PERMIT TO WORK: "Working Aloft"

Validity period: From:

(max 24 hours)

Date:

To:

Name of SHIP:

Work to be
carried out:
(Brief description)
HAZARD IDENTIFICATION

Severity

*What if ?
*What can go wrong ?
*What can cause harm ?
*Possible exposure, impact on
Health / Industrial Hygiene ?
*Adequate Personal Protective
Equipment?
*Fatigue?
*Any hazardous conditions in
vicinity of work to be taken care
of (eg. Steam piping, electrical
cables, etc)

Likelihood

RISK
(I, II, III)

Double security, safety harness, lifeline

Only experienced AB allowed
Radio communication to Bridge/ Ch Off (for remote
Double
location)security: safety rope + safety harness
Securing area under works/ lashing tools with small
marline
PPE/helmet

REST RISK LEVEL

OK?

Likelihood

RISK
(I, II, III)

3
3

2
2

III
III

III

III

III

Severity

Person working aloft falling

Material breakdown-rope/ safety harness

5
5

3
2

II
II

Dropping tools

II

Use of fog horn /Use of ship whistle

loosing balance, falling hearing damage

II

In vicinity of exhaust lack of oxyen, high temperature,

CO intoxication

II

Weather condition

Reducing as much as feasible emmision of steam, harmful

gasses
Working Upwind gases, fumes,
Breathing apparatus stand by
If weather condition worsening stop work

III

In vicinity Radar/antennas :Radio transmission/ Radar use

II

Stop radar and transmission/warning notice posted bridge

III

Staging instable
Fatigue condition, loosing concentration
Lighting inadequate , increased falling risk
Other?

5
5
5

4
4
4

I
I
I

Staging to be checked by Chief Officer or Bosun

Verify No fatigue condition with person prior start
Adequate lighting

3
3
3

2
2
2

III
III
III

Approval by Master:
Name:
Officers / Crew performing
the works:
Name:

SAFETY MEASURES
RISK REDUCING MEASURES

INITIAL RISK LEVEL

Signature:

Shut off power fog horn/ whistle and warning notice

posted
Bridge advised not to blow concerned horn

Approval by Superintendent: (for Initial Risk level I)

Name:
Signature/ E-mail ref.

I am satisfied with all safety precautions and risk reducing measures taken and agree to maintain these for the complete duration of the works.
Rank:

Signature:

Verification of the safety precautions & risk reducing measures

by the Authorised Officer prior to start work:
Name:

I am satisfied that all precautions have been taken and that safety arrangements and risk reducing measures will be maintained for the complete duration of
the works.

Signature

Close out / Cancellation of the Permit by the The work has been completed / cancelled. The work location / installation is left in safe condition.
Authorised Officer:
All persons under my supervision, materials and equipment have been withdrawn.
Lessons learned
for future use:

Appropriate communication done to all possibly affected by the results

of the work executed (Y/N)?:

(if YES make statement in ISManager

for follow up)

Name:

Permit to Work-Working aloft

Issue Date: 21/04/2006
Page: 1 of 1

Rank:

Date & Time:

Temporary Repair
(Y/N?):

Signature:

SP0757A1-1