24 Cat-fines issues and countermeasures

Cylinder liner
PistonCat-ﬁnes(AL+Si)Particles

Piston ring
Cylinder liner
Piston ring
Lubricating oil ﬁlm
Figure 5-26 Cylinder abrasion by cat-fines

90

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P&I Loss Prevention BulletinJAPAN P& I CLUB(a) Cat-fines embedded in the cylinder
and trace of abrasive wear(b) C at-fines embedded in thepiston ring←→

Figure 5-28 shows the length of ignition delay for diesel spray. Ignition delay canbe further subdivided into two stages: physical and chemical processes. The processof physical ignition delay begins with fuel oil being injected into a high-pressure
environment from the fine tips of the fuel injection valve whereupon it spreads andatomizes. The atomized oil droplets then draw heat from the surroundings, and as
surface evaporation progresses an air-fuel mixture of fuel vapor and air is formed.
The process of chemical ignition delay begins at the point where the air-fuel ratio (airmass/fuel mass) of combustible air-fuel mixture approaches the stoichiometric air-fuelratio. Chemical ignition delay depends mainly on the ignition quality inherent in the fuelPhotograph: ClassNK Guidance

Photograph 5-27 Cat-fines embedded in the piston ring and cylinder liner

5-2-5 ⑤ Ignition and combustion quality

components.
Since both the cetane number and cetane index are not applicable to marine heavy fueloil, CCAI (Calculated Carbon Aromaticity Index) is used as the indicator of ignitability.

Ignition quality

CCAI (Calculated Carbon Aromaticity Index) was developed as an indicator for the“Ignitability” here is divided into two stages: ignition and combustion quality. Ignition

practical evaluation of the ignition quality of residual oil in the 1980s. It is an empiricalquality reflects the degree of ease with which a fuel self-ignites. It is generally expressedindex simply calculated from the oil density and viscosity. The higher the CCAI, theas the time taken from the initial injection of fuel oil into the combustion chamber tohigher the aromaticity is, and consequently the poorer the ignition quality.

ignition (i.e., ignition delay).

The guidelines set forth in “ISO 8217:2017 Petroleum products — Fuels (class F) —Specifications of marine fuels” specify the upper limit value of CCAI for RM (residualoil) grade. The CCAI was developed based on the two following assumptions: “(1) the
ignition delay of fuel correlates to the carbon aromaticity of that fuel” and “(2) there
is a correlation between carbon aromaticity and viscosity/density.” From 2020 various
low sulphur blendstocks will be increasingly blended with VLSFO meaning that thecorrelation between CCAI and actual ignition delay will be less than before.
For the time being, the following formula should be used:

CCAI = ρ 15-81-141・log 10 [ log 10(v+0.85)]-483・log 10
ρ15：density ＠ 15 ℃ , k g/m3

T+273
323

v ：kinetic viscosity ＠ T ℃, cSt
FIgure: ClassNK Guidance

Figure 5-28

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P&I Loss Prevention BulletinJAPAN P& I CLUB

Combustion

oil leakage caused by abrasive powder from the abnormal wear

Whereas the term “ignition” refers to the start of combustion, the term ‘combustion’of piston ring/cylinder liner.

refers to the latter half of the combustion process. It represents the extended combustion④ Surface wear and burn-out of exhaust valve.

period, the flame length, and the proportion of unburned components such as black⑤E xhaust valve sticking due to accumulation of unburnt deposits

smoke and deposits in the combustion chamber.

in the exhaust valve guide aperture.
⑥B low-by and high-temperature corrosion, due to poor sealing of
exhaust valve seat.
⑦ Surface wear and burn-out of piston crown.
⑧T urbocharger problems due to accumulated unburnt deposits(e.g., explosion overrun).
2 Medium/high speed 4-stroke diesel engine problems

Photograph 5-29

Ignition and combustionP otential issues and countermeasures for machinery/plant systems affectedby Ignition and combustion

The higher the engine speed, the greater are the chances of adverse
ignition delay. In particular, when the temperature and pressure inside
the cylinder are low and the load is also low, diesel knocking may leadto unstable combustion. This will also increase PM and black smoke
emissions. Such situations can be alleviated by increasing the load to
improve ignition condition. Bear in mind that the same problems related
to the low speed 2-stroke engine mentioned above, can also occur in themedium/high speed 4-stroke engine.

Table 5-30 shows a summary of issues.

Machinery and plant system issues in the engine room
Compared to conventional fuel oil (HSHFO), VLSFO is blended with higher
levels of LCO and CLO which can inhibit ignitability and flammability.
LCO, mainly composed of 2-ring aromatics, particularly affects the ignition
quality of fuel oil.
CLO, mainly composed of 4 or more ring polycyclic aromatics, particularly
affects the combustion quality of fuel oil.
1 Typical damage on a low speed 2-stroke diesel engine① Excessive wear and breaking of piston ring.
② Excessive wear and scuffing of cylinder liner.
③E xcessive wear of piston rod/stuffing box packing and excessive

94

Table 5-30 Ignition and combustibility issuesD etection of and countermeasures for issues arising from oil with poor
ignition and combustibility
Table 5-31 shows a summary of diagnostic issues regarding the detection of ignition andcombustion problems.
Diagnosis of potential issues

Countermeasures

It is essential that crew members carefully
monitor the following engine conditions andmake a correct diagnosis:

In the event of any abnormal
combustion, crew members must take
immediate onboard action and follow theappropriate measures outlined below:

95

P&I Loss Prevention BulletinJAPAN P& I CLUBDiagnosis of potential issues

2-stroke engine① Ensure proper maintenance of the fuelinjection valve and secure the valve
opening pressure in order to atomize
fuel oil properly and produce a good
spray.
1② Enhance engine monitoring(e . g . m o n i t o r i n g o f e x h a u s t g a s
temperature, rpm of the turbocharger(surging), specific fuel consumption,
concentration of iron in drain oil
s a m p l e d f ro m t h e b o t to m o f t h ecylinder liner).

Countermeasures
1① Reduce engine load.
Reducing engine load will help toreduce thermal and mechanical loads
at relevant locations. This is effective inpreventing any further deterioration.
② I f m e c h a n i c a l l y p o s s i b l e ,crewmembers should adjust andadvance fuel injection timing.
Be aware though that by advancing
fuel injection timing, Pmax
(maximum in-cylinder pressure) andNox (nitrogen oxide) values will also
rise. Crewmembers must ensure that
Pmax limits are within a range which
does not exceed the upper limit
outlined in the Nox technical file.

③ For engines equipped with temperature
sensors, continuously monitor thecylinder liner temperature.
④ For engines equipped with cylinderpressure sensors, crewmembers mustevaluate the state of combustion byreading the cylinder pressure. Where
sensors are not equipped, measure andevaluate in-cylinder pressure with amechanical indicator.
2 4-stroke engine① Ensure proper maintenance of the fuelinjection valve and secure the valve
opening pressure in order to atomize
fuel oil properly and produce a good
spray.

② Enhance engine monitoring( e . g . m o n i t o r i n g o f e x h a u s t g a s
temperature, rpm of the turbocharger(surging), specific fuel consumption).

2

4-stroke engine① If possible, adjust and increase theengine output to a medium load.
H o w e v e r , f o r t h e g e n e r a t o r s ,consideration must be given to thebalance between onboard power
demand and the number of operating
engines.
② C r e w m e m b e r s s h o u l d a d d a
combustion improver to the fuel( in case of emergency, it is advisable
to keep a reserve stock of combustion
improver onboard).

③ In order to improve startability, cylindercooling water in the engines should be
preheated, if possible.
Table 5-31 Detection of and countermeasures for ignition and combustibility issues

96

5-3 Countermeasures for the safe use of cylinder oil

2-stroke engine

The following is a summary of recommended precautions for the selection of cylinder
oil when using low-sulphur compliant fuel oil.
In a two-stroke engine, cylinder oil, which has a close relationship with combustion,
serves the following functions:①

Prevention of corrosion of the cylinder liner and other combustion chambercomponents by neutralizing acids formed from the by-products of the fueloil combustion process.

②

During Hydrodynamic Lubrication, it spreads uniformly over the cylinder
liner surface forming a stable oil film between the piston rings and thecylinder liner to ensure smooth lubrication.

③

Provision of a gas seal between the piston rings and the cylinder liner toprevent blowing out of combustion gas and compressed air.

