Code
Code for the Investigation of Marine Casualties and Incidents
1. Introduction
1.1 This Code recognizes that under IMO conventions each flag
State has a duty to conduct an investigation into any casualty occurring
to any of its ships when it judges that such an investigation may assist
in determining what changes in the present regulations may be desirable
or if such a casualty has produced a major deleterious effect upon the
environment. The Code also takes into account that under the provisions
of UNCLOS article 94, a flag State shall cause an inquiry to be held,
by or before a suitably qualified person or persons into certain casualties
or incidents of navigation on the high seas. However, the Code also recognises
that where a casualty occurs within the territorial sea or internal waters
of a State, that State has a right, under UNCLOS article 2, to investigate
the cause of any such casualty which might pose a risk to life or to the
environment, involve the coastal State's search and rescue authorities,
or otherwise affect the coastal State.
1.2 The aim of this Code is to promote a common approach to the
safety investigation of marine casualties and incidents, and also to promote
co-operation between States in identifying the contributing factors leading
to marine casualties. The result of this common approach and co-operation
will be to aid remedial action and to enhance the safety of seafarers
and passengers and the protection of the marine environment. In achieving
these aims, this Code recognizes the need for mutual respect for national
rules and practices and puts particular emphasis upon co-operation.
1.3 By introducing a common approach to marine casualty investigations
and the reporting on such casualties, the international maritime community
may be better informed about the factors which lead up to and cause, or
contribute to, marine casualties. This may be facilitated by:
.1 Clearly defining the purpose of marine casualty investigation
and the guiding principles for its conduct.
.2 Defining a framework for consultation and co-operation between
substantially interested States.
.3 Recognizing that the free flow of information will be promoted
if individuals who are attempting to assist the investigation may be
offered a degree of immunity, both from self-incrimination and from
any ensuing risk to their livelihood.
.4 Establishing a common format for reports to facilitate publication
and sharing of the lessons to be learned.
1.4 It is not the purpose of the Code to preclude any other form
of investigation, whether for civil, criminal, administrative, or any
other form of action, but to create a marine casualty investigation process
the aim of which is to establish the circumstances relevant to the casualty,
to establish the causal factors, to publicise the causes of the casualty
and to make appropriate safety recommendations. Ideally, marine casualty
investigation should be separate from, and independent of, any other form
of investigation.
2. Objective
The objective of any marine casualty investigation is to prevent similar
casualties in the future. Investigations identify the circumstances of
the casualty under investigation and establish the causes and contributing
factors, by gathering and analysing information and drawing conclusions.
Ideally, it is not the purpose of such investigations to determine liability,
or apportion blame. However, the investigating authority should not refrain
from fully reporting the causes because fault or liability may be inferred
from the findings.
3. Application
This Code applies, as far as national laws allow, to the investigation
of marine casualties or incidents where either one or more interested
States have a substantial interest in a marine casualty involving a ship
under their jurisdiction.
4. Definitions
For the purpose of this Code:
4.1 Marine casualty means an event that has resulted in any of
the following:
.1 the death of, or serious injury to, a person that is caused
by, or in connection with, the operations of a ship; or
.2 the loss of a person from a ship that is caused by, or in
connection with, the operations of a ship; or
.3 the loss, presumed loss or abandonment of a ship; or
.4 material damage to a ship; or
.5 the stranding or disabling of a ship, or the involvement
of a ship in a collision; or
.6 material damage being caused by, or in connection with,
the operation of a ship; or
.7 damage to the environment brought about by the damage of
a ship or ships being caused by, or in connection with, the operations
of a ship or ships.
4.2 Very serious casualty means a casualty to a ship which involves
the total loss of the ship, loss of life or severe pollution.
4.3 Serious casualty means a casualty which does not qualify as
a very serious casualty and which involves:
.1 a fire, explosion, grounding, contact, heavy weather damage,
ice damage, hull cracking or suspected hull defect, etc., resulting
in;
.2 structural damage rendering the ship unseaworthy, such as
penetration of the hull underwater, immobilization of main engines,
extensive accommodation damage etc.; or
.3 pollution (regardless of quantity); and/or
.4 a breakdown necessitating towage or shore assistance.
4.4 Marine incident means an occurrence or event being caused
by, or in connection with, the operations of a ship by which the ship
or any person is imperilled, or as a result of which serious damage to
the ship or structure or the environment might be caused.
4.5 Causes means actions, omissions, events, existing or pre-existing
conditions or a combination thereof, which led to the casualty or incident.
4.6 Marine casualty or incident safety investigation means a process
held either in public or in camera conducted for the purpose of casualty
prevention which includes the gathering and analysis of information, the
drawing of conclusions, including the identification of the circumstances
and the determination of causes and contributing factors and, when appropriate,
the making of safety recommendations.
