Dart Harbour Permit to Work

I am a - *

Contractor for Dart Harbour

Dart Harbour Employee

Name of person requesting permit. *

Contractor Section

Company Name *

Company email address

Your Contact Telephone Number *

Office or Emergency Contact number

Confirm the following: *

The task has a Risk Assessment completed.

The task has a Method Statement completed.

I am suitably trained and qualified.

I hold valid third party liability insurance.

Please provide any further information you feel we need below:

Please read (or download) P54 - Contractor Permit to work

When Shore Side:
Wherever possible contractors should stick to Yellow marked walkways in the workshop & yard. All health & Safety signage to be adhered to. Contractors should be made aware of fire exits and muster stations. If an alarm sounds contractors should:
Stop work. Turn off equipment if possible.
Leave building by nearest safe exit.
Make way to muster point (DHNA Carpark – Across railway line).

When Afloat:
When contractors are working afloat they should adhere to DHNA guidelines and advice. When aboard any DHNA vessels or pontoons a life jacket must be worn, this can be provided by DHNA. Our office telephone number is 01803 832337 for any enquires.

Do you agree to the above? *

Yes

Will you be bringing your own lifejacket? *

Yes

No - Need Dart Harbour lifejacket

Not Required - working ashore.

Please provide us with copies of your RAMS and insurance.

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Name of people carrying out the task - including Dart Harbour employees.

Have you read P51 - Permit to work (inc confined spaces) *

Yes

Date of task *

Start time of task *

:

Estimated end time of task *

:

Location of task *

Staff involved *

Task that requires a permit. *

Description of works or tasks to be carried out *

Are the public at risk? *

Yes - describe mitigationsYes - describe mitigations

No

Diving Operations

Please confirm that the Tide and Weather are suitable for your intended dive. *

Yes

Confirm high water time for date of dive: (Tide data can be found on Dart Harbours Website) *

Are you requesting a LNTM to be issued?

Yes

No

Dive Supervisor Qualification: *

If diving from a Vessel, state the Vessel's name:

Approved code of practice under which Dive will be undertaken (tick box) *

All diving operations must display the appropriate International Code Signal whilst diving takes place.
The Harbour Office must be informed by either VHF or telephone before and after diving takes place.
If diving operations take place outside of normal working hours then start and finish times of diving operations are to be notified to the Duty HM on 07968 839846.
The dive will be conducted under relevant HSE ACOP’s the contents of which I am aware, and a site-specific risk assessment has been undertaken.
No diving is to take place without this permit being approved by the Duty HM

I agree to the above dive instructions. *

Yes