Permit to Allow Small Craft Alongside

M.V./S.S.: POSITION /PORT Page 1 of 2
  VALID FOR FROM hrs DATE:
  PERIOD * TO hrs DATE:
Name of Small Craft
 
 
 
Specific Location and Description of work:  
 
 
 
 
 
Special Conditions:  
 
 
 
 
 
Personnel assigned to the work:  
 
 
 
 
 
We, the undersigned, are satisfied that the checklist on page 2 have been completed correctly and that it is safe for the work to commence.
 
Chief Officer’s Signature :  
 
Master’s Signature:  
 
 
 
Permit Cancellation:  
 
To be signed  when the work is completed or cancelled.  +
 
Chief Officer’s Signature:  
 
Date:   Time:  
 
* Valid only for time of work, not to exceed 8 hours.
+ Delete as appropriate.
   
   

 
 

 

 
   
  CHECKLIST  
   
    YES NO REMARKS
                 
1.0 Has the terminal/facility supervisor              
  been advised of the intention of work              
  with small craft alongside and given              
  approval              
                 
2.0 Have personnel (including ER where              
  appliable) been briefed on the              
  requirements of the work?              
                 
3.0 Are all deck openings securely closed?              
                 
4.0 Have suitable precautions been              
  observed where other craft are              
  alongside or special operations are              
  being carried out?              
                 
5.0 Have communications methods been              
  Agreed between ship and craft              
                 
6.0 Is the craft properly secured              
  alongside?              
  5.1 Has a lifebuoy with light and              
        line been placed in position?              
                 
  5.2 Is lighting adequate              
                 
                 
  5.3 Is there safe access between the              
         ship and craft?              
                 
7.0 Has the Master of the craft been              
  advised of safety regulations,

perticularly smoking and naked lights?

             
                 
                 
                 
8.0 Is the craft in a state of readiness to              
  depart under her own power?              
                 
9.0 Has the Master of the craft been              
  advised of the emergency signals              
  and action to take in emergency?              
                 
10.0 Has a copy of this permit been placed              
  by the craft’s position?              
11.0 Has declaration of security been filled              
                 
   
Chief Officer’s Signature:  
                                          Date/time

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