4.7 Marine casualty investigator means a person or persons qualified
and appointed to investigate a casualty, or incident, under procedures
laid down in national legislation for the furtherance of marine safety
and protection of the marine environment.
4.8 Serious injury means an injury which is sustained by a person
in a casualty resulting in incapacitation for more than 72 hours commencing
within seven days from the date of injury.
4.9 Ship means any kind of vessel which is used in navigation
by water.
4.10 Lead investigating State means the State that takes responsibility
for the conduct of the investigation as mutually agreed between the substantially
interested States.
4.11 Substantially interested State means a State:
.1 which is the flag State of a ship that is the subject of
an investigation; or
.2 in whose internal waters or territorial sea a marine casualty
has occurred; or
.3 where a marine casualty caused, or threatened, serious harm
to the environment of that State, or within those areas over which the
State is entitled to exercise jurisdiction as recognised under international
law; or
.4 where the consequences of a marine casualty caused, or threatened,
serious harm to that State or to artificial islands, installations,
or structures over which it is entitled to exercise jurisdiction; or
.5 where, as a result of a casualty, nationals of that State
lost their lives or received serious injuries; or
.6 that has at its disposal important information that may be of use
to the investigation; or
.7 that for some other reason establishes an interest that is
considered significant by the lead investigating State.
5. Conduct of marine casualty investigations
5.1 Where an investigation is to be conducted, the following should
be taken into consideration:
.1 Thorough and unbiased marine casualty investigations are
the most effective way of establishing the circumstances and causes
of a casualty.
.2 Only through co-operation between States with a substantial
interest can a full analysis be made of a marine casualty.
.3 Marine casualty investigations should be given the same priority
as criminal or other investigations held to determine responsibility
or blame.
.4 Marine casualty investigators should have ready access to
relevant safety information including survey records held by the flag
State, the owners, and classification societies. Access to information
should not be barred by reason of competing investigations.
.5 Effective use should be made of all recorded data, including
voyage data recorders (VDR), if fitted, in the investigation of a marine
casualty or marine incident wherever it occurred. The State conducting
the investigation should arrange for the read-out of the VDR.
.6 Marine casualty investigators should be afforded access to
Government surveyors, coastguard officers, vessel traffic service operators,
pilots or other marine personnel of the respective States.
.7 The investigation should take into account any recommendations
or instruments published by IMO or ILO, in particular those relating
to the human factor, and any other recommendations or instruments adopted
by other relevant international organizations.
.8 Reports of investigations are most effective when released
to the shipping industry and public.
5.2 In accordance with 9, other substantially interested States
should be invited to be represented during any such investigation and
should be admitted as a party in the proceedings and have equal standing,
rights and access to evidence as the State conducting the investigation.
5.3 Recognizing that any vessel involved in a casualty may continue
in service and that a ship should not be delayed more than is absolutely
necessary, the State conducting the investigation should start the investigation
as soon as practicable, without delaying the ship unreasonably. Other
substantially interested States may, by mutual agreement, join the investigation
either immediately or at a later stage.
6. Responsibility for investigating casualties and incidents
6.1 Flag States are encouraged to ensure that investigations are
carried out into all casualties occurring to its ships. All cases of serious
and very serious casualties should be investigated.
6.2 Where a marine casualty or incident occurs within the territorial
sea of a State, the flag and coastal States recognizing the obligations
of that State to its citizens and the legal status of the territorial
sea under the provisions of UNCLOS and also recognising the duties placed
on a flag State, the flag and coastal States should co-operate to the
maximum extent possible, and mutually agree which State should take the
role of lead investigating State.
6.3 Where a marine casualty or incident occurs on the high seas,
a flag State should carry out an investigation into a casualty to, or
on, any of its ships. If that casualty is a collision involving a ship
of another flag State, then the States should consult with each other
and agree which will be the lead investigating State and determine the
best means of co-operation under this Code. In line with 9.1, if another
State is a substantially interested State by virtue of the nationality
of the ship's crew, passengers or other persons, or the location of the
casualty, that State or States should be invited to take part in the investigation.
6.4 By fully participating in an investigation conducted by another
substantially interested State, the flag State shall be considered as
fulfilling its obligations under UNCLOS article 94, section 7.
6.5 An investigation should be started as soon as practicable
after the casualty occurs. Substantially interested States should, by
mutual agreement, be allowed to join an investigation conducted by another
substantially interested State at any stage of the investigation.
7. Responsibilities of the lead investigating State
The lead investigating State should be responsible for:
.1 developing a common strategy for investigating the casualty
in liaison with substantially interested States;
.2 providing the investigator in charge and coordinating the
investigation;
.3 establishing the investigation parameters based on the laws
of the investigating State and ensuring that the investigation respects
those laws;
.4 being the custodian of records of interviews and other evidence
gathered by the investigation;
.5 preparing the report of the investigation, and obtaining and
reflecting the views of the substantially interested States;
.6 coordinating, when applicable, with other agencies conducting
other investigations;
.7 providing reasonable logistical support; and for
.8 liaison with agencies, organizations and individuals not part
of the investigating team.
