Per 03 - Working Aloft, Overside, on stages

Deck Officer is the Responsible officer for work on deck / overside

1AE is the Responsible officer for machinery spaces
C/E to authorize for work in E/R and Master for work outside

Warning
Do not start work if any applicable checkpoint in Section 1 is “NO”.
STOP work if any of the initial conditions noted in the permit change to “NO”.

Caution: Personnel with less than 12 months experience at sea, shall not work aloft or
over side unless accompanied by an experienced person or adequately
supervised.

1) Make a permit for all work carried out “at height” or over side.
Note: “At Height”- Anyone working and not standing on level ground or at deck level.
This includes work inside a tank, near an opening (such as a hatch) or on a fixed stairway
if there is a danger of injury.
2) Display the permit at the work location.

Work description and location:

Vessel: Location of Ship (Sea/Port/Anchor): Permit No.:

Description and location of work:

JSA Number: JSA Review Date:

Permit valid Date: Valid Time: Expiry Date: Expiry Time:

Note: Permit validity time starts after Master’s /CE’s authorisation.

Maximum duration of the permit shall be 08 hours.
Details of any other Permit Type:
Expiry Date: Expiry Time:
applicable for the job: Number:
Details of any other Permit Type:
Expiry Date: Expiry Time:
applicable for the job: Number:

SECTION 1 - SAFETY CHECKS BY RESPONSIBLE OFFICER YES NA

1) Check all personnel are using the correct PPE (such as safety harness, fall arrestors,
 
buoyancy aids)
2) Check safety net rigged where necessary and appropriate  
3) Check all equipment (such as radar scanners, whistle), valves and machinery in the
 
vicinity has been shut off, isolated and appropriate notices posted
4) Lock out and tag out the identified hazards
a) Type of LOTO used and location _______________________
b) Update LOTO register
5) Inspect equipment (ropes, planks, ladders) are in good order  
6) Confirm portable tools / gears in use are secured against falling
 
Note: Lift and lower tools using bucket and lanyard.
Printed copies of this document may not be the valid version. It is the responsibility of the user to verify this in Docmap
Doc: Per 03 Ver: 8 Issue: 1 Oct 2019 Use: As req File: S 03b Retention: 2 Yrs Page: 1 of 2
Per 03 - Working Aloft, Overside, on stages
7) Identify standby man / on site supervisor  
8) Inform duty officer / duty engineer  
9) Check communication between the work team -- standby man -- duty officer /  
engineerthe JSA with all personnel involved
10) Discuss  
11) Update permit register Log  

ADDITIONALLY, FOR WORKING OVER SIDE

1) Check lifebuoy and lifeline available at the worksite  
2) Confirm overboard discharges shut  

Personnel carrying out the work:

I have participated in the onsite toolbox meeting for this work.

Name Rank Signature

SECTION 2 – AUTHORISATION
I am satisfied with the safety arrangements. These will be maintained for the entire duration of the
work.

Responsible Officer (Name / Signature):

Master/ CE (Signature):

Date: Time:

SECTION 3 – PERMIT CANCELLATION

Yes NA
1) Check all systems and the space is returned to normal service condition  
2) Remove all notices and securing arrangements
 
a) Remove all LOTO and update LOTO Register
3) Confirm work area and equipment is in safe condition  
4) Inform duty officer / engineer  

Responsible Officer (Signature):

Master/ CE (Signature):

Date: Time:

Printed copies of this document may not be the valid version. It is the responsibility of the user to verify this in Docmap
Doc: Per 03 Ver: 8 Issue: 1 Oct 2019 Use: As req File: S 03b Retention: 2 Yrs Page: 2 of 2