Category Archives: productivity

Attacks on hospital’s nurses blamed on ER overflow, congestion

Violence against nurses has continued at Abbotsford Regional Hospital in Abbotsford, B.C., and incidents over the last few months have led to a recent WorkSafeBC inspection report noting an emergency room (ER) running over capacity.

A registered psychiatric nurse (RPN) suffered a severe concussion after getting kicked in the head by a patient in the ER on Oct. 17, and two RPNs and a security guard were assaulted by a young patient on Sept. 8. Both assailants had been patients with mental-health issues whom the police had brought in, said Val Avery, president of the Health Sciences Association of British Columbia (HSA), one of the unions representing the hospital’s employees.

“Mental health is the public healthcare crisis of our times,” said Avery. “Our ability to respond to it in a healthcare setting has not grown with the same type of need that is required here. So we’re getting these overflowing departments and not the appropriate settings to care for the patients.”

Three more RPNs at the facility have been assaulted in the past few weeks, according to a Nov. 16 news bulletin from HSA. The hospital had 62 reported violent incidents between 2008 and early 2015, the union added.

Avery agreed that the large number of patients in the Abbotsford ER was a strong factor in the frequent violence. “Regardless of how many bodies are there, the police are still bringing in more people than the space can adequately handle. And so that places a lot of stress on the situation,” she explained.

But she also charged that the facility was not putting the right safety measures and practices in place to protect staff. For example, at the time of the Sept. 8 attack, the security guard who was assaulted was the only guard assigned to the area – “instead of the three that were supposed to be there,” she said. “There are a number of those types of violations.”

Last year, Fraser Health Authority (FHA), the organization that runs the Abbotsford hospital and others in the region, hired an outside consultant to conduct a review on violence in the facility. Released in July 2015, the report offered 29 recommendations to the hospital. But the hospital has yet to implement most of them, Avery claimed.

“I think they have looked at some things,” she said, “but staffing is an issue.” On top of understaffing, the hospital often does not assign a sufficient number of security guards to the ER, she added. “They haven’t adequately educated and trained all of their staff; I think there’s still at least ten per cent of the staff that haven’t received violence training.”

Valerie Spurrell, the executive director of Abbotsford Regional Hospital, disagreed that the facility had failed to implement the FHA report’s recommendations. She countered that the hospital had “often gone above and beyond just what was recommended” in areas such as training, staffing, protocols and personal protective devices for nurses over the previous year.

“We take every incident that happens very seriously,” Spurrell told COHSN, “so that we learn from them.”

Most significantly, the hospital has spent millions of dollars constructing a new emergency area designed specifically for patients with mental-health and substance-abuse issues. This space will open next summer, according to a news release that FHA sent out on Nov. 18. Adjacent to the current ER, the area is expected to have its own nursing station, consult rooms, stretcher bays and seclusion stations, with emergency doctors, nurses and psychiatrists on hand for immediate assessment and treatment.

“That will create a more calm and compassionate environment and increase safety for both patients and staff,” explained Spurrell, “and also reduce the congestion, a regular part of our emergency department right now, which is where those patients would normally be.”

“There are just a number of things that need to be looked at to ensure we have safer workplaces,” said Avery. “People just should not have to fear going to work in a healthcare setting.”

CP clashes with union over scheduling, workplace fatigue

The Canadian Pacific Railway (CP) continues to dispute publicly and privately with one of its unions, the Teamsters Canada Rail Conference, about the issue of fatigue among railway employees. The union has accused the railway of allowing unpredictable shift schedules that prevent workers from getting enough rest and even discouraging them from booking unfit (COHSN, Oct. 18).

In response, CP launched a new website, WorkRestAndTimeOff.ca, on Nov. 8. The site is intended as a fact-based resource about the corporation’s policies and procedures on employee breaks and time off. It includes information on what workers are entitled to in terms of rest and breaks, as well as on past union negotiations and more.

