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 | |||||||||||||