④

Prevention of build-up of deposits in the piston rings, piston ring grooves
and cylinder liner which could otherwise lead to ring sticking or breakage.

Engine crew members should therefore ensure proper management and control of thecylinder oil which is designed to suppress deterioration of the fuel oil. Care must be taken
to maintain both oil viscosity and the proper functioning of any additives to the cylinderoil. These additives help to disperse any sludge generated by the products of combustionand prevent agglomeration and adhesion to machine parts, whilst also reducing theformation of deposits. Compliant fuel oil (VLSFO sulphur content 0.50% or less) has alower sulphur content than conventional fuel oil (HSHFO sulphur content 3.50% or less).
When selecting a lubricating oil, careful consideration must be given to the ability of thatoil’s alkalinity to neutralize acid (refer to the above mentioned point ① ).
The main component of additives is an alkaline earth metal (mainly Ca). The alkalineability to neutralize is expressed as the base number (BN).
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P&I Loss Prevention Bulletin

Characteristics:
alkalinity(can neutralize
acidic products)

Characteristics:
cleaning ability

JAPAN P& I CLUBCharacteristics:
alkalinity(can neutralize
acidic products)

Characteristics:
cleaning ability

5-4 Onboard check
Regarding the five properties of compliant fuel oil as previously described, there is aBN70-100BN70-100

BN 40

Cylinder oils suitable for use
with conventional fuel oils (HSHFO)

BN 40

short and simple method to diagnose the compatibility, cold flow properties, and ignitionand combustion quality, which can be done in about 30 minutes whilst bunkering.

Cylinder oils suitable for use
with compliant fuel oils (VLSFO)

Figure 5-32 BN selection considerations based on degree of pollution by sludge, deposits etc.

If cylinder oil previously used in the conventional fuel oil HSHFO is used in thecompliance fuel oil VLSFO, the alkalinity will be excessive, and carbonate deposits will
form around the piston and on the piston crown.
In two-stroke engines prior to 2020, ships used a cylinder oil of about 70 to 100 BN for
the high sulphur content of the conventional fuel oil HSHFO in open sea areas outsideof ECAs.

Photograph 5-33(a)Ship bunker manifold

Photograph 5-33(b)Sampling of fuel oil

However, from 2020, ships need to use a cylinder oil of 40 BN which corresponds tofuel oil with a sulphur content of 0.50% or less.
As shown in Figure 5-32, cylinder oil with a high BN has a high ability to disperse
incomplete combustion products, such as soot and other substances inside the cylinder
oil film. Careful consideration should be given to this dispersing ability when the piston
ring/cylinder liner are in poor condition, and when using fuel oil with poor combustion
quality. It is therefore recommended that the company consult with the engine
manufacturer before selecting and using cylinder oil for a two-stroke engine. Pay carefulattention to the matching of compatible fuel oil VLSFO and cylinder oil.
Similarly, consultation is also recommended when selecting lubricating oil for a fourstroke trunk piston type engine.

98

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P&I Loss Prevention BulletinJAPAN P& I CLUB

=Simple diagnostic test=

5-4-2 Diagnosis of cold flow properties

5-4-1 Diagnosis of Compatibility
As described in “5-2-3③ Cold flow properties”,

As described in “5-2-1 ① Compatibility”,

these properties indicate the ability of a fluid to flow

asphaltene can begin to aggregate when different

at low temperatures. Since the average temperature

fuels are mixed, and/or when undergoing thermalof most domestic refrigerators is around 5°C,

shock or when the fuel is oxidized. Thesecrew members can simply evaluate the cold flow

particles will grow from fine to coarse, and will

properties of fuel oil by leaving a cup of bunker

finally deposit as asphaltene sludge.

sample oil in a refrigerator for about 30 minutes with

Compatibility can be checked by a fuel oil spota thermometer.

test (ASTM D4740) using a portable test kit as

Any low viscosity or loss of cold flow properties

shown in Photograph 5-34. Assessment is madeshould be reported to the charterer and the shipby the circular patterns that appear after the heated

operator and a request made to implement the countermeasures shown in 5-2-3 above.

sample oil is dropped onto the test paper and dried.
Particles that cannot smoothly pass through the

Photograph 5-34 Spot test kit for FO
compatibility and stability

For issues regarding “Cold flow properties” andtest paper are deposited in a circular shape (inner ring), making it easy to judge by their“Compatibility”, please refer to Japan P&I News

appearance. As shown in Photograph 5-35, when a more distinctive spot can be seen in

No. 1044 “THE 2020 GLOBAL SULPHUR CAP

the center of the filter paper, this implies that the fuel is unstable. If we think of the filter－ Precaution of “Compatibility” and “Cold flow

paper as a strainer, it can be seen that the strainer would immediately become clogged if

properties” for compliant fuel oils” published by

the oil did not spread evenly and appears thick around the center.

this club on 11 November 2019. Please also refer×◎

Figure 5-36
Simplified test methods
for Pour point in refrigerator

to the TEC-1190 “Booklet for ship crew members
Precautions concerning change-over to 0.50%
sulphur compliant fuel oils [First Edition]” publishedby ClassNK on 30 September of the same year. Thisis a particularly practical booklet containing details
about additive manufacturers.

Left ：Evaluation

1

Good compatibility

Right：Evaluation 5

Very Poor compatibility

Photograph 5-35 Example of test result (compatibility of FO)

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P&I Loss Prevention BulletinJAPAN P& I CLUB

5-4-3 Assessment of ignition quality

５－５ Summary

As described in “5-2-5 ⑤ Ignition and combustion quality”, CCAI has until now been

For safe usage of compliant fuel oil, it is recommended that the shipowner, ship

the main indicator of ignitability. CCAI can be calculated by referring to the density

management company, and crew members adopt the following onboard measures:and kinematic viscosity described in the Bunker Delivery Note (BDN). Depending on
the oil quality grade, the international standard “ISO 8217:2017 Petroleum products —Fuels (class F) — Specifications of marine fuels” states that a CCAI value of 860 or
870 or less is required for the operation of marine engines. This should be compared tothe estimated value calculated by the crew and used as a guide to the ignitability index.
If CCAI exceeds the upper value limits, the ship should report this to the charterer and

1

With the manufacturer’s cooperation, review the operation manual for
proper fuel oil management (engine, purifier, fuel oil, lubricating oil,additives, etc.) and draw up a revised set of operation procedures.

2

Verify previous cases of fuel oil problems.

the ship operator, and make a request to implement the countermeasures shown in Table
5-31 above.

3

Establish a system for the monitoring of the operational status of

4

Organize regular inspections to ensure the proper working of machinery5

machinery, and countermeasures to deal with any abnormalities.

in accordance with the manufacturer’s instruction manual.

Ensure a sufficient store of spare parts and fuel oil additives onboard.
Make sure that crew members are fully versant with various work

6

procedures, previous cases of trouble, and appropriate emergency
responses, and provide emergency onboard training drills based on set
contingency plans.

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P&I Loss Prevention BulletinJAPAN P& I CLUB(1) To move out of their comfort zone.

Chapter6

Conclusion(2) To aid the development of younger crewmembers who willlead the next generation.
(3) To create and secure a Psychologically Safe Space whereexperienced crewmembers can fully support their younger
counterparts.

In the current climate, in Japan’s domestic shipping industry, the securing of younger
crewmembers is becoming a challenge, and the current personnel is aging, thus theshortage of human resources is becoming more serious. On the other hand, in Japan, theinternational shipping industry tends to rely heavily on foreign crew because of intenseinternational competition, meaning that more Japanese crewmembers are engaged inland-based activity. As a result, on the rare occasion that they board a ship, they tend
to have mostly theoretical knowledge. In the past, the environment was conducive tofostering skills whereby it was natural to hand over maritime ship skills (operation,
repair/inspection/maintenance, and management, and so on) to the succeeding
generations: ① On oceangoing vessels all of the crew members were Japanese, and ②
on coastal vessels, there was a seamless transition between ages of the personnel on
board. However, under the current circumstances, it is difficult for the shipping industry
to realize this. Furthermore, the STCW Convention and the Mariners Act in Japanrequire that crewmembers of the engine department acquire ERM ability to function
more organically with resources such as information, human resources, and equipment.
As mentioned in the conclusion of Chapter 2, how to create a sustainable workplace iskey. Experienced crewmembers are required to take the following actions (non-technicalskills):104

This will lead to a mutual understanding of the entire team and encourage cooperationand empathy. It will also build robust teamwork.
On the other hand, it is impossible to prevent human error that may cause a marine
accident. And, in order to break the chain of human errors, it is also necessary to foster
harmony amongst people, systems, and the environment. Shipowners, ship managementcompanies, and even the ship may realize a reduction in engine accidents by including
awareness, that harmonizes and aligns the gap between technical safety and humanweak points, to form a firm understanding of (must-do) maintenance.
For “effective engine management and maintenance”, the engine department’s
crew members should build the strongest “One Team” relationship through mutual
understanding. They must then continually be aware that human beings are to be at
the center daily jobs being performed, such as lubricating oil management, fuel oil
management, and inspection/repair/maintenance of the engine. Furthermore, throughregular drills/training, shipowners, ship management companies, and even the ship needto prepare measures that incorporate both soft aspects and hard aspects, so that humanbeings do not panic in an emergency and can respond calmly without making errors.

