Issue De-Bunkering Permit
Section 1: Requisition
Permit No.
Date
Issue Time
Valid Up To
Applicant (Mukadam)
Ship Name
Location / जगह
Work Description / काम का विवरण
JHA Report No.
Name of Workers / Sub. Cont.
Sub Cont Name / Contact
SECTION 2: ASSOCIATED PERMITS
Confined Space
Safe Entry (Vessel)
Work at Height
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
Dust mask / अग्निरोधीड्रेस
Coveralls / ड्रेस
Cotton gloves / सूतीमोजा
Safety harness for worker on truck
Latex gloves / लेटेक्सदस्ताने
Filter mask / फ़िल्टरमास्क
Safety Goggles / सेफटीचसमा
Ear plug/Ear muff / ईयरप्लग
Disposal suit / निपटानसूट
Section 5: Emergency Items
S.C.B.A set/ एससीबीए सेट
E.E.B.D / ई.ई.बी.डी.
Stretcher/स्ट्रेचर
Fire suit/फायरसूट
Fire Blanket / अग्निकंबल
First Aid Box / प्राथमिकउपचारडिब्बा
Fire Extinguisher/ फायरबाटला
Fire pump Fire Hose ready
Sand bucket / रेतकीबाल्टी
Wet Gel Blanket / गीला जेल कंबल
Safety Harness/ Tripod
Mechanical Blowers
Ladder / सिडी
Rope/ रस्सी
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 is closed; job is contd. Please issue new permit.
Permit is closed; job is completed.
Permit is cancelled, conditions are not conductive.
Closure Time:
Permit Status:
Open (Active)
Closed
Void / Cancelled (Error)
SAVE DE-BUNKERING PERMIT
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