“There’s a lot of myth, inside and outside of our organization, with respect to what the expectations and what the opportunities are to take rest and time off in the railway industry,” said Peter Edwards, CP’s vice president of people, explaining the motivation behind the website. “We never make anyone go to work. It is the rule in all of our agreements. It says if you’re tired, you call in unfit. We’ve never proposed taking that away.”

Edwards said that CP gave employees ample opportunities for rest and time off, but noted that the rest periods were not mandatory and that the company had pushed for compulsory time off in negotiations. “People may or may not take any amount of rest on a given day,” he said, elaborating that it was up to the employees to manage their own time. “I’d say the majority, they do a pretty good job. In fact, they do a good job of managing their life and work and rest.

“We want to make sure people have good, predictable schedules. We want to make sure that people have good time off. And that’s quality-of-life consideration.”

Teamsters national president Doug Finnson called WorkRestAndTimeOff.ca an “incomplete” website with a lot of untruthful information.

“To be blunt, it’s an amateur act. It’s a very poor representation and a very misleading representation of reality,” said Finnson. “They’re blaming the workers for the problem. It’s so beneath a company that should be better.”

On Nov. 9, the union released a nine-page document, a Fatigue Risk Management Guiding Philosophy, to the public. The document, which the Teamsters have already shared with government and industry representatives as well as CP, details the union’s proposals for managing workplace fatigue through policy and scientific research.

“The document is a foundation of how we’re going to be moving forward,” explained Finnson. “We’re building a foundation of our fatigue-management system from the ground up. And so that’s really the foundation of everything we’re doing. And that’s going to govern our discussions with CN, CP, Bombardier, anybody that we deal with.”

He added that the union had hired a fatigue specialist to assist them in their research, “so that anything we do is grounded in science and we can justify doing it,” he said. “So we’re confident that the basis of our fatigue science is sound.”

Edwards referred to the Guiding Philosophy as “a nice general statement,” but felt that it did not provide anything “actionable” with which to work. He maintained that many CP employees worked excessive hours by their own choice, not because they were forced to do so through unpredictable shifts.

“I can’t think of one in all the industries I’ve been in where a person can say, ‘No, I want to do my next shift now,’ and we have to comply,” he said. “There’s absolutely no need for fatigue, no room for fatigue.”

While railway operations run on nonstop schedules, Edwards added, workers are not required to be available 24/7. Regarding claims that employees were ordered to start work at unpredictable times, he said, “It makes a good story; it just doesn’t happen to be true.”

Finnson said that the Teamsters had been successful in negotiating better scheduling systems with Canadian National, Bombardier and Toronto’s GO Transit, but that CP was making bargaining difficult with unacceptable concessions and false representations of failed negotiations. He accused CP of blaming everybody except itself for the ongoing employee fatigue problems.

“They’ve declared war on workers,” he said. “It’s absolutely ridiculous what’s taking place there.”

Alberta introduces bill against workplace bullying, harassment

Alberta employers may have a tougher time getting away with bullying and harassment from now on, as the provincial legislature has just proposed a law that would make harassment policies mandatory for workplaces.

Craig Coolahan, the MLA for Calgary-Klein, tabled a private member’s bill in the legislature in Edmonton on Nov. 9. The Occupational Health and Safety (Protection from Workplace Harassment) Amendment Act, 2016 passed its first reading and is moving on to its second.

“Currently, there is no legislation that recognizes bullying or psychological harassment in the workplace,” Coolahan wrote in an op-ed column submitted to various media outlets, including COHSN. “We can do better. Albertans deserve a workplace that is safe from both physical harm and the psychological and emotional damage that workplace harassment inflicts.”

If the bill passes, every Alberta employer will have to establish a workplace harassment policy and investigate all harassment complaints. If an employee is not satisfied with the resolution of a complaint, he or she will be able to file another complaint with a government occupational health and safety officer, who may mediate a resolution if the matter appears to have merit. An unsuccessful mediation could potentially result in “corrective action” against the accused perpetrator.

