Defects and observations

ISM Code 9 — reports and analysis of non-conformitiesThe safety management system shall include procedures ensuring that non-conformities, accidents and hazardous situations are reported to the company, investigated and analysed with the objective of improving safety. A reporting route the crew will not use satisfies the letter of that and none of the point.

Reporting culture is not created by a policy. It is created by whether a deck hand with oily hands, standing next to the thing that is wrong, can report it before he forgets — on the phone in his pocket, in under a minute, without a login he does not have and a form with a mandatory root cause field.

So this module is two cards and one button. A defect is something broken. An observation is something unsafe that has not broken yet. Both take a photo, a place and a sentence, and both go somewhere a person will read them.

• Reportable by everybody. The permission to report is held by every role in the product, including the ones that can do almost nothing else. A system where only officers can report is a system that hears from officers.
• A photo, reduced on the device. The image is scaled down before it leaves the phone, so a report goes out over a satellite link at a size that arrives.
• A defect becomes maintenance, and keeps its origin. When a defect turns out to be work, it becomes a job on the component with the report still attached — so the history shows what was seen, not just what was done.
• Observations are not a performance metric. There is no card count per department and no league table. Counting observations is how you get observations about tidy stores and none about the thing everybody is worried about.
• A place from the vessel’s own register. The same locations the permits use. A report that says which space is the report that can be found again.
• Visible to the office, without being taken off the vessel. The superintendent sees it as soon as the vessel has a link, and the vessel keeps the record whether the link comes back or not.

• Report something — one button, two cards
• Observations — the register, by year and month
• Defects — open, in hand, and what became a job

We timed it. A defect with a photo, a place and a sentence takes about forty seconds on a phone from a cold start, including the unlock. That number is the design constraint, and every field that was proposed for this form was measured against it and most of them lost.

The analysis fields — cause, category, corrective action — exist, and they are filled in afterwards by the person whose job that is. Asking the reporter for them is how you get no reports.