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ARCHIRODON GROUP NV Integrated Management System
Health, Safety & Environment (HSE)
Rev. Issued For General Use Reference No. HSE-PRO-06-F03 Serial No. Page 1 of 3
FORM Diving Permit To Work
0.0
Section 1. Permit Information 1.1
1.2 Permit Validity
Permit No.
from to
1.3
Issued to
Permit Holder
NAME / SURNAME
1.4
Issued by
Permit Authority
NAME / SURNAME
1.5
Job Location:
1.6
Work Activity:
HH:MM
on date
DD/MM/YYY
HH:MM
on date
DD/MM/YYY
Company
Section 2.1 Required Controls 2.1 Completed by Diving Supervisor Sr
01
Description Primary / Secondary Breathing Media on line with adequate Volume
Yes
No
N/A
Sr.
Description
13
Adequate team size
02
DDC Operational and Ready
14
Stand by diver ready
03
Compressor functioning with proper intake position
15
Diving rules and logs in place
04
All Comms. checked available/ working
16
05
All CCTV checked available/ working
17
06
Diving flag displayed and visual
18
07
Safe diver entry and retrieval
19
No Over head Lifting Work
08
Safe Weather Conditions
2o
Suction Inlets/Outlets isolated
09
All alarm working properly
21
No scaffolding Work
10
Weather Conditions Safe and Forecast
22
No Fishing
23
Diving vessel secured
24
Pre-Task Briefings to be carried out Prior to activities
11 12
Port /Employer permit in place , valid and confirmed by VHF Radio Pre-Dive check to be undertaken prior to each dive.
Yes
No
N/A
Employer and Employer and Company’s safety procedure in place Approved method statement in place Operation discussed with divers and all involved parties
Section 2.2 Completed by Marine Master/Officer/Foreman on watch Controls Sr
01
Description Employers Standing Marine instruction are met
Yes
No
N/A
Sr.
09
02
Weather – OK – OK and Forecasts available
10
03
Signals/ Lights Displayed
11
Description Appropriate Alarms/ Monitors Checked Other Vessel Informed and Warned
No Over head Lifting Work
Y
N
N/A
ARCHIRODON GROUP NV Integrated Management System
Health, Safety & Environment (HSE)
Rev. Issued For General Use Reference No. HSE-PRO-06-F03 Serial No. Page 2 of 3
FORM Diving Permit To Work
04
Vessel Adequately secured
12
05
Comms available and Tested
13
06
Access/to/From Sea Adequate
14
07 08
Support Equipment Available & Operated Notices placed on bridge and engine room
15 16
0.0
Suction Inlets/Outlets isolated No scaffolding Work / No Fishing Operation discussed with divers and all involved parties Props & Thrusters Stopped and secured Look out posted
Section 2.3 Completed by Employer Representative (If Applicable) Sr
Description
Yes
No
N/A
Sr.
Description
01
Employer and Contractor's Safety Requirements are met
04
Suction Inlets/Outlets isolated
02
Platform Aware of Restriction and prohibitions
05
Permission to Dive from Employer ’s Port/Platform/Installation
03
Approved method statement in
06
Operation discussed with divers and all involved parties
place
Yes
No
N/A
Section 3. Attachments (M ethod Statements, Risk Assessments, Dr awin gs, Certi fi cates...etc) List all documents attached to this P.T.W:
Section 4.
Permit Management
4.1
This Permit is valid only when Sections 1-3 and 5 are complete.
4.2
The original Permit shall be displayed at the work place and shall at all ti mes remain under the responsibility of the Permit Holder.
4.3
A separate copy of the completed Permit at both the approval and closure stages shall be given to the Permit Authority, the HSE Department and the Employer if required.
4.4
Any adverse change in circumstances shall cause this Permit to become immediately invalid. In this case, the Permit Holder shall cease the work, withdraw the workforce and report to the Permit Authority.
4.5
This Permit is issued for t he task specified within this PTW only and is valid for one shift or 12 hours only or between the times specified in section 1 of this document.
ARCHIRODON GROUP NV Integrated Management System
Health, Safety & Environment (HSE)
Rev. Issued For General Use Reference No. HSE-PRO-06-F03 Serial No. Page 3 of 3
FORM Diving Permit To Work
0.0
Permit No: Section 5. 5.1
Permit Approval
I the permit holder shall abide to the control measures mentioned within this P.T.W and attachments.
Name
NAME / SURNAME
Signature Name
5.2
I the marine Master/Officer/Foreman in charge of diving vessel and vicinity shall abide to the control measures mention within this P.T.W and attachments
Diving Supervisor
NAME / SURNAME
Marine in Charge
Signature Signature Name
5.3
NAME / SURNAME
HSE Review Signature
5.4
The Permit Authority, I am satisfied that all foreseeable control measures to avoid an accident are in place prior to me authorizing this permit.
Name
NAME / SURNAME
Signature
HSE Department
Permit Authority
Permit No. Port /Employer Authority Permit
Issued by 5.5
The local / port / Employer authority permit approval Valid from
(If Applicable)
Valid to I the Employer representative shall abide to the control measures mentioned within this P.T.W and attachments. 5.6
I am satisfied that all required precautions have been met and agree to commence diving
Section 6.
Name
(If Applicable)
Company
Permit Closure
Indicate either 6a or 6b. For 6b state the reason in t he space provided
