Working Aloft Permit

Working Aloft Permit

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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
     
     

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