“In consultations with Alberta businesses of all sizes, individual victims, labour organizations and pertinent non-profit and professional organizations,” wrote Coolahan, “there is clear support for providing all Albertans with a safe, harassment-free work environment.”

One of the bill’s vocal supporters is Linda Crockett, a social worker and the founder and executive director of the Alberta Bullying Research, Resources & Recovery Centre in Edmonton.

“I am extremely excited to see this happen. I thought we were going to be waiting a few years before we saw it,” said Crockett. “All those people out there that are suffering, either just beginning that process or suffering in isolation, I see hope for them now.”

Coolahan cited a recent study revealing that 60 per cent of Alberta workers had experienced workplace harassment, while half of the victims of bullying or harassment would not report it. Of the ones who had sought help from their employers’ human-resources departments, 62 per cent said that the companies had taken no action.

If Coolahan’s bill becomes law, “employers are going to be accountable,” said Crockett. “If there is a policy that exists, they’re going to update it; they’re going to make it current. If there isn’t a policy, they’re going to be held accountable to create a policy. And then they’re going to be accountable to follow through on it.”

Only about 70 per cent of Alberta workplaces have harassment policies in place, according to recent information from the Human Resources Institute of Alberta. The policies that do exist are inconsistent, tending to vary from employer to employer.

Crockett explained that workplace bullying is usually an insidious type of psychological abuse that happens behind closed doors. “The tactics are quite subtle, passive-aggressive,” she said. So many perpetrators never face any consequences for their behaviour; indeed, many get promoted or transferred to other locations where they continue to bully employees.

“The process doesn’t work,” said Crockett. “There’s a breakdown in the system of complaint and policy.”

She added that Alberta also needed more education and training on workplace harassment by “qualified anti-bullying specialists,” as well as resources both for victims and for those who act out.

“Most people in the workplace don’t realize that they are being bullied until at least a year after, or until they become quite ill, and that’s when they finally reach out for help,” she said.

Coolahan clarified that the bill was intended to be preventative rather than punitive. “It’s about protecting all Albertans. It’s about ensuring that all employers and employees are familiar with what harassment is and what it is not, through the use of a robust harassment policy and training,” he said.

“I’m thrilled to be able to listen to Albertans and support them with this important legislation.”

Labour federation starts disability-prevention program for injured Ontario workers

The Ontario Federation of Labour (OFL) is hoping to diminish the number of disabilities from occupational injuries in the province with its prevention program, Prevention Link, which it launched at the beginning of November.

With support from the Government of Ontario, Prevention Link is now the only comprehensive disability-prevention program in the province, according to its website. Prevention Link will focus on the link between primary and secondary prevention – the former involving prevention of disease or injury before they happen, the latter aiming to reduce the long-term effects of an injury or illness.

“Secondary-prevention services are crucial to ensuring safe and healthy workplaces for all workers,” OFL president Chris Buckley said in a press statement. “It has been a diligent, collaborative and persistent effort to secure support for Prevention Link, and we are proud to once again have a tangible disability-prevention program at work.”

An expansion of the Occupational Disability Response Team (ODRT), which has served for more than 25 years, Prevention Link aims to offer training, mentorship, outreach and advice for both employers and workers. The program intends to help injured workers return to their jobs sooner, through education and awareness aimed at those most at risk.

“Ontarians can be confident that the reputable and effective training and injury prevention resources we’ve long offered have been enhanced by the ODRT redesign,” Prevention Link executive director Rob Halpin said in his own statement.

In a Nov. 1 media release about the program, the OFL cited statistics from the Workplace Safety and Insurance Board, Ontario’s workers’ compensation authority. According to the Board, there were 212 claims for Ontario workers who had died from occupational diseases in 2015, as well as 229,000 registered claims for lost time from work-related injuries or illnesses during the same year. But the real numbers were likely higher, since there are hundreds of deaths from unreported diseases every year, the OFL claimed.

“It’s a thrill to deliver a program that will place increased emphasis on the links between primary and secondary prevention of occupational injury, illness and disease in workplaces,” said Halpin.

