French investigators pointed to crew preparation and equipment troubles among factors contributing to the September death of a crew member on a Royal Caribbean Cruises vessel during an abandon ship drill.
The report by the French Marine Casualties Investigation Board (Beamer) and released by the Bahamas Maritime Authority comes more than seven months after a lifeboat on the 5,400-berth Harmony of the Seas (built 2016) fell to the sea during a drill at the port of Marseilles.
The incident, which killed one crew member and injured four others, is among a string of incidents that have raised concerns about lifeboat safety.
The Beamar report found four contributing factors, although the agency noted that Royal Caribbean's lifeboat procedures did not present any unnecessary risk and the Miami cruise giant strengthened those procedures after the fatal accident.
Among the factors, investigators cited "unclear division of roles" by seafarers during the drill on the Bahamas-flagged ship.
And they said there was an absence of cross-checking during the lifeboat drill to ensure that there were no omissions in carrying out Royal Caribbean's procedures.
The report also says that there was no lifeboat gravity launching mechanical prevention device deployed at a key juncture in the drill.
The Beamar report also says that the stop pawls that are meant to prevent an uncontrolled lifeboat release proved inefficient "when the lifeboat is subjected to brutal movements and to a heavy trip angle".
But the agency did not issue any recommendations because of the measures taken by New York-listed Royal Caribbean.
"Within days after the accident, the shipowner carried out a review of the lifeboat preparation and launching procedure," Beamar said in its report.
The review was followed by strengthened policies for lifeboat training and procedures.