The coal carrier was due to enter the Port of Newcastle to load 58,000 tonnes of coal when it was beached at Nobbys Beach off Newcastle during gale force winds and high seas on June 8 last year.

It remained beached for 25 days until it was eventually guided to deep water by three tugs on July 2 amidst concerns of an oil leak from its cracked hull.

The ATSB report concluded the master made a number of decisions contrary to the principles and practice of good seamanship. Furthermore, if some had been made differently, the grounding “probably would not have occurred”

“The master’s decisions when the ship was at anchor were probably made on risky assumptions that the weather forecast was not significant enough to be of real concern and that the anchor would hold in the weather which was forecast,” the report said.

“These ill-founded assumptions were due to his poor understanding of anchor holding power and local weather conditions and the limitations of the Newcastle anchorage.

“The master continued to ignore signs that a dangerous situation was developing and subsequently became affected, to varying degrees, by fatigue, anxiety, overload and panic.”

The report found the critical decisions made by the master included:

Failing to ballast the ship appropriately for the forecast heavy weather;

Failing to leave the anchorage at an appropriately early stage;

Not preparing appropriately for the emergency deployment of the anchors and not deploying the anchors;

Conning the ship inappropriately at critical times, including ordering the 20-degree course alteration to put the ship’s head through strong gale force winds without controlling the turn himself by giving appropriate rudder orders or monitoring the helm subsequently; and

Attempting the final turn to starboard towards the lee shore that was less than a mile away.

The report also found that a number of other ships attempted to ride out the gale at anchor and the majority also dragged their anchors.

“It was also found that the substantial ship queue increased the risks in the anchorage and resulted in another near grounding, a near collision and a number of close-quarters situations at the time,” the report said.

The ATSB’s sequence of events that led to the grounding:

May 23:Pasha Bulker anchored about two miles off the coast near Newcastle and joined the queue of 57 ships to wait its turn for loading coal.

June 7: The Bureau of Meteorology issued a gale warning for the area. At midday, the master deployed additional anchor cable and decided to monitor the weather and the ship’s anchor position.

6am, June 8: The wind was gusting to nearly 50 knots and Pasha Bulker was among 27 ships still at anchor. At 6.37am, the master decided to weigh anchor.

7.48am: The ship got underway and for more than an hour moved in a northeast direction parallel to the coast about one mile away with the wind on its starboard bow.

9.06am: The master decided to alter course to put the wind on the ship’s port bow and clear the coast in a southerly direction. The course change in the extreme weather was poorly controlled and the ship’s heading became southwesterly instead of south-southeast as intended.

9.51am: Grounding at Nobbys Beach.