Under Water Work Permit

M.V./S.S.: POSITION /PORT Page 1 of 3
  VALID FOR FROM hrs DATE:
  PERIOD * TO hrs DATE:
 
Specific Location and Description of work:  
 
 
 
 
 
Special Conditions:  
 
 
 
 
 
Personnel assigned to the work:  
 
 
 
 
 
We, the undersigned, are satisfied that the checklist on pages 2 and 3 has been completed correctly and that it is safe for the work to commence.
 
Officer in Charge Signature:  
 
Chief Engineer’s Signature :  
 
Master’s Signature:  
 
 
 
Permit Cancellation:  
 
To be signed by an officer when the work is completed or cancelled. +
 
Officer in Charge Signature:  
 
Date:   Time:  
 
* Valid only for time of work, not to exceed 8 hours.
+ Delete as appropriate.
   
   

 

   
   
M.V./S.S.: CHECKLIST Page 2 of 3
   
    YES NO REMARKS
 
1.0 Master has determined that diver              
  assisted work plan/procedure is safe.              
                 
2.0 Precautions have been explained to all              
  personnel involved              
                 
3.0 Deck/Engine watch notified when work              
  is to begin and when expected to be              
  completed              
                 
4.0 Other vessels or bunker barges not to be alongside during the diving              
  operations              
                 
5.0 No other operations such as cargo,              
  ballast movement, storing etc while              
  the diver is in the water              
                 
6.0 Engine room notified not to start to              
  stop any machinery which may change              
  status of discharges and intakes              
                 
7.0 Terminal, Port Authority, Government              
  approvals obtained as necessary              
                 
8.0 Have all personnel involved been              
  advised which valves are open,              
  closed or locked shut/open              
                 
9.0 Lifeboat / rescue boat lowered and              
  ready for use.              
                 
10.0 Agreement of Management Office              
  obtained              
                 
11.0 Emergency Response Plan discussed              
  and agreed              
                 
12.0 Safety Meeting held and job scope/              
  technical aspect clarified              
                 
13.0 Divers additional safety request or              
  instructions agreed              
                 
14.0 Deck Officer in way of diving location              
  has adequate personnel to handle              
  diving boat, mooring lines etc              
                 
15.0 Engine / Propeller status agreed              
                 
16.0 Code flag “A” hoisted              
                 
 
Chief Engineer’s Signature:  
 

 

 

 

   
   
M.V./S.S.: CHECKLIST Page 3 of 3
   
    YES NO REMARKS
 
17.0 Walkie-talkie radios and              
  communications between diving boat,              
  Deck/Bridge and Engine Room tested              
                 
18.0 Weather forecast obtained and              
  suitable for the work period              
                 
                 
19.0  Work plan made              
                 
20.0 Sea condition checked and found

acceptable for th work

             
                 
21.0 Diver properly advised about intakes              
  and overboard discharges in use and              
  shown locations of same on              
  drawing              
                 
22.0 Steering gear shut down and              
  disengaged              
                 
23.0 Main Engine turning gear: disengaged              
  locked out, tagged out              
                 
24.0 Main Engine locked out, tagged out              
                 
25.0 Bilge pumps are lined up and valves              
  have been test operated if applicable              
                 
26.0 Cathodic protection system secured              
                 
27.0 All sea intakes/or overboard lines              
  not in use, secured by double valve              
  Protection and locked out/tagged out              
                 
28.0 protection and locked out/tagged out              
  materials, equipment checked and              
  ready for use              
                 
 
Chief Officer’s Signature:  
 
     
     

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