What happened
During a turnaround at the Gold Coast, a ground handling crew failed to identify a container located in position 31 of the aircraft hold. The process began with an issue regarding documentation, as the crew was unable to obtain a pit load sheet and could not reach ground operations controllers for accurate load information.
During the unloading phase, the loader operator inspected the hold but did not notice the container in position 31. While the leading hand observed this inspection, they did not perform an independent check of the compartment. Following the unloading, the crew proceeded to the loading phase. However, the primary loader operator was called away from the task, carrying the yellow ULA copy in their pocket rather than on the standard clipboard.
Because the second loader operator continued the loading process without the documentation, they operated under the assumption that all necessary containers had already been pre-loaded. This lack of communication and the absence of the ULA copy meant that the loading process was completed without a proper verification of the container positions or a completed loading sheet.
The investigation
The investigation focused on the breakdown in loading procedures and the lack of available documentation. Investigators found that the ground crew lacked the necessary information regarding how many containers needed to be off-loaded due to the missing load sheet.
Furthermore, the investigation examined the roles of the crew members during the turnaround. It was noted that the responsibilities of the loader operator changed mid-task, which contributed to a misunder understanding regarding the progress of the loading. The investigation also looked into the workload of the ground team, noting that the crew was managing additional responsibilities, such as toilet cleaning and water top-ups, which were outside their usual scope for this specific task.