Issued by Approved by Revision Date Page

Asia International Maritime Services S.A. Managing Director 03 17.01.2005 1 of 1

Files – Chief Mate SAFETY MANAGEMENT SYSTEM
Files – Chief Engineer CH.12.8.7.2.4 047/4
PERMIT FORMS

UNDERWATER WORK PERMIT No.

Description and location of work: ................................................................................................................

Validity of permit (should not exceed 24 hours) from.................hrs Date .............................................
to......................hrs Date ..............................................
Authorized person in charge of the work:......................................................................................................

CHECK LIST
General precautions:( Master to apply initials) Initials
Master is satisfied that plannig / procedures for diver(s) are work safe ______
All involved persons briefed about precautions taken ______
Deck / Engine Officers on watch informed about starting / completion of work ______
No vessels or bunker barges alongside during diving work ______
No operations as cargo, ballasting, storing, etc. while diver(s) in the water ______
Engine room notified not to operate machinery which could change the selected overboard
discharges and intakes ______
Terminal, Port Authority, Government approvals obtained ______

To be endorsed by Master
Technical Department approval obtained ¨
Emergency response plan analyzed and agreed ¨
Safety meeting explaining scope of work held ¨
Conformed with eventual additional diver(s) safety request ¨
Deck Officer in way of diving location has sufficent crew to handle diving boat lines, ship’s moorings,
etc. ¨
Propeller status agreed ¨
Code flag "A" hoisted ¨
Tested walkie-talkies and other communications between diving boat, deck, Officers on watch on
bridge and in engine room ¨
Weather forecast favourable for the work period ¨
Sea conditions acceptable for the work ¨

To be endorsed by Chief Engineer

Work planned ¨
Diver(s) briefed about intakes and overboard discharges in operation and shown locations of same on
drawing ¨
Main Engine turning gear: disengaged and notice posted ¨
Main Engine: secured and notice posted. ¨
Valves of sea intakes and overboard discharges which not in use because of the work, secured and
notices posted. ¨
Impressed current system disactivated. ¨
All applicable emergency tools, materials, equipment checked and ready for use ¨
Master Authorizing Officer Diver

Work started Date/Time Work completed Date/Time

Asia International Maritime Services S.A.