SAFETY & ENVIRONMENTAL Prepared by: DP

MANAGEMENT Approved by: MD

504 Date: 01.11.2007
PERMIT TO WORK ALOFT / OVERSIDE Rev No:1
Page 1 of 2

Ship’s Name: Date:

Time of Issue: At Sea / Port:

This permit is valid from……………………….hrs Date…………………

To………………………hrs Date………………….
(Max 12 hours)
Location:

Description of Work:

Special Condition:

Personnel assigned to the work:

Team Leader

Type of Communication in use: Walkie Talkie Ch:

We, the undersigned, are satisfied that the checklist on the page 2 has been
completed correctly and that it is safe for the work to commence.

Safety Officer.……….…………….………….Date…………….Time……………..

Master………………………………………….Date……………Time……………..

Caution:
Personnel under 18 years of age or with less than 12 months experience at sea,
should not work aloft unless accompanied by an experienced person or otherwise
adequately supervised.

to be recorded: as becomes necessary to be kept for: 3 years

 SAFETY & ENVIRONMENTAL Prepared by: DP
MANAGEMENT Approved by: MD
504 Date: 01.11.2007
PERMIT TO WORK ALOFT / OVERSIDE Rev No:1
Page 2 of 2

No. Check Items Yes No

1. Have all persons involved been briefed on the requirement of the
work?
2. Are all persons competent to carry out the work?
3. Are there enough persons to do the work?
4. Are all persons wearing safety harnesses with lifeline(if required)
5. If the work is done over side, does the persons involved worn
lifejackets? Is there a lifebuoy with sufficient line attached kept
ready?
5. Has the equipment to be used been checked and found to be in
good condition (eg. Wooden components of staging, gantlines,
Bosun’s chair, shackles etc.)
6. Are there adequate securing points at the work position
7. Has a method of communications been set and agreed by all
parties?
8. Has the OOW been informed of the work-taking place?
9 Does any of the following equipment need to be isolated or
immobilized
1.Whistle
2. Scanners
3. Aerials
4. Lights
5. Boiler soot blowers
6. Cargo Winches
7. Deck Cranes
8. Other (Specify)
10. Has isolated or immobilized equipment been clearly marked with
suitable warning notices and locked where possible?
11. Has a responsible officer signed to having checked, that the
equipment is isolated or immobilized?
12. Is access available? (a ladder to boat or shore) when working
overside?
13. Has the rescue boat been swung out (where appropriate)
14 Has a copy of this permit been posted at the place of work

NB: Working aloft means more than 2 meters above any deck surface.

to be recorded: as becomes necessary to be kept for: 3 years