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: | |||||||||||||||