ANDROMEDA – PERMIT TO WORK

WORKING ALOFT and/or OVERSIDE

Work to be done: Location:

Authorising Person: Responsible person:

Crew involved:

Inform:
Bridge OOW & EOOW Chief Officer or Chief Engineer

Pre-Work Checklist Job Specific Checklist

Tool box talk conducted, Risk assessment

Anchor points inspected
consulted
Appropriate warning notices displayed Outside
Equipment isolated as necessary Stage/ Bosun’s Chair rigged
Personnel working below informed Harness + Life Jacket to be worn
Equipment condition checked Mast and above bridge
Assistant posted at deck level Whistle isolated

Radars isolated
Safety line and fall arrester rigged
Transmitting aerials/VSAT off

Safety harness (to be worn at all times) Open Heli Hanger Door
PPE as appropriate (helmet, shoes, gloves) Crane and other
Secured ladder pitched at 75° from
Work tools secured from falling
horizontal

ENSURE SAFETY GEAR IS RECHECKED EACH TIME PERSONNEL RESUME WORK

Period of Validity (not exceeding 24 hours)

From: Until:
Time: Date: Time: Date:

AUTHORISING PERMIT
*Signing this section states that you are satisfied any additional safety measures required have been
implemented and the work can commence*
Signed Authorising Person: Time:

Signed Responsible Person: Date:

CLOSING PERMIT
*Signing this section states that you are satisfied any additional safety measures required have been
returned to their original condition
Signed Authorising Person: Time:

Signed Responsible Person: Date:

PTW. 1 Version 2.1 Last revised: October 2021

ANDROMEDA – PERMIT TO WORK
ENCLOSED SPACE ENTRY
Work to be done: Location:

Authorising Person: Responsible person:

Crew involved:

Inform: Bridge OOW & EOOW Chief Officer or Chief Engineer Medical

Pre-Work Checklist
Tool box talk conducted, Risk assessment
Entrant wearing personal multi-gas detector
consulted
Space vented for sufficient time Communication methods agreed and tested
Responsible person designated to be in
BA Rescue, torches & resuscitation equipment
constant attendance at the entrance to the
available and tested.
space
Lockout/tag out completed as necessary Emergency procedures discussed

Correct PPE equipment & torches in use Access and illumination secured
Area and entry secured, warning notices
Additional equipment inspected and tested
posted
Multi-gas detector within calibration date & Rescue party designated
Linked PTW?
Fresh air calibration completed
___________________________________

Pre-entry & repeated atmosphere test readings:

Oxygen (O2) vol%, 20.8%: Carbon Monoxide (CO), max 20ppm:

Hydrogen Sulfide (H2S), max 5ppm: Hydrocarbons LEL vol%, <1%:

Period of Validity (not exceeding 24 hours)

From: Until:
Time: Date: Time: Date:

AUTHORISING PERMIT
*Signing this section states that you are satisfied any additional safety measures required have been
implemented and the work can commence*
Signed Authorising Person: Time:

Signed Responsible Person: Date:

CLOSING PERMIT
*Signing this section states you are satisfied that all personnel are clear, and the work area is secured
(tank lid back on/safety barrier in place)/back to normal*
Signed Authorising Person: Time:

Signed Responsible Person: Date:

PTW. 2 Version 2.1 Last revised: October 2021

ANDROMEDA – PERMIT TO WORK
PRE-ENTRY CHECKLIST – TO BE COMPLETED BY EACH PERSON ENTERING THE SPACE:

Names of persons entering the space

I have received
instructions and
authorization from the
authorized officer to
enter the space.
I have agreed and
understood the
communication
procedures
Emergency and
evacuation procedures
have been agreed and
are understood
I have witnessed the
testing of the atmosphere
and am satisfied it is safe
to enter

I am aware that the

space must be vacated
immediately in the event
of ventilation failure or if
the atmosphere test
shows a change from the
agreed safe criteria

