The captain of the vessel and his 14-year-old son were among those who died when the Bourbon Dolphin turned turtle as an anchor-handling operation involving a drilling rig went tragically wrong.
The vessel was pulling a heavy anchor chain from the rig when it suddenly slid across the side of the boat and dragged it over. Only seven of the 15 people on board survived.
A detailed report on the capsize, published yesterday by a commission of inquiry in Norway, concludes that no single error, either technical or human, was to blame for the loss of the eight lives.
But the commission declared that a combination of weaknesses in the design of the vessel and failures in the handling of safety systems by both the vessel's owner and the operating company on the rig, were "major contributory factors".
Systemic failures on the part of a number of individuals also caused vital safety barriers to be ignored or breached, exposing the vessel and its crew to risk.
The commission also claims that the cost of the anchor-handling operation, already "considerably delayed" by bad weather, may also have been a factor.
The report states: "Even if the operator has emphasised that the safety of the operation is always considered more important than rapid implementation, there is also reason to believe that the overall cost of the operation was also under continuous review.
"In the commission's opinion, the possibility cannot be ignored that a conscious or unconscious wish to get finished on the part of those involved may have led to an inadequate focus on safety in the concluding phase."
The eight people drowned on 12 April last year when the Bourbon Dolphin capsized 85 miles west of the Shetland coast.
Those who died included the vessel's Captain Oddne Arve Remy and his son David, who was on a work-experience trip.
The report states: "The commission is of the opinion that failure in the handling of safety systems on the part of the company, the operator and the rig alike are major contributory factors in the coming out of control of the operation on 12 April, 2007. In addition, weaknesses in the design meant that the vessel had poor stability characteristics, without either the shipyard or the company having clearly communicated this to the owners. Seen all together, system failure in the players at several levels meant that necessary safety barriers were missing, were ignored or were broken, so that crew and vessel were exposed to an uncontrolled risk, resulting in the accident."
Jake Molloy, the general secretary of the dedicated oilworkers' union OILC, said it was vital that lessons were learned. He said: "From the very moment this vessel was built, there have been failures right the way down the line."
Referring to the commission's comments on the costs of the operation, Mr Molloy said: "Yet again it appears that production imperatives have taken precedence over health and safety. The message is quite clear from the Norwegian authorities that that cannot be allowed to continue."
A spokesman for the rig operator Chevron said it would not be in a position to comment until it had fully studied and digested the commission's findings. He added: "All of us at Chevron were deeply shocked and saddened by the tragic loss of life following the capsizing of the Bourbon Dolphin and our heartfelt sympathies are with the families of those lost, the surviving crew members and all those whose lives have been touched by this terrible event."
REPORT CRITICAL OF OWNERS
THE vessel, owned by Bourbon Offshore Norway, was involved in an anchor handling operation for the Transocean Rather drilling rig which was on charter to oil giant Chevron.
The accident happened as the Bourbon Dolphin began to run out a giant chain for one of the drilling rig's anchors. The chain suddenly slid to the side of the deck, causing the vessel to roll.
The report states: "The capsizing happened suddenly and without much warning.
"Of those on the bridge, only one of the first officers managed to get out."
According to the report, Bourbon Offshore should have undertaken more critical assessments of the vessel's operational limitations.
It states: "The company did not pick up on the fact that the vessel had experienced an unexpected stability-critical incident about two months after delivery. In practice the Bourbon Dolphin was unsuited to dealing with the great forces to which she was exposed."