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P&I Loss Prevention BulletinJAPAN P& I CLUB

Emergency
response

Blackout recovery

Alarm Response

SMS

Communication

Routine WorkEngine & Equipment
operation

Periodical
maintenance

No. of ships
experienced

・There are 3 scores (A: Merit, B: Pass, C: Needs to improve) allocated for all aspects

Averagescore

department’s ability diagnosis within one week after boarding.

Total Score

To achieve the purpose and mission on board, the Chief Engineer conducts the engine

Rank

Each person's
fundamental
capability

Reference Material 01:
Ability diagnosis of onboard work performance: Main Text P. 7

Behaviouralcharacteristics

Reference Materials

C/E

Hurries(impatient)

75

A

80.9

81

81

78

86

76

86

76

83

15

1/E

Lazy

80

A

84.9

85

85

82

90

80

90

80

87

13

2/E

Emotional

65

B

74.9

75

75

72

80

70

80

70

77

9

3/E

Assumptions(preconceptions)

55

C

69.9

70

70

67

75

65

75

65

72

4

G/E

Does not notice

75

B

79.9

80

80

77

85

75

85

75

82

13

Engineer/OtherTransgression(violation)

30

F

59.9

60

60

57

65

55

65

55

62

2

FitterHurries(impatient)

50

B

74.9

75

75

72

80

70

80

70

77

20

Oiler/A

Only able tosee one thing

45

C

64.9

65

65

62

70

60

70

60

67

15

Oiler/B

Transgression(violation)

55

C

69.9

70

70

67

75

65

75

65

72

10

Oiler/C

Moments ofinattention

60

C

64.9

65

65

62

70

60

70

60

67

10

Oiler/D

Careless

45

F

54.9

55

55

52

60

50

60

50

57

5

Wiper

Forgets

35

F

39.9

40

40

37

45

35

45

35

42

4

Oiler/Other

Panics

30

F

34.9

35

35

32

40

30

40

30

37

2

Total
evaluation
score ofEngine
Dept.

—

54

F

65.7 65.8 65.8 62.8 70.8 60.8 70.8

60.8

67.8

—

of the engine department that make up a comprehensive evaluation. If ability or
knowledge is not satisfactory (less than 60%), an “F” will be given.
・Chief Engineers and First Engineers will work together with experienced crewmembers
in order to further strengthen management of the engine department.
They are to support younger crewmembers and develop countermeasures that will
work on improving their weak points.
・If anyone remains below average for 3 months, it is considered dangerous, so it will
be necessary to consult with the captain and discuss the reassignment of crew with
the Human Resources Department.

Table: Reference 1 Example of ability diagnosis

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Reference Material 02:
Under what circumstances does an error occur?: Main Text P. 16
The following tables are from a seminar on human factors of the Japan AeronauticalEngineers’ Association, and is used by the shipowner/ship management company or
the ship to analyze fault weaknesses. If it is known how such errors occur, it will help

Please imagine the folowing situations.
・When you know something, but cannot recollect it when you need to.
・When you lose your memory.
Limitation of・When your memory gets distorted.

Long-term

・Semantic memory: letters, symbols, numbers, etc.

memory・Episodic memory: personal memories such as joining a company or
wedding.

develop efficient responses to human factors that may have caused the fault.

・Procedural memory: procedural (how to ride a bicycle, how to use(1) Error when registering information

chopsticks, etc.)

Error when registering information
・Vision/hearing is limited.
Information is not registered.

Table: Reference 3 Error in the memory process (Lapse)(3) Error in the judgment process (mistake)・Field of view is limited.
・Visible range is limited.
・A lack of interest.

Error in the judgment process (mistake)
Making misjudgements such as:・Insufficient consideration

・Prospect・Short cut reaction

not processed.

・Mechanical reaction

  ・Hopeful observation

・Speculation

Information registered, but

・Reckless/indiscreet

Information is registered, but

was illuded.

・The information is of interest but misinterpreted. (Hasty
judgments, misunderstanding, assumptions)

Table: Reference 2 Error when registering information

Table: Reference 4 Error in the judgment process (mistake)(4) Temptation to deviate (violation)(2) Error in the memory process (lapse)
To prevent errors in the memory process (Lapse), there must be opportunity for crew

May deviate from the rules because of:members review everything repeatedly. For example, in the engine department, “In the・Time pressure

meeting before work starts, the person in charge explains the specific notes of important・Too much work

work from the viewpoints of 4 M.” Moreover, “Engine crewmembers check the・Respect for speed (even if the outcome of work is not perfect, it is fast anyway)emergency response procedures, including the low probability of accidents, one theme
each day.”Error in the memory process (Lapse)
・Memory is limitated. Most of the information kept in short-term memory
Limitation of
Short-term
memorywill be stored for approximately 20 seconds. The memory can be improved
using visuals and rehearsal.
・Normal person, 7 items (5-9) Example: Colours of the rainbow, musicalscales (c d e f g a b), main characters of a drama (The Magnificent Seven)・It is easy to remember telephone numbers, because they are grouped.

108

Temptation to deviate (violation)

・Rules that are unclear or unfit for the situation.
・Situations where it is permissible not to follow the rules
・Inappropriate deployment of appropriate facilities and materials (resources)
・Supervisor is too tolerant or lacks ability to manage
・A climate that overvalues boldness
・A climate that places less emphasis on safety (aloft work/high places of work (2m or more) but
no safety belt is worn)Countermeasure: We must not make excuses.
Table: Reference 5 Temptation to deviate (Violation)

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P&I Loss Prevention Bulletin(5) Error in the output process (slip)
Error in the output process (slip)

JAPAN P& I CLUB

Reference Material 03
Problem Solving Method: Main text P. 21, P. 41

Errors in output (behaviour) ⇒ Subconsciously unwillingly.
In spite of the correct judgment result, if the action (output) is different from the decision result at

Even if younger crewmembers have little experience, they can analyze accidents in a

the action stage, an error may be caused by any of the following.

logical way, and can plan countermeasures by utilizing solution methodology.

・Limitation of movement capability (force, dimensions).

MUST POINT

・Limitation of operating time.

Build up a stock of solutions.

・Confused by surrounding events.
・Subconsciousness.

Finally, establish a successful formula.

Example: He meant to address the audience with "an opening address" butinstead used "a closing address".
Table: Reference 6 Error in the output process (Slip)

We have provided the following with reference to “Jyohowo shunjini seirishi Aidhiawo
Umidasu! Noto・Memo Furukatsuyo Jyutsu.” (provisional translation) by Nagaoka
Shoten.

1. Logic tree: We would like to analyze problems and plan solutions!
1. Introduction“How to analyze problems & come up with a solution!” (Provisional translation.)
A logic tree is a useful thinking tool for logically analyzing work problems andformulating solutions.
First, break down a problem or solution into elements to be considered and then analyze
them further into a lower hierarchy.
As a result, the logical reason is shown in the form of a tree diagram (tree)
2. Advantage① It is possible to grasp the whole picture of the task.
② It is possible to avoid oversight/omission of problems, and it is possible to findsolutions easily.
③ It is possible to correct gaps in the discussion easily, because it is clear whichhierarchy the discussion belongs to.

110

111

completed logic tree.