I have been provided

with appropriate PPE,
including a personal
multi-gas detector

Signatures of persons
entering the space

TIME IN

TIME OUT

PTW. 2 Version 2.1 Last revised: October 2021

ANDROMEDA – PERMIT TO WORK
HOT WORK
Work to be done: Location:

Authorising Person: Responsible Person:

Crew Involved:

Inform: Chief Officer or Chief Engineer

Bridge OOW & EOOW
EngineerEnEngineer

Pre Work-Checklist
Tool box talk conducted, Risk assessment Detector heads isolated:
consulted No___________Location: ________________

Area and adjacent spaces clear of

Other equipment isolated as necessary
combustible materials and pressurised cylinders
Area and adjacent spaces gas free/flooded Responsible person as fire watch
Correct PPE worn – mask, welding gauntlets
Protection of surrounding area
etc
Adequate ventilation in place Fire watch in adjacent spaces as necessary
9kg Powder fire extinguisher on standby Port authority approval (as required)
Emergency procedures discussed Chemist’s gas free certificate (as required)
Insurance approval (as required) Equipment tested and in good working order
Comms established and tested

Period of Validity (not exceeding 24 hours)

From: Until:
Time: Date: Time: Date:

AUTHORISING PERMIT
*Signing this section states that you are satisfied any additional safety measures required have been
implemented and the work can commence*
Signed Authorising Person: Time:

Signed Responsible Person: Date:

Post Work-Checklist
Detector head covers removed Post Hot work fire watch in place / increased safety
Detector heads de-isolated rounds (as required)

CLOSING PERMIT
*Signing this section states that you are satisfied any additional safety measures required have been
returned to their original condition and that ADDITIONAL FIRE WATCH/HOT SPOT MONITORING is in place as
appropriate after work finishes *
Signed Authorising Person: Time:

Signed Responsible Person: Date:

PTW. 3 Version 2.1 Last revised: October 2021

ANDROMEDA – PERMIT TO WORK

WORKING ON MACHINERY
Work to be done: Location:

Authorising Person: Responsible person:

Crew involved:

Inform: OOW and EOOW Chief officer and Chief Engineer

Pre-Work Checklist

Toolbox talk with all persons involved Warning notices in place, access secured

Current and valid risk assessment complete Lockout/tag out completed as necessary
Permission granted by Chief Engineer, Chief Inform end users of planned outage to their
Electrician equipment
Communication agreed and tested as
Consider cover and protection
required
Correct PPE to be worn Electrical circuits tested and proved safe

All tools and equipment tested and inspected Bridge OOW informed of equipment isolations
Vessel operations and weather conditions
considered

Period of Validity (not exceeding 24 hours)

From: Until:
Time: Date: Time: Date:

AUTHORISING PERMIT
*Signing this section states that you are satisfied any additional safety measures required have been
implemented and the work can commence*
Signed Authorising Person: Time:

Signed Responsible Person: Date:

CLOSING PERMIT
*Signing this setion states that you are satisfied any additional safety measures required have been returned
to their original condition
Signed Authorising Person: Time:

Signed Responsible Person: Date:

PTW. 4 Version 2.1 Last revised: October 2021

ANDROMEDA – PERMIT TO WORK
LIFTING OPERATIONS
Work to be done: Location:

Authorising Person: Responsible Person:

Crew Involved:

Inform: Bridge OOW & EOOW Chief Officer or Chief Engineer

Pre Work-Checklist
Tool box talk between lifting party & comms
Weather conditions assessed
agreed
Risk assessment consulted Crane controllers batteries charged

Barriers/Cones/Warning notices in place Taglines prepared

PPE checked and in use (helmet, gloves, ECR advised of nature of lift, which side &
footwear, whistles) power packs used
HPPs started (20 seconds apart) & time
Well Deck scuppers plugged
allowed to warm up
Lifting arrangement/gear prepared & checked
Crane indication & manual controls checked
(cranes, shackles, hooks, strops, spreaders)
Centre of gravity of lift ascertained (as
Overload test carried out
appropriate)
Pre-launch boat checks complete as
Mast forestays are removed and correctly
appropriate (fuel, oil, power, bungs, keys,
secured onto mast (for forward crane)
safety equipment etc)

