Issue Boat Embarkation Permit
Section 1: Requisition
Permit No.
Date
Issue Time
Valid Up To
Applicant (Mukadam)
Ship Name
JHA Report No.
Location of Embarkation (Yard)
Location of Disembarkation (Ship)
Name of Workers / Passengers
SECTION 2: ASSOCIATED PERMITS
Safe Entry (Vessel)
Debunkering Permit
Cold Work Permit
Other / अन्य
Section 3: Work Site Preparation / Precautions
Criteria
Yes
No
N/A
Remarks
Section 4 & 5: PPE & Emergency Items
Section 4: Personal Protective Equipment
Safety Helmet/ हैलमेट
Safety Goggles/ सेफटी चसमा
Safety Shoes/ सेफटी जूता
Cotton gloves/ सूती मोजा
Ear plug/ ईयर प्लग
Coveralls/ ड्रेस
Dust mask / धूल मुखौटा
Personal Life Jacket/ व्यक्तिगत जीवन जैकेट
Section 5: Emergency Items
Spare Life jacket / अतिरिक्त जीवन जैकेट
Life buoy / लाइफबॉय
First Aid Box/ प्राथमिक उपचार डिब्बा
Rope/ रस्सी
Pair of Oars / चप्पुओं की जोड़ी
Fire Extinguisher/ फायर बाटला
Rescue boat + Crane / बचाव नाव + क्रेन
Approvals & Signatures
Sec 6: Applicant / Mukadam
Sec 6: Safety Officer / HSE
Sec 6: Plot Manager / GM
Sec 7: Mukadam Declaration
Sec 8 CLOSURE: Mukadam
Sec 8 CLOSURE: Safety Officer
Clear Pad
Save Signature
Applicant (Sec 6)
Safety (Sec 6)
Plot Mgr (Sec 6)
Mukadam (Sec 7)
Close: Mukadam
Close: Safety
Supervisor Name
Safety Officer
Plot Manager
Section 8: Permit Return / Closure
Permit closed, ride needs to be contd. Please issue new permit.
Permit closed, ride is completed.
Permit is cancelled, conditions are not conductive for operation.
Closure Time:
Permit Status:
Open (Active)
Closed
Void / Cancelled (Error)
SAVE BOAT EMBARKATION PERMIT
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