112
Develop and install special jigs
that can facilitate device
disassembly and transportationmeans to the workshop

Arrange machinery layout ease
work

Figure: Reference 7 How to consider reducing work stressEstablish a proposal and patent
system for innovation withshipyards, increase movablescaffold or fixed scaffolds onsite

Introduce machinery layout of
ergonomic design considering how
to ease repair/maintenance workon machines

Establish a proposal and patent
system for innovation collaboration
with manufacturers
Upgrade to lightweight material
Reduce and miniaturize numberof tool parts

Establish re-training programs suchas manufacturer's training for all
employees (manage training
history)

Experienced crewmembers toacquire common skills above acertain level to train and guideyoung crewmembers

Make supply of new spare parts to thesite after repair/maintenance work
mandatory
Establish onboard education
program for younger crewmembers"Purpose-Means" (How), "Whole-Part" (What), etc.

Conduct training repeatedly
on-site to aid young
crewmembers in working moresmoothly and accurately

ConcretenessConduct work inworkshop⑤ O bjectively compare and examine ways to solve problems by referring to the

Improve work
surroundings

second layer. Do this until you reach the fifth layer.

Reduce weight oftools④ Similarly, disassemble the components disassembled in the first layer to appear in the

No duplicationand no omission③  Disassemble the disassembled components into 2 to 4 elements.We will extend it toStandardize
implementation of
conventional work
recommended bymanufacturer

lower layers to make it more specific. (The second layer in Figure: Reference 7)
Unify specifications to simple structure
design and general-purpose models of
all machinery, equipment, and devices
onboarddepending on the task, the method of disassembling will be "Result ⇒ Cause" (Why),

Stop reusing used parts andmeasuring devices during
maintenance and replace all

exclusive and collectively exhaustive" information (called "MECE"). Also,

Simplify and unify work
procedure at each job site

At this time, it is important to be aware that there should be "no overlap, mutually
5th layer(Countermeasures)in Figure: Reference 7)

4th layer(Problems)② Break down the starting point task into 2 to 4 components (up to 5). (The first layer

Streamline work
procedures

3rd layer(Problems)

about how you may solve it, e.g. reducing work stress.

Shorten time

2nd layer(Problems)① At the starting point, write down the problem you want to solve and start thinking

Reducework stress

1st layer(Problems)

P&I Loss Prevention BulletinJAPAN P& I CLUB3. How to draw a logic tree (Refer to Figure Reference 7)

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P&I Loss Prevention Bulletin
2. F
 ishbone: Illustrate issues and their causes in the form of a fishskeleton!
1. Overview

JAPAN P& I CLUB⑤A
 fter you have completed your Fishbone diagram, you can develop ideas andfurther ideas based on this. It is similar to a logic tree, but it is not a bird’s-eye
view, yet it allows you to intuitively understand causal relationships.

・Fishbone is an idea generation method that looks at “Cause and effect”.
・Originally it was a classic tool for analyzing factors that affect quality

2

characteristics in the quality control of products.
・Business analysis often uses this method. This is similar to a logic tree.

Workload（Stress)

・It is not exhaustive. This method’s characteristics are such that we can understandthe causal relationship between issues and factors more intuitively.
2. Advantages

Exclusive special tool
made onboard

3
Working surroundings① It is easy to visualize causal relationships and find solutions.
Narrow② It is possible to grasp issues and factors intuitively.

4

Structures of machinery
Special-shaped parts

apply ideas to develop a special tool for maintenance.

① We draw an arrow shape with a triangle and a horizontal bar and write our

Cheaper andheavy materialHot③ It is easy to summarize important points and organize discussions. We can also

3. How to draw a Fishbone diagram (Refer to Figure Reference 8)

Manufacturer's support

Impossible to use general tools

No exclusive special
tool for maintenanceon certain machinery,so work takes a lot oftime to complete.

Foundational strengthof science(physics, chemistry)and engineering

theme (issue or situation) in the triangle. This corresponds to the fish head andbones.
②W
 e focus on 3 to 8 important factors when thinking about the theme. We draw

Quality control

large bones coming out of both sides of the spine in a well-balanced manner andDeveloping Know-how

write each factor at the end of each large bone.
③W e further break down the factors written at the end of the large bones andconsider 3 to 6 elements. We draw medium-sized bones on either side of the largebones and write down considered elements.
④W
 e then break down these elements further and consider causes and solutions.
Similarly, stretch small bones from the medium-sized bones and write down

Specifications forship construction

Figure: Reference 8

Proposal and patent
system for innovation

How to develop a special tool for maintenanceconsidered elements.

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Reference Material 04:
Details of Power Loss Accident in Norway: Main Text P. 35

Accident details(d) 13:37 When DG4 registered an alarm indicating that the DG was
shedding load due to low lubricating oil pressure. A few seconds later, it
registered a low lubricating oil pressure alarm.
(e) 13:39 DG1 registered a low lubricating oil sump level alarm.
(f) 1 3:45 DG4 shut down, and then eight seconds later, DG2 shut down.
(g) 13:56 DG2 was restarted.
13:58 DG1 and DG2 shut down.
It caused a complete blackout and loss of propulsion, and then the ship
began drifting toward the bank (shoal).
(h) W ithin 30 seconds of the blackout: The emergency diesel generator
started and powered the emergency switchboard.

Chapter 3 introduces an accident in which an electric propulsion ship lost its powercompletely while cruising in stormy weather and where it was forced to urgently drop
anchor.
The details of the accident are as shown in Table: Reference 9 below.
Accident details（1）

At 13:50 on March 23, 2019, an electric propulsion passenger vessel was sailingsouthwest from Tromsø in Norway to Stavanger with three generators operating.

（2）

The weather at that time is as follows. Strong gale to storm winds: from thesouthwest (Beaufort 9-10 or 22-25 m/s).
Very high waves: Total Significant Wave Height from the west over deep waterof 9-10 meters (with a mean wave period of 12-13 seconds).

（3）

（4）

116

（5）

14:00 Master broadcasted a "mayday".

（6）

14:06 ～ 14:20 Master instructed the crew to drop both anchors. However, theanchors did not hold, and the ship continued to drift astern towards the shore
at a speed of 6–7 knots.

（7）

14:22 The engineers transferred a total of 10.8 m3 of lubricating oil to the
lubricating oil sump tanks of DG1, DG2, and DG4. DG2 started. DG2 restored
power to the main switchboard, in manual load-sharing mode.

（8）

14:29 ～ 14:34 hours: Both propulsion motors started, providing sufficient
propulsive power to maintain slow speed ahead.

（9）

15:05 The first helicopter hoisting operation took place. The evacuation ofpassengers continued until the next morning.

（10）

15:24 ～ 15:46 DG1 and DG4 were restarted in automatic load-sharing mode,and the starboard propulsion motor was restarted to enable the propulsion
motors' output to maintain a speed between slow ahead and half ahead.
Although DG1, DG2, and DG4 had been restarted, the engineers had tocontinuously balance the electrical load manually. The Navigation Officers
manoeuvred towards open waters, still with both anchors lowered.

（11）

16:40 The first tugboat arrived. However, the weather conditions were too
severe to secure a towline.

The total number of people was 1373 people. (915 passengers on board and458 crew members.)T he following abnormalities in the generator had occurred by the time theaccident occurred on the afternoon of March 23.
(a) On March 16, the turbocharger on No. 3 generator (hereinafter referred toas DG3. In the same manner No. 1, No. 2, and No. 4 generator are referred
to as DG1, DG2, and DG4 respectively) failed rendering the turbocharger
inoperable. On the day of the blackout, a maker's technician was on board
to dismantle the damaged turbocharger to prepare for a replacement tobe fitted at the next port.
(b) The ship was equipped with 4 generators, but since DG3 was inoperable,
generators DG1, DG2, and DG4 continued to operate. 3 generator engines
could manage to supply electric power for the propulsion machinery andship services without the use of a standby generator engine.
(c) Between 05:00 and 09:04, on March 23, before the accident occurred, theoperational DGs registered alarms of "Lubricating oil low level and low
volume" 18 times.
T he Engineers on watch accepted them, but each alarm was cleared
within a few seconds.
A fter that, the alarms did not occur until 13:37.

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Accident details（12）

Until the morning of March 24, the helicopter rescue of passengers continued.

（13）

06:30 On 24 March: Weather conditions had improved sufficiently to enabletugs to be made fast, and towlines were secured fore and aft, although thevessel maintained its propulsion.

（14）

（15）

09:15 The master decided that the vessel was out of danger and that it wassafe to stop the passengers' evacuation. The local Police reported that 479
passengers had been evacuated safely and received at the emergency centre
ashore.

