HSE Permit Issuance App
Section 01: Requisition
Ship Name
Internal Permit No.
External Permit No.
Permit Date
Check Time
AM
PM
Issue Time
AM
PM
Valid Till
PM
AM
JHA Report No.
Sections 02 & 03: Gas Meters & Readings
Meter 1: GMI PS 241
Used for permit
Meter 2: MSA ALTAIR 4X
Used for permit
O2 [%]
LEL [%]
CO [ppm]
H2S [ppm]
Section 04: Locations
Engine room
Pump room
Forepeak tank
Poop deck
Bosun store
Upper/main deck
Steering Gear Rm
Void Space:
WB Tank:
Cargo Hold:
Deck No:
Multiple Blocks/Sections
Section 05: Safety Instructions & Equipment (All Requirements)
Safe for Entry Tag displayed
Valid certs of access ladders
Marking of assembly area
ERT members displayed
Access is restricted/barricaded
Emergency items near assembly
Illumination >= 60 lux
Wind speed <=35 km/hr
Temperature <= 45*C
Escape route free from obstacles
Emergency contact displayed
Open edges barricaded 1m away
Temporary holes are covered
Continuous power / back-up active
Head count system active
Temporary ladders are tied
Section 06: Emergency Items (All Items)
SCBA sets
Safety Harness
EEBD
Fire Pumps
WetGel Blanket
Fire Hoses
Fall Arrestor
Emergency Siren
Tripod
Fire Blanket
Sand Buckets
Fire Extinguishers
First Aid Box
Pilot ladder
Stretcher
Fire Suits
Oil Spill Kit
Spare fire Nozzels
Life Buoys
Life jackets
Rope >= 20m
Sections 07 & 08: Approvals & Signatures
1. Select Role to Sign:
Section 7: Safety Officer
Section 7: HSE Manager
Section 7: Plot Manager
Section 8 CLOSURE: Safety Officer
2. Draw Signature:
Clear Pad
Save Signature to Role
Signatures Currently Saved to this Permit:
Safety Officer
HSE Manager
Plot Manager
Sec 8 Closure
Safety Officer Name
HSE Manager Name
Plot Manager Name
Section 08: Permit Closure (Fill only when closing)
Permit closed, new permit issued for continuation.
Permit closed/cancelled, all persons disembarked.
Closure Time:
Permit Status:
Open (Active)
Closed
Save Permit & Return to Dashboard
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