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