Prevention Link is already offering disability-response training workshops and classes. Its core curriculum has six levels beginning with rights and obligations and ending with occupational disease. Other courses available cover topics like work disruptions, disability principles, mental stress, hearing loss, work transition and more.

More information about Prevention Link is available at its website, at http://www.preventionlink.ca.

Nursing-home director accused of harassing, abusing employees

A nursing home in Saint-Quentin, a mostly francophone town in northern New Brunswick, has hired an outside investigator to look into staff allegations that the home’s executive director has subjected workers to a poisoned work environment with verbal abuse, harassment and intimidation.

The allegations against André Savoie of the Résidence Mgr. Melanson stemmed from a petition circulated by local physicians, concerned about why so many employees of the home were requesting time off and whether its residents were getting appropriate care. This led to numerous staff complaints about Savoie’s treatment of them, according to René Doucet, a national representative with the Canadian Union of Public Employees (CUPE) assigned to the Melanson home.

“If I’m not mistaken,” said Doucet, there were “over 200 complaints that have been received. So it’s not the nature of the complaints that is completely out of reason; it’s the number of complaints that really sparked the interest of the board of directors for the nursing home.”

Many complainants accused Savoie of intimidating staff while being unresponsive to their questions and concerns, he added. “So they’re getting to the point where they’re worried about their safety and security, but also that of the residents.”

The board of directors contacted the New Brunswick Association of Nursing Homes (NBANH) for advice. Michael Keating, the executive director of the association, advised the board to launch an immediate investigation.

Keating, who also acts as legal counsel for NBANH, told COHSN that he hoped the independent investigator would “shed some light on what’s going on, and then we’ll be in a position to make a decision.”

Within a week, the board hired Claire Savoie (no relation to André Savoie), a retired former human-resources advisor with the provincial health authority and nursing-home administrator, to conduct the investigation. Claire Savoie began interviewing staff at the Melanson home on Nov. 3.

Keating cautioned against jumping to conclusions about the validity of the complaints, calling them “just allegations as far as we’re concerned.

“Like everywhere, you have people who don’t like the boss or the managers,” he said. “It happens on a fairly frequent basis. We’re very aware that they escalate to this type of situation, and most cases are resolved between the employer and the employee.”

For now, André Savoie has been temporarily suspended from the nursing home while the investigation is taking place, in order to maintain the probe’s integrity and so that employees will not feel intimidated during interviews. So far, the investigation has been going well, according to Doucet.

“They’re being very open with that investigator,” he said about the workers. “They get the feeling that they’re being heard. So already, they’ve seen some difference in the ambience in the nursing home. There’s less stress.”

Speaking for CUPE and NBANH, Doucet added, “We’re both concerned that this has gotten to this point without anybody really notified of the extent.”

Keating said that André Savoie could potentially face job termination if the investigation finds merit in the employees’ allegations. “But that has to be a pretty serious type of thing for that to happen,” he added.

Saint-Quentin is located in Restigouche County, which borders on Quebec.

CN employees speaking out against chronic workplace fatigue

Railroad workers with the Canadian National Railway Company (CN) are attempting to bring public awareness to the issue of chronic workplace fatigue in the industry. A group of CN employees – including engineers, conductors and yardmen – with Teamsters Canada Rail Conference Division 796 participated in an information picket in Edmonton’s Grand Trunk Park on Oct. 5.

The rally in Edmonton was intended to bring attention to the prevalence of fatigue and long working hours, as well as the safety risks inherent in them, according to Teamsters national president Doug Finnson.

“I think it’s a fantastic thing for them to do,” said Finnson about the information picket, explaining that the workers wanted to raise awareness of the problem in a positive way. “So what better way than a nonviolent, nonaggressive information picket?”

Don Ashley, the union’s national legislative director, told COHSN that fatigue in the rail industry is a national issue that affects not just CN employees, but also those with the Canadian Pacific Railway (CP).