Reference Material 05:
The investigation reports of the Japan Transport Safety Board:cases of loss of power: Main Text P. 39
Probable causes and countermeasures for the eight accidents in “3-2-3 Transport Safety
Board investigation reports for Japan: Cases of loss of power” are summarized in Table:
Reference 10 and Table: Reference 11.
List of probable causes of loss of power in Japan
Accident
Vessel type,
LocationNo.
Accident type

Probable causes

If emergency
anchored

CoastalNorthern
Japan

Cargo ship
(Blackout)

In stormy weather following a wind, snow andwave warning, during coastal navigation, the ship
became unable to run the main engine due to lossof power (blackout). The coast guard patrol boat
tried in vain to tow the ship but was forced to giveup due to the stormy weather. After anchoring andrepairing by the crew, the ship restored power, andshe resumed sailing after anchoring. There was noannouncement as to the cause.

Droppedemergency
anchoring

Car carrier(Blackout)

While departing port, the "crimp type terminal
connecting the electric wires of electric motor forthe stern thruster " broke due to hull vibration,
resulting in a single-phase operation. An overcurrent
flowed, the overload protection device of the stern
thruster was activated, and the generator was
unable to accept the load fluctuation which resulted
in over-speed. Since the over-speed protection
device activated, the ship lost electric power andcould not run the main engine.

―

Cargo ship
(Loss ofcontrol power)

While the ship supplied power onboard using ashaft generator during coastal navigation, thefuse holder of the DC24V power on charge anddischarge board caused contact failure, and theship lost control power. Finally, the ship could not
run the main engine.

―

Around 16:25 The ship was moored alongside in Molde.
Table: Reference 9 Details of power loss accidents on electric propulsion ships

1

Insideharbour
2
Central
Japan

3

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CoastalCentralJapan

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P&I Loss Prevention Bulletin

Accident
Vessel type,
LocationNo.
Accident type

Probable causes

If emergency
anchored

CoastalCentralJapan

During coastal navigation, the cooling fan of the"converter that converts AC current to DC current"
broke down, which caused the converter tooverheat, and the ship became unable to supply
DC 24V as control power. Finally, the ship could notcontrol both the main engine and the changeable
pitch propeller. After emergency towing, the ship
dropped emergency anchoring.

Afteremergency
towing,droppedemergency
anchoring.

4

In thebay
5
CentralJapan

Insideharbour
6
WesternJapan

120JAPAN P& I CLUB

Cargo ship
(Loss ofcontrol power)

Cargo ship
(Blackout)

Passenger
ferry(Blackout)

The ship operated two generators in parallel while
manoeuvring for entering port operation. However,
emergency stop was activated due to a lubricating
oil leakage of the governor.
The ship equipped with four generators driven
by a diesel engine, two of which were operated
in parallel normally while passing the narrow
channel, and the ship used the other two as
standby generators. However, when the accident
occurred, the crew cleaned the engine's lubricating
oil strainers, and set the automatic start switch tomanual so as not to start the standby generator.
Therefore, the backup standby generator could not
automatically backup.
While departing port, a phase-to-phase shortcircuit occurred in the wiring of A and B circuits inthe junction box, resulting in a short-circuit current
flow between circuits A and B. Then, the safety
protection device of the main switchboard A-MCCB(Moulded Case Circuit Breaker) was activated. The
function worked and turned off (disconnected). At
that time, the two branch lines connected to the
A-MCCB were damaged and bounced off, resulting
in an interphase short circuit caused by contact
with the C-MCCB branch line. The ground fault
generated by contact with the wall surface of themain switchboard caused an excessive current toflow to the main switchboard's busbar. As a result,the ACB (Air Circuit Breaker) safety protection
function was activated and opened. The ship
stopped the main engine due to loss of power, andthe generator was still running, and crewmembers
tried to reconnect the ACB, but it was impossible.

Accident
Vessel type,
LocationNo.
Accident type

Insideharbour
7
CentralJapan

Probable causes

If emergency
anchored

Cargo ship
(Blackout)

While entering the port at the harbour, the safety
protection device functioned incorrectly due to a
defective sensor board of the boiler. This resulted
in the main boiler misfiring. Therefore, in orderto reduce steam consumption, crewmembers
transferred electric load from one of the two
turbine generators (2,500 kW ) to the diesel
generator. However, after crewmembers opened
the ACB of one turbine generator, the operation
condition of the manually started diesel generator(1,500kW) became unstable. As a result, the ACBs ofboth generators tripped, and the ship lost power.

After theemergency
towing,droppedemergency
anchoring.

Cargo ship

The Chief Engineer stopped using the heavy fueloil shortly after leaving the port in the bay. In orderto improve the combustion condition of the main
engine, the switching valve was opened halfway
in an attempt to mix marine gas oil with heavy
fuel oil. He had "confirmation bias" regarding thecheck valve, and he assumed that heavy fuel oil
would never flow to the marine gas oil side. Since
the heavy fuel oil service tank's oil level was higher
than that of the marine gas oil service tank, theswitching valve opened at the same time, so theheavy fuel oil flowed back into the marine gas oil
service tank. In the generator engine, heavy fueloil flowed to the marine gas oil service tank. As
a result, the running generator received Fuel oilwith increased viscosity, and the atomization of
the fuel injection valve became defective and thegenerator engines stopped, resulting in the ship
losing power. As a result, the main engine also
stopped suddenly (emergency procedure). Afterthe accident, crewmembers discovered that thevalve was not a switching valve.

Droppedemergency
anchoring―

In thebay
8SouthernJapan

Droppedemergency
anchoring

Table: Reference 10 List of probable causes of loss of power in Japan

121

P&I Loss Prevention BulletinJAPAN P& I CLUB

List of countermeasures of loss of power in Japan
Accident No.

Countermeasures: Safety Action:1(1) The ship must review measures for stormy weather. The ship is toimplement additional remedial measures if necessary.

2

Accident No.

As a safety measure for the entire company, the managementcompany held a Masters/Chief Engineers meeting to disseminate
information among the ship and other managed ships within thecompany.
The ship must do the following:(1) Secure the wiring to the junction box.
(2) R eplace any damaged MCCB (Moulded Case Circuit
Breaker).

(1) The ship must make an inspection plan for the crimp typeterminals that connect the electric wires of the thruster motor. This
is to be carried out regularly.

(3) Correct final drawings and important documents for
newly installed electric equipment for appropriate
inspection/repair/maintenance. Carry out an occasional
survey by a Recognized Organization after the repair.

(1) The ship is to establish an inspection plan for the fuse holder of theDC 24V power supply charge/discharge board. To be carried out
regularly.

(4) M easure and record insulation resistance of electric
equipment and devices for refrigerated vehicles with aninsulation resistance tester, every month: ① insulation
resistance between the electric circuit and the hull and ②interphase insulation resistance.

3(2) Since the managers/supervisors of the ship managementcompanies had discovered that the fuse holders had deteriorated
after the accident, fuse holders on all ships have been replaced.

4(1) The ship must develop an inspection plan for the cooling fan andregularly carry it out. This is to be replaced if necessary.
(2) The ship must install a failure alarm device for the cooling fan.

5122(1) W hen carrying out maintenance and inspection work on
generators, and so on, the ship must consider the navigation
area. When passing a narrow channel traffic route such as the
Uraga Channel and Kanmon Straits, the ship must maintain anengine plant system so that it can automatically start the standby
generator in case of an emergency. The crewmembers must refrainfrom cleaning the strainer.

Countermeasures: Safety Action:6(5) R egularly vacuum-clean the interior of electricalequipment and devices and remove soot and dust.
(6) ① Inform and remind crewmembers of the danger ofshort circuits related to electrical equipment and devices,and ② conduct re-training regarding safety such as
inspection, cleaning, and electric shock.
(7) Crewmembers must use and operate the public address
system onboard effectively based on the procedure"Information for passengers in an emergency" to provide
the correct information to passengers.
Other recommended measures(1) The ship must consult with manufacturing companies, and so on,
regarding the main switchboard and MCCB, and establish regular
maintenance plans for all equipment and devices, including
equipment and devices that were not part of the accident.
T he company must continuously confirm and evaluate the recordof insulation resistance measurement of electric equipment anddevices for refrigeration vehicles with the managing ship andtheir crewmembers of their ship.

123

P&I Loss Prevention BulletinJAPAN P& I CLUBCountermeasures: Safety Action:

Accident No.

