Marine Engineering

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:

(If any)

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

PART 1

1.0

Have all persons been briefed on

the requirements of the work?

2.0

Are all persons competent to carry

out the work?

3.0

Have all personnel been provided

with the Personal Protective

Equipment necessary for the task

being undertaken?

4.0

Are Isolation Valves secured or

locked in closed position and

suitably labelled to prevent thembeing inadvertantly opened?

5.0

Is the part of the system  to be

Worked upon effectively isolated by

Closing the appropriate valves

6.0

Have personnel been instructed to

slacken Nuts and Bolts slowly before

breaking the joint, not to remove

Bolts completely, and to stand clear

of the path that will be followed bythe release of any residual pressurein the system

7.0

Has pressure been bled off the part

of the system to be worked on by

opening Drain Cocks or Vents as

appropriate and ensuring that

pressure remains off?

8.0

Has a copy of this Permit been

posted at the place of work?  If the

vessel is a Chemical or Gas Carrier,

also complete part 2.

9.0

Have all Valves and Pipes been

re-secured properly on completion

of the work?

Chief Engineer’s Signature:

 

 

M.V./S.S.:

CHECKLIST

Page 3 of 3

YES

NO

REMARKS

PART 2 CHEMICAL/GAS CARRIERS

10.0

Has the section of pipe or vessel to

be worked upon been purged with

inert gas or Nitrogen?

11.0

Have precautions been taken to

avoid the hazards of Static

Electricity particularly when

removing components?

12.0

Have precautions to avoid Toxic

Vapour Emission Release or

Inhalation been taken?

13.0

Are the equipment tested/calibrated prior use

Chief Officer’s Signature:

Date/time: