Vessel Hot Work Permit

For planned works this form must be submitted 24 hours before commencing. An issued hot work permit shall not exceed a period of 12 hours, unless the Approving Officer has authorised otherwise.

Vessel name

Berth wharf

East Arm Wharf

Fort Hill Wharf

Harbour Anchorage

Darwin Marine Supply Base

Vessel contact name

Vessel contact number

Description of hot works

eg. Work to be completed, specific location on vessel, and equipment to be used must be detailed here.

Name of the responsible person carrying out work

eg. Ships crew or name of local contractor

Contact number of responsive person carrying out work

eg. phone number / mobile number

Agent or master's name

Agent or master's number

Has the vessel master read and understood the 'Vessel Hot Work Port Notice'?

Yes

Permit valid from date

Permit valid from time

Permit valid to date

Permit valid to time

Fire fighting equipment

eg. List the types of fire fighting equipment available on board like a hose, extinguisher.

Questions

The following questions are derived from the 'Vessel Hot Work Port Notice'. Please read the Port Notice before proceeding any further with the completion of this Hot Work Permit.

Will a hot work supervisor be appointed?

Yes

Will a job safety environmental analysis be conducted?

Yes

Are the mandatory minimum control measures in place?

Yes

Have the minimum seperation distances been observed?

Yes

Can you conduct hot work safely as there are no incompatible operations being undertaken concurrently? eg. bunkering or transfer of dangerous goods?

eg. Bunkering or Transfer of Dangerous Goods

Yes

Have weather conditions been taken into account?

Yes

Are the protective guards and shields appropriate for the work?

Yes

Has the fire watch person been appointed and understands their duties?

Yes

Is the vessel free of Class 1 dangerous goods?

Yes

Do you have a permit to work system for hot work that may be carried out in a confined space/enclosed space on the vessel?

Yes

Have all checks and precautions as per the vessel Hot Work Port Notice been undertaken to commence hot works?

Yes

Notes - Where you have answered NO or N/A please explain why.

Please provide valid email address for approval

This email address must be correctly entered to receive approval.

Add attachments

eg. JSEA, SWMS etc
Maximum 5 files.
6 MB limit.
Allowed types: jpeg, jpg, png, zip, doc, docx, pdf.

The persons name who is submitting this application

Declaration

By submitting this form the master of the vessel is agreeing that information provided is true and correct and to provide the Port assurance that the appointed Hot Work Supervisor will complete their section of the Hot Work Permit before commencing work.
(The link for the Hot Work Supervisor form to complete will be provided in approval email.)

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