The management company must instruct on the following safetymeasures to both the ship and other ships.
(1) A major casualty may occur during manoeuvring standby,
berthing, and passing congested or high traffic routes if themain boiler misfires.
 ship must not operate the main boiler in combustionA
mode if it is difficult to handle load fluctuations well.
(2) The ship must regularly hold tests to confirm the starting
and running of diesel generators, with it operating in normal
load. The generators are also to be regularly overhauled.
7

 ship must carry out the following maintenance: RenewingA
air cooler, and repair/inspect/maintain/overhaul theturbocharger and cooling freshwater system, and so on.
(3) A ship must hold tests to confirm the starting and runningof the emergency diesel generator using a load applicablethe machinery in accordance with the manual.
 ship must carry out the following maintenance: InspectA
the switchboard, and replace ACB.
(4) A ship must increase the frequency of operation tests for theboiler safety protection device. A ship must carry out thefollowing maintenance: Renew damaged sensors.

Reference Material 06:
Emergency response checklist immediately after loss of propulsion
and loss of power: Main Text P. 45
The following is a checklist for emergency response on board.

✓ CHECK LIST
□ M
 aster must follow the company SMS procedures for loss of propulsion
and blackout, which is described in the “Emergency Procedures Manual”
as a contingency plan.
□ C rewmembers must record the position of the vessel and time accurately
in the deck logbook and in the engine logbook.
□ M aster may have to drop anchors to reduce the ship’s speed. Whenmanoeuvring in confined waters, the anchors should be ‘cleared’ for
immediate use.
□ M
 a s t e r a n d C h i e f E n g i n e e r m u s t “ k e e p g o o d ” a n d e ff i c i e n tcommunication between the bridge and the engine room. The bridge andengine room should exchange critical information so that key personnel
can fully understand the situation and make informed decisions.
Each department on board must quickly inform other departments as

8(1) T he ship must evaluate risk and check for any adverse
influences on the system using piping diagrams before
opening and closing the valves.
(2) The ship must mix marine gas oil and heavy fuel oil using
a dedicated device and not mix them directly by operating
several switching valves simultaneously.
Table: Reference 11 List of countermeasures of loss of power in Japan

Please refer to the URL in a list of references at the end of this bulletin regarding detailsof the above tables.

124

follows:

・What they require,・what is happening at their station,・what problems they are facing and experiencing,・and what risks are present? And so on.

If bridge and engine room crewmembers do not exchange critical information
during an emergency, we must know that there is a risk that key personnel will
not be fully aware of the situation and may make ineffective decisions.

125

P&I Loss Prevention Bulletin✓ CHECK LISTJAPAN P& I CLUB

Reference Material 07:
How to prevent panic: Main text P. 55□ M
 aster and Chief Engineer must instruct some of the crewmembers to
go to the emergency generator room to try and start the generator when
it does not automatically start.
□ M aster and Chief Engineer must instruct some of the crewmembers to(1) Inability to move or think
Ms. Amanda Ripley investigated and wrote about some of the most harrowing
catastrophes in history in order to piece together exactly how humans react in a crisis

go to the steering room to attempt emergency steering.

such as survivors from the September 11 attacks and Hurricane Katrina, in her book “The

However, the master and deck officers must predict and recognize that

Unthinkable: Who Survives When Disaster Strikes - and Why”, Random House Audio

this becomes less effective when the engine has stopped and when
the ship’s speed is reduced to below steerage along with the vessel’s
forward movement cutting through the water.

(Translated into Japanese by Machiko Oka, Kobunsha Co., Ltd.). According to thebook, in moments of total disaster, the first phase of human reaction is “denial”, the next
phase moves into “deliberation” that considers the actions to be taken, and as a result,□ W hen engineers find that the machinery driven by steam turbine devices

humans take “action”. However, in many cases, after “awareness of the situation”, mosthas stopped after a blackout or boiler emergency trip, they must carrypeople tend to shut down their mind entirely in the disaster and seem to lose all strategicout turning the rotor shaft by any means possible to prevent the rotor
shaft from bending.
□ E ngineers must operate the feedback system from ESB to the mainawareness. On the other hand, those who have been selected for special missions havethe common features of being able to react more effectively under stress, which isprobably due to the environment and background in which they developed.

switchboard (MSB) if possible.
S ome ships are equipped with an electric feedback system. On such a

In other words, when humans are exposed to hazards, they experience what is known as

ship, the electric power source from the emergency generator via thenormalcy bias in which they consider themselves to be indifferent or minimally affected

ESB can feedback to the main switchboard, so that the ship recovers
power to the main switchboard (MSB) during a blackout. (Please refer toby threat warnings, “It is okay” and “That can’t be true.” when faced with a situation.

“3-3-3(2) 2) Precautions for recovery work”). Engineers must understandHowever, in the event of an emergency, ship crewmembers are required to do theand be familiar with how to operate and control it practically.

following:□ W hen engineers find an overload of current on the electrical devices,① to train themselves to deal with stress effectively,

they must operate (push) the reset button to reset and recover the② to react calmly, andelectrical breaker function after it has tripped.

③ to respond immediately to critical situations without panic,in the same way as those who are selected for special
missions.

□ It will probably be necessary to bring the engine to a STOP to enable
the restart. The engine control room should take control until power has
been fully restored.

126

127

P&I Loss Prevention Bulletin(2) Preventive measures against panic

JAPAN P& I CLUBRegarding hard aspect measures, “modifying wiring to important machinery such as

As mentioned above, when humans encounter an emergency, they fall into a state ofcooling water pumps and air compressors from an emergency generator” and “changing“Inability to move or think”. To prevent this, it is essential to plan controllable measures

specifications of the speed control scheme of the induction motor using the pole change

for emergencies and implement such manageable measures during normal conditions as

method, so that these motors will be able to run using the power supply from anwell. (Please always be ready for what you have planned).

emergency generator” should be prepared.
It is recommended that the ship management company and the ship take account of① Reduce the anxiety factor (discomfort) in an emergency

these tips when considering a further framework for emergency response.

 oster a flexible mentality that can cope with anything② F
on sitePreparation for panic prevention measures for loss of power
1. Soft measures

According to the book “Behavioral Science of Natural Disasters, (preliminarytranslation)” in order to prevent panic, it is possible to divide panic into soft aspects andhard aspects for both during normal times and in emergencies:
Soft aspect measures(measures that include information and social psychological elements)：
・・・Information transmission, trouble recovery procedures,
Hard aspect measures（measures that mobilize both physical and human resources)：・・・The reviewing and improvement of machinery, securing of
personnel, emergency machinery operation, emergency repair,and so on.

The table “Panic prevention measures during disaster evacuation (preliminarytranslation)” from the book is divided into 2 classifications of which 4 categories canserve as countermeasures. Following the same structure, we have applied this to the caseof loss of power, as can be seen in Table: Reference 12 below.
For example, regarding soft aspect measures during ordinary times, “emergency
response training, including low probability accidents” should be carried out repeatedly.

128

A. Ordinary

training for situation judgment, and so on.

2. Hard measures(1) Clarify and establish information trans- （1）Reconfirm fuel supply pipeline of theregular generator and the emergency
mitting organization / role allotment.
generator.
(2) Produce manuals for:（2）Carry out regular inspections of the・normal recovery procedures,
following batteries:
・feedback method from the emergency
generator via emergency the・for starting the emergency generator.
switchboard to the main switchboard,・for the control system power source.
・t h e s w i t c h i n g m e t h o d r e c e i v i n g （3）Improve regular repair and maintenancepower from the main switchboard
methods for defective piping, structure,wiring, machinery, and equipment.
to emergenc y switchboard for theDiesel generator air compressor in an （4）Re-inspect machinery/equipment thatemergency.
can be operated from the emergency
generator and switchboard.
・the special recovery procedures to plantup the engine system by the emergency （5）Modify the power supply wiring thatgenerator.
can start the regular generator start
air compressor from the emergency(3) Regularly conduct recovery training forswitchboard. Modify auxiliary machinery
loss of power, including low probability
required for plant-up to low powersituations (Normal start-up, air circuit
variable specifications.
breaker failure, emergency generator(Please consult this with thestart fail, regular use generator start fail,classification society, manufacturer, andemergency anchoring, etc.)
shipyard beforehand.)(4) Conduct simulations (to strengthen the（6）Test run emergency generator andmind) assuming that the worst-casebackup alternative power supply.
scenario occurs based on past accident（7）Secure and store parts for important
cases.
machinery.
（8）Secure space for temporary evacuation
space when engine room overheats.