8. Consultation
8.1 Notwithstanding the obligation placed on the master or owners
of a ship to inform its flag State authority of any casualty occurring
to the ship, where a casualty or incident occurs in the internal waters
or territorial sea of another State, the coastal State should notify,
with a minimum of delay, the flag State or States of the circumstances
and what, if any, action is proposed by the coastal State.
8.2 Following a casualty, the investigating State should inform
the other substantially interested States, either through the Consular
Office in that State or by contacting the relevant authorities listed
in MSC/Circ.781/ MEPC.6/Circ.2. That State and the other substantially
interested States should consult, at the earliest opportunity, on the
conduct of the investigation and to determine details of co-operation.
8.3 Nothing should prejudice the right of any State to conduct
its own separate investigation into a marine casualty occurring within
its jurisdiction according to its own legislation. Ideally, if more than
one State desires to conduct an investigation of its own, the procedures
recommended by this Code should be followed, and those States should co-ordinate
the timing of such investigations to avoid conflicting demands upon witnesses
and access to evidence.
9. Co-operation
9.1 Where two or more States have agreed to co-operate and have
agreed the procedures for a marine casualty investigation, the State conducting
the investigation should invite representatives of other substantially
interested States to take part in the investigation and, consistent with
the purpose of this Code, allow such representatives to:
.1 question witnesses;
.2 view and examine evidence and take copies of documentation;
.3 produce witnesses or other evidence;
.4 make submissions in respect of the evidence, comment on and
have their views properly reflected in the final report; and
.5 be provided with transcripts, statements and the final report
relating to the investigation.
9.2 States are encouraged to provide for maximum participation
in the investigation by all States with a substantial interest in the
marine casualty.
9.3 The flag State of a ship involved in a marine casualty should
help to facilitate the availability of the crew to the investigation and
encourage the crew to co-operate with the State conducting the investigation.
10. Disclosure of records
10.1 The State conducting the investigation of a casualty or incident,
wherever it has occurred, should not make the following records, obtained
during the conduct of the investigation, available for purposes other
than casualty investigation, unless the appropriate authority for the
administration of justice in that State determines that their disclosure
outweighs any possible adverse domestic and international impact on that
or any future investigation, and the State providing the information authorizes
its release:
.1 all statements taken from persons by the investigating authorities
in the course of the investigation;
.2 all communications between persons having been involved in
the operation of the ship;
.3 medical or private information regarding persons involved
in the casualty or incident;
.4 opinions expressed during the conduct of the investigation.
10.2 These records should be included in the final report, or
its appendices, only when pertinent to the analysis of the casualty or
incident. Parts of the record not pertinent, and not included in the final
report, should not be disclosed.
11. Personnel and material resources
Governments should take all necessary steps to ensure that they have
available sufficient means and suitably qualified personnel and material
resources to enable them to undertake casualty investigations.
12. Issue of marine casualty reports and submission to IMO
12.1 The lead investigating State should send a copy of the draft
of the final report to all substantially interested States, inviting their
significant and substantiated comments on the report as soon as possible.
If the lead investigating State receives comments within thirty days,
or within some mutually agreed period, it should either amend the draft
final report to include the substance of the comments, or append the comments
to the final report. If the lead investigating State receives no comments
after the mutually agreed period has expired, it should send the final
report to the Organization in accordance with applicable requirements
and cause the report to be published.
12.2 By fully participating in an investigation conducted by another
substantially interested State that will be reporting to IMO, the flag
State shall be considered as fulfilling its obligations under IMO conventions.
12.3 Reports, or relevant parts of reports, into the circumstances
and causes of a marine casualty should be completed as quickly as practicable,
and be made available to the public and the shipping industry in order
to enhance safety of life at sea and protection of the marine environment
through improved awareness of the factors which combine to cause marine
casualties.
12.4 Where a substantially interested State disagrees with whole
or part of the report referred to in 12.1 above, it may submit its own
report to the Organization.
12.5 The investigating State, upon determining that urgent safety
action is needed, may initiate interim recommendations to the appropriate
authority.
13 Re-opening of investigations
When new evidence relating to any casualty is presented, it should be
fully assessed and referred to other substantially interested States for
appropriate input. In the case of new evidence which may materially alter
the determination of the circumstances under which the marine casualty
occurred, and may materially alter the findings in relation to its cause
or any consequential recommendations, States should reconsider their findings.
Survey Results
Results of a Survey on the Implementation of the IMO Code for the Investigation
of Marine Casualties and Incidents.
Website: http://maiif.tsb.gc.ca
Username: maiif
password: maiifsurvey

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