Under Water Work Permit

M.V./S.S.: POSITION /PORT Page 1 of 3
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
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              
4.0 Other vessels or bunker barges not to be alongside during the diving              
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              
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
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              
22.0 Steering gear shut down and              
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:  

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