129

P&I Loss Prevention Bulletin

B. In time of emergency

1. Soft measures

JAPAN P& I CLUB2. Hard measures(1) R eport and share accurate information
related to trouble.

(1) Mobilize personnel from otherdepartments in time of emergency.

(2) E stablish a common understanding andrecognition of the situation. Promptly instructregarding recovery work procedures.

(2) Operation of emergency generator andbackup alternative power supply.

(3) Status report on recovery prospects.
(4) C ooperate with other departments. Propose
a special system for emergency anchor andcargo management.

(3) Prevent engine room from overheating.
Repair defective machinery. Rescue andnurse injured persons.

References
Chapter

Page No.

Corresponding
section

Chapter 2

P. 5

The standards of navigational watchkeeping

Web site of Ministry of Land, Infrastructure,
Transport and Tourism, Japan
Kokai tochoku kijyun (heisei 8 nen unyusho
kokuji dai 704 go) (saishu kaisei heisei 25 nen
3 gatsu 1hi kokudo kotsu sho kokuji dai 158go), (in Japanese),
URL http://www.mlit.go.jp/notice/noticedata/
pdf/201703/00006415.pdf

Chapter 2

P. 8

6 capabilities"Boueidai ryu saikyo no rida",
Yoshifuru Hamagata, Gentosha Inc.,(in Japanese)(4) Secure a means of contact with the head
office.

(5) P rovide any other information to reassure
everyone.

References

Table: Reference 12 Preparation for panic prevention measures for loss of power

A seminar on the humanfactors of aeronauticalengineers

Chapter 2
Reference
Material

Chapter 2

Chapter 3

130

P. 11/108

Reference Material 02  
Under what circumstances does an error
occur?

"Koku seibi niokeru hyuman fakuta semina(1nichi kosu)" Japan Aeronautial Engineers'
Association, (in Japanese),
URL https://www.jaea.or.jp/

P. 22

Managing Maintenance
Error"Managing maintenance error : a practicalguide" James Reason, Alan Hobbs,
Ashgate Publishing Company (Kenichi Takanotranslated into Japanese, JUSE Press. Ltd.)

P. 34

3-2-1
Incident case of loss of
propulsion in the US:
Incorrect operation of
the main engine at thewheelhouse

Investigation report of U.S. National
Transportation Safety Board, NTSB/MAR-11/04,
PB2011-916404, "Tankship Eagle Otome"
URL https://www.ntsb.gov/investigations/
AccidentReports/Reports/MAR1104.pdf

131

P&I Loss Prevention Bulletin

Chapter

Page No.

Chapter 3
Reference
Material

P. 35/116

Corresponding
section3-2-2
Incident case of loss of
power in Norway: Inadequate replenishingof system lubricating oil
to diesel generators onelectric propulsion vessel
Reference Material 04:
Details of Power Loss
Accident in Norway

JAPAN P& I CLUB

References

Investigation report of Accident Investigation
Board Norway -Interim Report 12 November
2019 On the investigation into the loss of
propusion and near grounding of Viking Sky, 23
March 2019
URL https://www.atsb.gov.au/publications/investigation_reports/2019/mair/me-2019005/
URL https://www.aibn.no/Marine/
Undersokelser/19-262"
The investigation reports of the Japan Transport
Safety Board; cases of loss of power, (inJapanese),

Chapter

Chapter 4

Page No.

P. 57

Corresponding
sectionPhotograph 4-1 (a), (b)Chaper 4

P. 58

Law Officesof Toda & Co.

Chapter 3
Reference
Material

P. 38/119
Reference Material 05:
Transport Safety Board
investigation reports forJapan; cases of loss of
power

Chapter 4
Chapter 5

P. 60/61/99

Photograph 4-2 (a), (b)Table 4-3
Photograph 5-33 (b)Accident4 URL http://www.mlit.go.jp/jtsb/ship/
rep-inci/2015/keibi2015-49_2014yh0152.pdf
Accident5 URL http://www.mlit.go.jp/jtsb/ship/
rep-inci/2015/keibi2015-919_2015yh0029.pdf
Accident6 URL http://www.mlit.go.jp/jtsb/
ship/rep-inci/2019/MI2019-32_2018tk0008.pdf

Chapter 5

P. 65

Figure 5-1

Accident7 URL http://www.mlit.go.jp/jtsb/
ship/rep-inci/2013/MI2013-111_2013tk0012.pdf
Figure 5-2
Chapter 5

132

P. 45

Photograph 3-11

DVD "Ship Handling in Restricted Waters Anchoring -", Japan Captains' Association

Text Book "BUNKERING" published by JSU,IMMAJ, MOL Engineering.
URL http://www.immaj.jp/

Web site of U.S. Energy Information
Administration (EIA)"Coming changes in marine fuel sulfur limits willaffect global oil markets DECEMBER 14, 2018(based on International Marine Organization,
European Union, and China’s Ministry ofTransport)"
URL https://www.eia.gov/todayinenergy/detail.
php?id=37793

Accident8 URL http://www.mlit.go.jp/jtsb/ship/
rep-inci/2012/keibi2012-1047_2012mj0062.pdf

Chapter3"Importance of Preservation of Evidence in Bad
Bunker Issue", Lawyer Mr.Aoki, Marine Proctor
Mr. Yamatani, Law Offices of Toda & Co.
URL http://www.todalaw.co.jp/index.html

Accident2 URL http://www.mlit.go.jp/jtsb/ship/
rep-inci/2018/keibi2018-117_2018yh0029.pdf
Accident3 URL http://www.mlit.go.jp/jtsb/ship/
rep-inci/2016/keibi2016-39_2015yh0132.pdf"07 August 2018 Contaminated Bunkers
damage hundreds of ships Do authorities
really care? Prelude to 1 January 2020 safety
problems? ", An INTERTANKO Critical Review(INTERTANKO) ,URL https://www.intertanko.com/topicsissues/issuearticle/contaminated-fuels-anintertanko-critical-review?topicID=115

Accident1 URL http://www.mlit.go.jp/jtsb/ship/
rep-inci/2019/keibi2019-63_2018hd0069.pdf

3-2-3
Transport Safety Board
investigation reports forJapan; cases of loss of
power

References

P. 66/67

5-1-1
Production of marine
fuel oils"2020nen no IMO kisoku tekigouyu nitsuite",
Manabu watanabe, JXTG Nippon Oil & Energy
Corporation, Japan Ship Machinery andEquipment Association, dai 27kai hakuyo
gijyutsu foram, September 19th 2019, (inJapanese)133

P&I Loss Prevention Bulletin

Chapter

Page No.

Corresponding
sectionJAPAN P& I CLUB

References

Chapter

Page No.

5-1
IMO 2020 compliant fueloil concerns

Chapter 5

P. 66/69/97

5-2
Precautions andcountermeasures forsafe usage of 2020 IMO
compliant fuel oil

2019 ClassNK Technical Seminars,(in Japanese)(Tokyo June 6th , Kobe June 12th ,Imabari June
13th , Hiroshima June 14th ),Chapter 5

P. 66/67

Corresponding
sectionReferences

5-1-1
Production of marine
fuel oils"Sekiyu seihin no dekirumade", Petroleum
Association of Japan, June 2010, (in Japanese),

Figure 5-3

URL https://www.classnk.or.jp/classnk-rd/
seminar/2019/0606.html

5-3
Countermeasures for thesafe use of cylinder oil

5-1
IMO 2020 compliant
fuel oil concerns

Chapter 5

P. 66/69/97

5-2
Precautions andcountermeasures forsafe usage of 2020 IMO
compliant fuel oil
5-3Countermeasures for thesafe use of cylinder oil

URL https://www.paj.gr.jp/about/publications/

Chapter 5

P. 66/67

ClassNK “Guidance for onboard use ofCompliant Fuel Oil with SOx regulation from2020” (March 2019)
Guidance is available to download free ofcharge via ClassNK’s website www.classnk.com
for those who have registered for the ClassNK
My Page” service.

