/ Form No : / APAOHS-04
Revision: / Mar 2014
Diving Permit / Issue Date:
Page: / 1 of 2
This permit is required to be completed & approved by the Port Authority Representative before any diving operations are undertaken within the Port area. This permit must be accompanied by a Dive Plan which identifies how the task will be performed and identifies and addresses hazards associated with the task.

Section 1: Applicant Details

Name: / Works Start Date:
Company: / Works Completion Date:
Contact Phone
Worksite Area:
Description of work
to be undertaken:
Dive Supervisor:

Section 2: Dive Team Requirements

Applicable Standard for Operations: / Commercial AS/NZS 2299.1:1999 / Scientific AS/NZS 2299.2:2002 / Other:
Please Tick relevant box – if not applicable – write N/A / Yes / No
1. / Are all operators qualified and competent to carry out the work?
2. / Has a competent person completed a Dive Plan including emergency procedures and a specific hazard assessment with mitigation methods? (This should include addressing the possibility of shipping movements and)
3. / Is all dive equipment serviceable and in current certification as per relevant regulations and standards?
4. / Is the dive vessel in survey?
5. / Do you have the correct licence to operate the vessel?
6. / Are appropriate first aid trained people available?
7. / Will first aid equipment (including oxygen) be carried?
8. / Have contact arrangements been established with the APA Principal?
9. / Do you have appropriate written safe work procedures for your operations, including working in the vicinity of ships if required?
10 / Duty pilot (0488 929 095) will be contacted daily to confirm shipping movements?

Section 3. Applicants Statement of Acknowledgement

I acknowledge the requirements of the AlbanyPort Authority to identify and control risks and work in a safe manner at all times. I confirm the company has satisfactory documented safe systems of work in place and that all permits and licences required are in order and understood.
Signature: / Position:
Name: / Date: / / /

Section 4: Port Authority Actions

Please tick relevant box / Yes / No
1. / Has the Port Authority Principal advised the pilots that diving will occur?
2. / Has a satisfactory communication method between dive team and Principal been agreed?
3. / Have Port maintenance activities likely to conflict with diving been halted or re-scheduled?
4. / Are divers aware that they may be required to leave the water for shipping movements as advised by the principal?
(HM or Duty Pilot to advise Principal as required)
5. / Have relevant Port personnelbeen informed about diving operations?
6. / Has cathodic protection been turned off and tagged out (if applicable)?

Section 5: APA Representative Statement of Acknowledgement (APA Use Only)

I am satisfied that the contractor information provided to me is sufficient to show that the contractor has a system in place to fulfil their legal obligations to conduct works in a safe manner. This Permit to Work is approved subject to any conditions listed below.
Comments and
any special
conditions
The APA may withdraw this permit at any time if unsafe work practices are seen
Signature: / Position:
Name: / Date: / / /

Section 6: Notifications

Engineer / Maintenance
Safety / Environment
Security / Pilots