“There are some issues that are going on with CN and CP that we wanted to bring to everyone’s attention,” said Ashley. “So you may see similar-type information sessions throughout the country. Edmonton was the first.”

Ashley explained that the problem has a lot to do with scheduling. Although worker assignments are booked in advance, work shifts may change unexpectedly, with employees often unable to get sufficient rest between shifts.

“The train lineups are terrible, and they’ve been terrible for years,” he said. “You can anticipate when you’re going to get called to work, but that moves ahead or back ten or 12 hours.” It is nearly impossible for an employee to manage rest breaks, said Ashley, “when you don’t know when you’re going to get called.”

CN declined to comment specifically on the rally, but Kate Fenske, its manager of media and community relations for western Canada, said that the corporation was aware of the workers’ grievances.

“CN is committed to running a safe railway, and we’ll be discussing last week’s event with senior union leaders,” said Fenske, referring to the information picket. “We don’t have anything further to add.”

Finnson said that fatigue had become an inescapable aspect of rail work in Canada. “Our members don’t sit down every couple of weeks and then talk about it because it happens to be an interesting subject. They live in the world of the railroad, and many of them have worked for many years,” he said.

“It’s a 24/7 rail operation, and so if people think that chronic fatigue doesn’t exist, then they’re ignorant. And I don’t mean that they’re ignorant people; they’re ignorant of that subject. If they just say that, ‘Well, you’ve had 36 hours off; why are you not rested?’ The minimum that you need is two consecutive nights in bed to offset. That’s just proven.”

Even when a worker does manage to get two straight nights of sleep, added Finnson, “that’s not a magic switch. That doesn’t turn off the previous 76 months of chronic fatigue.”

Both Finnson and Ashley pointed out the labour-relations process informally known as “Work now, grieve later” as a factor in the fatigue problem as well.

“Even though we have the provision to ask for rest after ten hours in our collective agreement, the company can ignore that, and then we have to proceed with a grievance,” said Ashley. “So it doesn’t do anything to mitigate the situation at the time.”

“It’s really infuriating to our worker, who perceives his health and safety as the issue,” said Finnson. “You give your employer sufficient notice, hours and hours of notice, and say, ‘Hey, at this certain point, I’m going to need rest.’ And so what happens is, you get to that point, and then a manager says, ‘Okay, you’ve got to keep going.’”

Finnson added that some managers had resorted to bullying workers into excessive work hours and even disciplining employees who had complained. “It’s definitely happening at CP, but at CN, there are still a few examples and still a few situations where the members feel that that’s the case,” he said. “But I can’t speak with certainty about that.”

An anonymous CP employee told COHSN in May that his employer had refused to accommodate him when he had booked unfit to work because of extreme fatigue last year.

“They said I had to go in for an investigation,” the worker claimed. “Usually, investigations, they’re used to intimidate employees. You could be questioned for seven, ten hours straight. And they ask you all kinds of inappropriate questions about your personal life and whatnot. And then usually afterwards, harsh discipline follows.”

The employee said that he’d taken time off to seek medical attention, but that he could not get his job back, even after his benefits had run out. “They don’t tell me anything. What they tell me is that, ‘We just have no positions available,’ and they just keep you in a state of limbo.”

But Peter Edwards, CP’s vice president of human resources and labour relations, denied that the railway disciplined employees who booked unfit.

“They’re entitled to do so under each of the collective agreements, and it’s a right that we defend,” he said. “It’s a right that is exercised several thousand times a year by employees.” Edwards added that CP rail workers were entitled to make their own schedules and often chose to work long hours in order to take more time off later.

Finnson disagreed. Whereas CN was taking measures to address chronic fatigue, he said, “CP’s management is more interested in attacking the workers and blaming the workers for everything.”

Electrical arc flash stuns employees at Shell Canada oil refinery

Three Shell Canada workers were examined at a health centre after an arc flash occurred at the corporation’s Scotford chemical plant and oil refinery in northern Alberta, on the afternoon of Sept. 18. Fortunately, there were no serious injuries, according to the company.

“Workers were preparing for a maintenance job in an electrical substation at our Scotford facility when there was an unexpected electrical arc flash,” said Shell Canada spokesperson Cameron Yost, noting that the incident had occurred late in the afternoon.

“Three employees were taken to the health centre as a precaution and were cleared for full duty later that evening,” added Yost.

“We are investigating the cause of the incident.”

Occupational health and safety officials with the Alberta Ministry of Labour are reportedly investigating as well, but the Ministry did not respond to COHSN’s request for comment.

First opened in 1984 and located about 45 kilometres northeast of Edmonton, Shell’s Scotford plant converts bitumen from Alberta’s oilsands into other products. The refinery was the first one to process synthetic crude oil exclusively from the oilsands, according to information from the company website.

The Canadian Centre for Occupational Health and Safety (CCOHS) in Hamilton, Ont. notes on its website that electrical arc flashes can cause serious injuries or worse, such as electrocution, electric shock, burns and falls.

“An arc blast can include a potential pressure wave released from an arc flash. This wave can cause physical injuries, collapse your lungs or create noise that can damage hearing,” CCOHS says. Another common means of injury is “thermal burns from the heat radiated from an electric arc flash.

“Ultraviolet and infrared light emitted from the arc flash can also cause damage to the eyes.”

New Brunswick observing Respectful Workplace Week again

FREDERICTON, N.B. – The annual Respectful Workplace Week is taking place in New Brunswick from Sept. 5 to 9 this year, as the provincial government continues to promote workplace equality while raising awareness of bullying and discrimination. In a Sept. 1 announcement, Premier Brian Gallant said that respectful treatment of colleagues helps to improve productivity and morale in work environments. “It is the employer’s responsibility to prevent and eliminate harassment,” said Gallant. “Harassment in the workplace is a form of discrimination. It is unwelcome and unwanted. It affects the individual’s ability to learn and work. It can also be an expression of abuse of power, authority or control and is coercive in nature, which has negative effects on the organization and employees.” As part of Respectful Workplace Week, he added, the Fredericton Public Library will host a series of free lectures and information sessions about workplace bullying on Sept. 8, courtesy of the Muriel McQueen Fergusson Centre for Family Violence Research. “Your government is committed to ensuring all New Brunswickers can work in healthy, respectful and inclusive workplaces where all people are valued,” said Gallant, who is also the province’s Minister Responsible for Women’s Equality.

Air-ambulance contractor ceases hospital landings after Transport Canada order

An organization that provides air-ambulance services in southwestern British Columbia has suspended landings at seven hospital heliports in the area. The suspension is based on the safety concerns of Transport Canada (TC), which claims that the aircraft are not properly designed for night flights in populated urban areas.

Helijet International Inc., which has been contracted to provide medevac helicopters for British Columbia Air Ambulance Services for the past 18 years, is currently landing the choppers at local airports or helipads, from which patients are transported to hospitals by ground ambulance. The company has stated that TC withdrew an exemption that had allowed the company to land at hospitals directly.

“Recent inspections discovered areas of non-compliance with requirements for the helicopters to be able to maneuver during engine failure while operating in built-up urban areas,” TC regional communications officer Sau Sau Liu told COHSN.

“For heliport operations, the aircraft must be configured in accordance with all of the manufacturer’s specifications for vertical operations,” continued Liu. “One of several specific requirements is a vertical visibility pilot door, which improves the pilot’s ability to see the landing area immediately below the aircraft in the event of an emergency landing.”

The facilities at which Helijet has suspended direct landings include Vancouver General Hospital, B.C. Children’s Hospital in Vancouver, Surrey Memorial Hospital, Nanaimo Regional General Hospital and Royal Columbian Hospital in New Westminster.

Helijet has declined to provide comment to the media on the matter, except for a press statement that Rick Hill, the company’s vice president of commercial and business programs, sent out on Aug. 18.

