WORK ALOFT/OVERSIDE PERMIT
Vessel: WORK PERMIT No:
| DESCRIPTION OF WORK:
|
Does job require hot work?
Does job require electrical maintenance?
Does job require equipment isolation? |
Y / N
Y / N
Y / N |
Permit no. ____________
Permit no. ____________
Permit no. ____________ |
| ITEM | YES | NA | ITEM | YES | NA | ||
| 1 | Bosun chair, stage, ropes etc checked and in order | 10 | Weather condition considered | ||||
| 2 | Warning notices posted | 11 | Any change in course expected | ||||
| 3 | Radars isolated | 12 | Communication verified | ||||
| 4 | Antennas isolated | 13 | Life buoy & line ready* | ||||
| 5 | Skill of worker verified | 14 | Ladder rigged aft of work area* | ||||
| 6 | Whistle isolated | 15 | Deck supervisor appointed* | ||||
| 7 | Duty Officer / Engineer informed | 16 | Lifeline attached | ||||
| 8 | PPE worn | 17 | Port control informed* | ||||
| 9 | All tools lashed by rope | 18 | Pollution preventive measures taken* |
*Applicable only when working overside
| Please note: |
| A tool box meeting, where the RISK ASSESSMENT is discussed, MUST precede the issuance of a WORK PERMIT |
| The Work Permit is only valid for a period of 12 hrs from issue. |
| If the job extends beyond 12 hrs, the permit shall be subsequently revalidated on a “DAY” and “NIGHT” basis. |
| A work permit thus revalidated may be extended up to a maximum of 7x 24 hrs. |
| Each permit is only valid for an individual job |
| Multiple jobs on the same equipment require their relevant permits to be filled out |
| “Do Not Operate” tags with respective Work Permit Numbers to be used to isolate the relevant equipment. |
Permit Issuance
I confirm that I have understood the work instructions and risks involved. I am satisfied with the precautions and safety arrangements provided.
________________ __________________ DATE / TIME PERMIT HOLDER |
I am satisfied that all precautions have been taken and safety arrangements will be maintained for the duration of the work.
________________ _____________________ DATE / TIME SENIOR OFFICER (sign/rank) |
WORK PERMIT REVALIDATION: (Permit Holder And Senior Officer To Countersign)
Permit Cancellation
I confirm that the work has been completed and that all the associated equipment, tools and materials have been withdrawn.
________________ _______________ DATE / TIME PERMIT HOLDER |
The work has been completed, and all personnel under my supervision, materials, equipment and tools have been withdrawn. This permit is hereby cancelled ________________ _______________________ DATE / TIME SENIOR OFFICER (sign/rank) |
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