A POSITIVE REPORT MUST BE MADE BY THE RESPONSIBLE PERSON TO THE BRIDGE ONCE TENDER/ITEM IS
HOOKED UP, WEIGHT ON AND FINAL CHECKS AT LIFTING POINTS HAVE BEEN MADE

Period of Validity (not exceeding 24 hours)

From: Until:
Time: Date: Time: Date:

AUTHORISING PERMIT
*Signing this section states that you are satisfied any additional safety measures required have been
implemented and the work can commence*
Signed Authorising Person: Time:

Signed Responsible Person: Date:

Post Work-Checklist
Scupper plugs removed Barriers removed Bridge OOW informed
Power packs off Batteries on charge

CLOSING PERMIT
*Signing this section states that you are satisfied any additional safety measures required have been
returned to their original condition
Signed Authorising Person: Time:

Signed Responsible Person: Date:

PTW. 5 Version 2.1 Last revised: October 2021

ANDROMEDA – PERMIT TO WORK

WORKING ON LIFTS / ELEVATORS

Work to be done: Location:

Authorising Person: Responsible Person:

Crew Involved:

Inform: Bridge OOW & EOOW Chief Officer or Chief Engineer

Pre-Work Checklist
Toolbox talk conducted; Risk assessment
Warning notices in place, access secured
consulted
Permission granted by Chief Engineer, EOOW,
Controls secured as necessary
Chief Electrician
Conduct toolbox meeting with all persons
Lockout/tag out completed as necessary
involved
Electrical circuits tested and proved safe Consider covering and protecting

Communication agreed and tested as required Correct PPE to be worn

All tools and equipment tested and inspected Props installed for pit work

Period of Validity (not exceeding 24 hours)

From: Until:
Time: Date: Time: Date:

AUTHORISING PERMIT
*Signing this section states that you are satisfied any additional safety measures required have been
implemented and the work can commence*
Signed Authorising Person: Time:

Signed Responsible Person: Date:

CLOSING PERMIT
*Signing this section states that you are satisfied any additional safety measures required have been
returned to their original condition
Signed Authorising Person: Time:

Signed Responsible Person: Date:

PTW. 6 Version 2.1 Last revised: October 2021

ANDROMEDA – PERMIT TO WORK

DIVING ON SHIP’S HULL

Work to be done: Location:

Authorising Person: Responsible person:

Crew involved:

Inform:
Bridge OOW & EOOW Chief Officer or Chief Engineer

Pre Work Checklist

Toolbox talk conducted; Risk assessment ‘DIVERS DOWN’ notices placed on bridge and
consulted ECR
‘ALPHA’ flag hoisted ECHO SOUNDER & ICCP SYSTEM ISOLATED
Weather conditions checked, sea conditions,
STABILISERS ISOLATED
swell, current and drift recorded
Port Authorities informed and permission
BOW THRUSTER ISOLATED
granted as required
Proximity to other vessels checked PORT & STBD AZIPULL UNITS ISOLATED
Adjacent vessels notified and have completed Local emergency diver contact numbers
their respective dive clearance noted
Communications established between OOW & Buddy system/standby diver briefed in case of
assistant on deck. emergency
Rescue boat standing by as necessary Medical kit and 100% O2 on standby

Equipment to be used inspected and tested Divers briefed by C/E and dive plan agreed

Period of Validity (not exceeding 24 hours)

From: Until:
Time: Date: Time: Date:

AUTHORISING PERMIT
*Signing this section states that you are satisfied any additional safety measures required have been
implemented and the work can commence*
Signed Authorising Person: Time:

Signed Responsible Person: Date:

CLOSING PERMIT
*Signing this section states that you are satisfied any additional safety measures required have been
returned to their original condition
Signed Authorising Person: Time:

Signed Responsible Person: Date:

PTW. 7 Version 2.1 Last revised: October 2021