Working Aloft 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: | (Weather condition/lightring etc.) | |||||||||||
| Personnel assigned to the work: | ||||||||||||
| We, the undersigned, are satisfied that the appropriate checklist on pages 2 and 3 has been completed correctly and that it is safe for the work to commence. | ||||||||||||
| Officer in Charge Signature: | ||||||||||||
| Master’s Signature: | ||||||||||||
| To be signed by an officer when the work is completed or cancelled. + | ||||||||||||
| Permit Cancellation: (authorised by) | ||||||||||||
| Officer in Charge Signature: | ||||||||||||
| Date: | Time: | |||||||||||
| NB Working Aloft means more than 2 metres above any Deck Surface. | ||||||||||||
| * Valid only for time of work, not to exceed 8 hours. | ||||||||||||
| + Delete as appropriate. | ||||||||||||
| M.V./S.S.: | POSITION/PORT | Page 2 of 3 | ||||||||||||
| CONDITION OF AREA / SPACE | ||||||||||||||
| CHECKLIST | YES | NO | REMARKS | |||||||||||
| 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 | Are there enough persons to do | |||||||||||||
| the work? | ||||||||||||||
| 4.0 | Are all persons wearing a Safety | |||||||||||||
| Harnesses (if required)? | ||||||||||||||
| 5.0 | Has the equipment to be used | |||||||||||||
| been checked and found to be in | ||||||||||||||
| good condition/calibrated? | ||||||||||||||
| 6.0 | Are there adequate Securing | |||||||||||||
| Points at the Work Position? | ||||||||||||||
| 7.0 | Has the Officer On Watch and/or | |||||||||||||
| Duty engineer been informed of | ||||||||||||||
| The work taking place. | ||||||||||||||
| 8.0 | Has a method of communications | |||||||||||||
| been set and agreed by all parties? | ||||||||||||||
| 9.0 | Does any of the following | |||||||||||||
| equipment need to be Isolated or | ||||||||||||||
| Immobilised: | ||||||||||||||
| 9.1 | Whistle | |||||||||||||
| 9.2 | Scanners | |||||||||||||
| 9.3 | Aerials | |||||||||||||
| 9.4 | Port unauthority informed if work | |||||||||||||
| planed in port | ||||||||||||||
| Chief Officer’s/2nd Engineer’s Signature: | ||||||||||||||
| Date/time: | ||||||||||||||
| M.V./S.S.: | CHECKLIST | Page 3 of 3 | ||||||||||||
| YES | NO | REMARKS | ||||||||||||
| 9.5 | Lights | |||||||||||||
| 9.6 | Boiler Sootblowers | |||||||||||||
| 9.7 | Cargo Winches | |||||||||||||
| 9.8 | Deck Cranes | |||||||||||||
| 9.9 | Engine Room Crane | |||||||||||||
| 9.10 | Other (specify) | |||||||||||||
| 10.0 | Has Isolated or Immobilised | |||||||||||||
| Equipment been clearly marked | ||||||||||||||
| with notices and locked where | ||||||||||||||
| possible? | ||||||||||||||
| 10.1 | As per weather condition Ship’ | |||||||||||||
| Course adjusted | ||||||||||||||
| 11.0 | Has a responsible officer signed to | |||||||||||||
| having checked, that the | ||||||||||||||
| equipment is Isolated or | ||||||||||||||
| Immobilised? | ||||||||||||||
| 12.0 | Has a copy of this Permit been | |||||||||||||
| posted at the place of work? | ||||||||||||||
| Chief Officer’s/2nd Engineer’s Signature: | ||||||||||||||
| Date/Place | ||||||||||||||