Notwithstanding, they did not offer any assistance or cooperation to the Master of the "Toya Maru", which was about to sail out under rough weather caused by the typhoon, nor pay any attention. Although the Transport Controller on watch received from the "Toya Maru" in question, which had sailed out, information to the effect that the main engines and generators were about to stop functioning, he was not able to appreciate that it was the emergence of a serious accident and did not report it immediately to his superiors. He recognized the seriousness of the nature of the accident only after he received a report on the landing of persons who had been thrown into distress as a result of the vessel's capsizing. At last he began to take measures to assist those in distress. As described up to now, the improper operation management of rail ferries at the Head Office and the Seikan Railways District Control Bureau of the Japanese National Railways is judged to have constituted part of the factors which caused such a serious marine accident in this case.
We should make a recommendation to the President of the Japanese National Railways, a designated person in the marine accident, in relation to the improper hull structure and operation management of the rail ferries, but we do not realize the need to do so since, in view of the occurrence of this accident, he is making efforts for improvements in hull structure and operational management by discussing and studying countermeasures thereafter.
We do not recognize any need to make a recommendation against the Chief of the Seikan Railways District Control Bureau, a designated person in the marine accident.
We do not recognize any need to make a recommendation against the Chief of the Central Weather Observatory and the Chief of the Hakodate Marine Weather Obseruatory, both designated persons in the marine accident.
The actions taken at the maternal time by the Second Officer of "Toya Maru" and the Second Engineer of "Toya Maru", both examinees, are not considered to have contributed to the occurrence of this accident.
