GeneralThis permit is valid From _____________________hrs Date: _____________ (Maximum validity 12 Hrs) To ________________________ hrs Date: _____________ Work Location: ____________________________________________________ Description of work to be done: _________________________________________________ ________________________________________________________________ Names / ranks authorized to work:___________________________________________________ ___________________________________________________________________________ |
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Section 1 – CHECKS |
YES |
N/A |
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| WORKING OUTBOARD SHOULD BE AVOIDED WHILE VESSEL IS MAKING WAY | |||||
| 1
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Has a formal Risk Assessment been produced and discussed with those involved in the work? | ||||
| 2 | Has a Stand-by man been appointed with provision to contact the OOW? | ||||
| 3 | If using a stage are gantlines run to water level to provide additional lifelines? | ||||
| 4 | Is a Lifebuoy and lifeline available at the worksite? | ||||
| 5 | Are all personnel wearing buoyancy aids / Harness as applicable? | ||||
| 6 | Has equipment been inspected and confirmed to be in good order? Tools & Equipment secured from loss ? | ||||
| 7 | Has the Duty Engineer been informed of the work planned? | ||||
| 8 | Rescue boat and crew immediately available | ||||
| 9 | Have overboard discharge and sea suctions been secured and tagged with “Danger Men Working – Do not operate” notices where appropriate? | ||||
| 10 | Is vessel : *Underway / Stopped / Lee Made / Speed Reduced. | ||||
| 11 | Are personnel aware of the tides / currents/ weather in the area? | ||||
| 12 | Are precautions being taken to minimise wash effects from passing traffic (Details to be added to the “Additional precautions below). | ||||
| 13 | If applicable, within port limits has permission from port authority been given? | ||||
| 14 | Adequate sea room to allow departure from passage plan. | ||||
| 15 | Weather conditions suitable, taking into account sea swell and vessel movement | ||||
| 16 | Illumination adequate and augmented where required | ||||
| 17
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Securing points for safety lines, gantlines, blocks of adequate strength, no sharp edges | ||||
| 18 | Work in the vicinity of Propeller, then immobilised, Chief Engineer informed. | ||||
| 19 | Any other permits involved with this job ? Please specify? | ||||
| 20 | Additional Precautions to be taken : ( please specify) | ||||
| SECTION 2 : AUTHORISATION | |||||
| I am satisfied that all appropriate safety measures are in place and that the work can be conducted safely. | Name, Rank and Signature of Responsible Person | ||||
| Work Authorised By: | Master | ||||
| SECTION 3 : PERMIT CLOSURE/CANCELLATION | ||||||
| Equipment /system has been de-isolated and returned to the “in-service condition” | ||||||
| All notices and tags removed | ||||||
| The work area and equipment is in a safe condition | ||||||
| Work Completed | Permit is time Expired | Work suspended | ||||
| Permit Closed By Responsible Person : | Signature : |
Date : Time: |
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