- Investigation finds master of Fiordland Navigator likely fell asleep due to fatigue
- Operator RealNZ criticised for poor fatigue management and safety monitoring systems
- Company has since improved policies, staffing and oversight to prevent future incidents
The pilot of the Fiordland Navigator was likely asleep when the vessel ran aground in Doubtful Sound in January 2024, according to a report released by the Transport Accident Investigation Commission.
The boat, operated by RealNZ, struck the shoreline on 24 January with 57 passengers on board. The grounding caused moderate damage to the vessel, including a hole below the waterline, and several passengers sustained minor injuries.
The Commission concluded it was “virtually certain the fatigued master fell asleep at the helm”. The report said the master was on the sixth day of a seven-day shift and had likely been experiencing workload-related fatigue. This fatigue had not been recognised or managed by RealNZ’s safety systems.
Chief investigator of accidents Naveen Kozhuppakalam said RealNZ had weak systems in place to manage fatigue risks. “RealNZ's safety system didn't monitor actual rest hours or effectively manage fatigue risks for sole-charge masters. And while the master held a valid medical certificate, there was no process to ensure ongoing medical fitness during the two-year certification period,” he said in a written statement.
He also noted that the person responsible for safety oversight had an “excessive workload”, which limited their ability to manage fatigue risks effectively.
The report added that the effects of prescribed medication may have contributed to the master’s drowsiness, but the Commission could not confirm this.
Following the incident, RealNZ took several steps to address the concerns raised. Kozhuppakalam noted that the company had “strengthened fatigue policies, training, and work-hour monitoring”. It also reintroduced a second person to the wheelhouse during navigation, reinstated the master’s assistant role, and created a new maritime resource planner role to help improve safety oversight.
The investigation serves as a reminder of the importance of effective fatigue management in ensuring maritime safety.