“We are working with provincial health authorities to ensure patient care and safety is maintained,” Hill said in the statement. “In the interim, Helijet is actively engaged with Transport Canada to meet regulatory requirements and has also applied for an exemption so regular service can resume as soon as possible.”

Hill added that the company “has provided exemplary safe, efficient and timely emergency transportation for British Columbians.”

Although the company reportedly has a stellar overall safety record, the crew of a Helijet Sikorsky S76C+ copter temporarily lost control of the aircraft last Nov. 15, while on their way from Vancouver International Airport to Tofino/Long Beach Airport. There were no injuries or fatalities, but the Transportation Safety Board of Canada (TSB) later determined that the aerodrome had not been certified for night landings.

“A post-landing inspection revealed the presence of oil on the rotor blades and airframe,” the TSB stated in an investigation update on Dec. 15. “Rotor hub spindle components were damaged, and a rotor head damper oil hose was pulled apart. Helijet maintenance crews changed these components, disabled the cockpit voice recorder/flight data recorder unit, and the helicopter was flown back to Vancouver later that day.”

Although the aircraft was back in medevac service after further inspection, it was taken out of commission again after the discovery that its main-rotor transmission had been exposed to excessive torque during the Vancouver-Tofino flight. The TSB investigation of the incident is still ongoing.

Liu said that TC offers safety exemptions to transportation companies only after rigorous risk assessments. “Conditions associated with the exemption include mitigation to ensure an equivalent level of safety is maintained,” she explained. “We are working with Helijet, the B.C. Emergency Health Services and the Provincial Health Authority regarding this matter.

“Transport Canada recognizes the importance of helipads to hospitals and health centres and the critical service they provide to patients.”

Boat modification, lack of life preservers may have killed three fishers, says TSB

A new investigation report from the Transportation Safety Board of Canada (TSB) stressed the continuing safety risks in the country’s fishing industry as it revealed information about an incident in Placentia Bay, N.L., in which three people died last year.

A small fishing vessel, CFV 130214, disappeared and was reported overdue at 7:23 p.m. on June 16, 2015, and a search-and-rescue team found the bodies of the boat’s crab-fishing crew members on Bar Haven Island the following day. The boat, believed to have sunk, has never been recovered.

Published on Aug. 2, the report could not make any firm conclusions about the cause of the tragedy, due to the lack of witnesses and survivors. But the TSB investigation did find that the master of the crew had modified a 7.1-metre vessel for crab fishing while his main boat had been out of commission. The fisher did not test the modified boat for stability, and investigators speculated that added weight from the modifications, crew members and fishing equipment had made the vessel more vulnerable to capsizing.

The master was required to request an exemption from the Fisheries Licensing Policy to lease another proper crab-fishing boat, but did not do so. Because there were only a few weeks left in the crab-fishing season and the master had not fulfilled his quota, he was under pressure to get results right away, the TSB claimed.

Additionally, the fishers did not have a distress communication device aboard the boat with them. Such a device was not mandatory, but has been known to save lives in the past, the report stated. The bodies of the victims were not wearing personal flotation devices (PFD) when they were discovered, the TSB also revealed.

“The safety of fishermen will be compromised until the complex relationship and interdependency among safety issues is recognized and addressed by the fishing community,” the report concluded, while highlighting communication equipment, PFDs and the lack of information about fisheries licencing as important issues in fishing safety.

Loss of life in the Canadian fishing sector has been on the TSB’s Watchlist since 2014. The report noted that there had been 31 commercial fishing fatalities in Newfoundland and Labrador between 2000 and 2015, with 189 across Canada during the same period.

“As this occurrence demonstrates, the number of accidents involving loss of life on fishing vessels remains too high,” the report read. “Although regulations have been proposed to address several of the safety deficiencies, there have been significant delays in the implementation of some of these initiatives.

“Concerted and coordinated action is required by federal and provincial authorities and by leaders in the fishing community to improve the safety culture in fishing operations.”