5-1-1
Production of marine
fuel oils
Figure 5-3

URL http://www.classnk.or.jp
Chapter 5

P. 66/67

5-1-1
Production of marine
fuel oils
Figure 5-3"Hakuyo teiiou nenryoyu no seizo houho tokyokyu taisei", Toshiaki Hayashi, Journal of
the Japan Institute of Marine Engineering,
Vol.43No.2 (2008), (in Japanese),
URL https://www.jstage.jst.go.jp/article/
jime2001/43/2/43_2_164/_pdf/-char/ja"Production Method and Quality of Low Sulfur
Fuels", Toshiaki Hayash, Journal of the Japan
Institute of Marine Engineering, Vol.50No.3(2015), (in Japanese),
URL https://www.jstage.jst.go.jp/article/
jime/50/3/50_341/_pdf

5-1
IMO 2020 compliant fueloil concerns

Chapter 5

P. 66/69/101

5-2
Precautions and countermeasures for safe usageof 2020 IMO compliant
fuel oil
5-4-2
Diagnosis of cold flow
properties

134

ClassNK “Booklet for ship crew members:
Precautions concerning change-over to 0.50%
sulphur compliant fuel oils”,（September 2019),
URL https://www.classnk.or.jp/hp/pdf/activities/
statutory/soxpm/soxbooklet201909en.pdf

Chapter 5

P. 66/67

5-1-1
Production of marine
fuel oils
Figure 5-3"Ippan kaiki 2020nen tekigoyu no seizo
houho to hinshitsu nitsuite" Toshiaki Hayashi,
National Institute of Maritime, Port andAviation Technology, Japan Marine Engineers’
Association, Technical lecture, November 15th
2019, (in Japanese),
URL http://www.marine-engineer.or.jp/keihin/

135

P&I Loss Prevention Bulletin

Chapter

Chapter 5

Page No.

P. 66/67

Corresponding
section

5-1-1
Production of marine
fuel oils
Figure 5-3

Chapter 5

P. 66/70/82

5-1-1
Production of marine
fuel oils
Figure 5-5JAPAN P& I CLUB

References"Banker jyuyu no tyakkasei hyoka", Yuta Mitsui,
JXTG central technical research laboratory.
JXTGTechnical Review Vol.55No.3 (October2013), (in Japanese),

Chapter

Chapter 5

Page No.

P. 75/86

Corresponding
sectionPhotograph 5-10
Photograph 5-20

Chapter 5

P. 77

Table 5-11

Figure 5-4

CIMAC Guideline "Cold flow properties ofmarine fuel oils" CIMAC WG7 Fuels. 2015,

Chapter 5

136

P. 74/83/87/91/94

P. 86

Photograph 5-20

Web site of U.S. Energy Information
Administration (EIA)"Crude oils have different quality characteristics
JULY 16, 2012 (international crude oil handbook
density and sulphur content of selected crudeoil)",
URL https://www.eia.gov/todayinenergy/detail.
php?id=7110#

Photograph 5-9
Photograph 5-17
Figure 5-18
Photograph 5-22
Photograph 5-25
Photograph 5-29

“Summary of Damage” ClassNK Technical
Review (Kaishi), (No312, No316)"Fuel oils", Nobuyuki Awai, Osamu Hanashima,
Saiji Yokosawa, Sankaido Publising Co.,Ltd.,
1994, (in Japanese)

Chapter 5

P. 68

Web site of Ministry of Land, Infrastructure,
Transport and Tourism, Japan
Guide for use of 2020 SOx regulation compliant
fuel oils ver.2, (Maritime Bureau of the Ministryof Land, Infrastructure, Transport and Tourism),
Oct 2019, (in Japanese),
URL h ttps://www.mlit.go.jp/common/0013074
84 .pdf

URL https://www.eneos.co.jp/company/rd/
technical_review/pdf/vol55_no03_07.pdf

Graph in Figure 5-15

Chapter 5

References"Sulphur Cap 2020 Tackling a Paradigm Shift in
the Shipping Industry 6 sept 2018"
Kjeld Aabo (Director New Technologies, MAN
Energy Solutions),
Charlotte Rojgaard (Bureau Veritas),
Fuel 2020 Circle SMM in Hamburg Sep. 2018
CIMAC Circle at SMM,
URL https://www.cimac.com/cms/upload/
events/circles/circle_2018_SMM/CIMAC_
Circle_SMM_2018.pdf

URL h ttps://www.cimac.com/cms/upload/
workinggroups/WG7/CIMAC_WG7_2015_01_Guideline_Cold__Flow_Properties_
Marine_Fuel_Oils_final.pdf

Guidance for shipowners and operators on
MARPOL Annex VI Sulphur Regulation [Sulphur
2020: What’s your plan?] Lloyd’s Register
Chapter 5

P. 87

Photograph 5-23
URL https://info.lr.org/l/12702/2018-06-04/4yx
18k/12702/188510/mo_sulphur_2020_
guidance_document_201805.pdf
Table 5-24

Chapter 5

P. 90/92/102

5-2-5 ⑤
Ignition and combustion
quality
5-4-3
Assessment of ignition
quality

ISO 8217:2017 Petroleum products — Fuels(class F) — Specifications of marine fuels,International Organization for Standardization
URL h ttps://www.iso.org/home.html (in English),Japanese Standards Association
URL h ttps://www.jsa.or.jp/ (In Japanese)137

P&I Loss Prevention Bulletin

Chapter

Chapter 5

Chapter 5

Page No.

P. 97

P. 97

Corresponding
section

5-3
Countermeasures for thesafe use of cylinder oil

5-3Countermeasures for thesafe use of cylinder oil

JAPAN P& I CLUB

References

Chapter"Performance of Marine Lubricants", Shigeki
Takeshima, Journal of the Japan Institute ofMarine Engineering, Vol.45 No.1（2010）,(inJapanese),
URL https://www.jstage.jst.go.jp/article/jime/
45/1/45_44/_pdf/-char/ja

Reference
Material"Kinnen no hakuyo enjinyu wo torimaku
kankyo to taio gijyutsu" Yoko Morita, ENEOS
Technical Review, Vol.54No.1(February 2012),(inJapanese),

Reference
Material

Page No.

Corresponding
sectionP. 127

Reference Material 07:(1) Inability to move or
think

P. 128

URL https://www.noe.jxtg-group.co.jp/
company/rd/technical_review/pdf/vol54_
no01_07.pdf

Reference Material 07:(2) Preventive measuresagainst panic

References"The Unthinkable: Who Survives When Disaster
Strikes – and Why" Amanda Ripley, Random
House Audio (Machiko Oka translated inJapanese, Kobunsha Co., Ltd.)"Anzen. kikikanri ni kansuru kosatsu (sono2)
Kinkyuji no ningen kodo tokusei""Tomihiko
Furuta, Kokusai chiikigaku kenkyu, No.6
March 2003 Faculty of Regional Development
Studies Toyo University (in Japanese),
URL https://toyo.repo.nii.ac.jp/?action=
repository_uri&item_id=3884&file_id=22&
file_no=1

CIMAC Recommendation 31 "The Lubricationof Two-Stroke Crosshead Diesel Engines"
CIMAC WG8 Marine Lubricants 2017
Chapter 5

Chapter 5

P. 97

5-3
Countermeasures for thesafe use of cylinder oil

P. 100Spot test kit
Photograph 5-34
Photograph 5-35

URL https://www.cimac.com/cms/upload/
Publication_Press/Recommendations/Final_
Draft_Recommendation_31_2017-06-23_
CIMAC_WG8-SG4_2-Stroke_Lubrication.
pdf

Reference
MaterialP. 128Reference Material 07:(2) Preventive measuresagainst panic"Natural Disaster and Panic" Shunji Mikami,
Fukumura Shuppan Inc., (in Japanese)

Nippon Yuka Kogyo Co., Ltd.  Onboard test kit:
fuel oil spot test
URL https://www.nipponyuka.jp/products08.
html

Acknowledgment:
The author sincerely thanks everyone for their precious contributions
and advice. Extended thanks also go out to colleagues and those who

Reference
Material

138

P. 111/114

Reference Material 03:
Problem Solving Method(1) Logic tree
(2) Fishbone

kindly allowed us use of their reference materials.
"Jyoho wo shunji ni seiri shite aidhia wo
umidasu! Noto ・ Memo furu katsuyo jyutsu"
Nagaokashoten Henshu-bu, (in Japanese)139

P&I Loss Prevention Bulletin

AuthorChief Engineer, Marine Proctor, Keishi Kuwada
The Japan Ship Owners’ Mutual Protection & Indemnity Association

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