Language selection

Backgrounder

Investigation findings (M15P0347) in the October 2015 capsizing and sinking of the passenger vessel Leviathan II off Plover Reefs in Clayoquot Sound, British Columbia

Investigations conducted by the Transportation Safety Board of Canada (TSB) are complex – an accident is never caused by just one factor. The October 2015 accident off Plover Reefs in Clayoquot Sound, British Columbia, was no exception. There were many factors that caused this accident, the details of which are contained in the seven findings as to causes and contributing factors. Furthermore, there were four findings as to risk as well as two other findings.

Findings as to causes and contributing factors

  1. While the Leviathan II was at Plover Reefs, the conditions were favourable for the formation of breaking waves.
  2. The vessel maintained position on the weather side of the reef, exposed to the incoming swell, to allow passengers to view wildlife. As the vessel was leaving the area, a large wave approached the vessel from the starboard quarter.
  3. Moments before the wave struck, the master became aware of it and attempted to realign the vessel to minimize its impact, but there was not enough time for his actions to be effective.
  4. The forces exerted on the vessel by this large breaking wave caused it to broach and rapidly capsize.
  5. The rapid capsizing resulted in the passengers and crew falling into the cold sea water without flotation aids or thermal protection, exposing them to the effects of cold water immersion.
  6. Approximately 45 minutes elapsed before search-and-rescue (SAR) resources became aware of the capsizing, as the crew did not have time to transmit a distress call before the capsizing, nor did the vessel have a means to automatically send a distress call.
  7. The crew members were able to discharge a parachute rocket, which alerted a nearby Ahousaht First Nation fishing vessel that was instrumental in saving the lives of a number of survivors.

Findings as to risk

  1. If companies that operate passenger vessels do not implement risk management processes to identify and address environmental hazards in their area of operation, such as the potential formation of breaking waves, then there is a risk of a similar capsizing and loss of life.
  2. If there is no requirement for companies to assess their operations to determine under which conditions flotation aids should be worn, there remains a risk that passengers on this class of vessel will be deprived of the benefits of a flotation aid in the event of sudden and unexpected immersion in cold water.
  3. If vessels do not have effective means to promptly notify SAR authorities of an emergency, especially in capsizing situations, there is a risk of a delay in SAR response that will hinder the survival chances of passengers and crew.
  4. If seafarers do not fully disclose medical information, and marine medical examiners do not request supporting data, medical files may be incomplete, increasing the risk that seafarers will carry out their duties when not medically fit.

Other findings

  1. The life raft deployed in the occurrence was fitted with a Class B (Canadian) emergency pack, which did not contain devices effective for initially signalling distress, such as a parachute rocket or buoyant smoke float.
  2. Although the master's eyesight was not causal in the occurrence, there was a discrepancy between test results for unaided vision obtained privately and those obtained during TC medical examinations.