Vessel Pulling Permit
SECTION 1: REQUISITION
Date
Issue Time
Valid Up To
Permit No
Applicant (Mukadam)
Ship Name
JHA Report No
Winch Numbers Used
Name of Workers
SECTION 2: WORK SITE PREPARATION / PRECAUTIONS
Items Check / Criteria
Yes
No
N/A
Remarks
SECTION 3: PERSONAL PROTECTIVE EQUIPMENT
Safety Helmet
Safety Goggles
Cut resist gloves
Safety Shoes
Cotton gloves
Ear plug
Ear muff
Coveralls
SECTION 4: EMERGENCY ITEMS
Life jacket
Fire Extinguisher
First Aid Box
Fire Hose Standby
Life buoy
Fire pump ready
Sand bucket
Stretcher
SECTION 5: JOINT INSPECTION & SIGNATURES
Permit Applicant (Mukadam)
Approval by HSE Dept.
Permit Controller (PM/GM)
Select Role to Sign:
Permit Applicant (Mukadam)
Safety Officer / HSE
Plot Manager / GM
Special Instruction Acknowledgment (Mukadam)
Permit Closure: Mukadam
Permit Closure: Safety Officer
Clear Pad
Save Signature
SECTION 7: PERMIT CLOSURE
Permit is closed; job is contd. Please issue new permit.
Permit is closed; job is completed.
Permit is cancelled (conditions not conductive).
Closure Time
SAVE VESSEL PULLING PERMIT
Cancel & Return to Dashboard
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