ALANGHSE SERVICES
REV. 01
Controlled Form
ALANGHSE SERVICES |
DE-BUNKERING PERMIT | ALANGHSE-F-05 REV. 01 Controlled Form |
| SECTION 1: REQUISITION / CONTROL INFORMATION | |||
| Applicant (Mukadam) | VISHAL PANDEY | Ship Name | VISHAL PANDEY |
| Location / Work Description | [ DB_LOCATION ] - [ DB_DESC ] | ||
| Workers / Sub. Contractor | VISHAL PANDEY / [ DB_SUB_CONTRACTOR ] ([ DB_SUB_CONTACT ]) | ||
| Date / Issue Time | 2026-08-10 / 08:00 AM | Valid Up to / Permit No. | 08:00 AM / [ DB_PERMIT_NO ] A/B |
| SECTION 2: COMPLIANCE MATRIX | ||||
| CHECK / CRITERIA | YES | NO | N/A | REMARKS |
| VESSEL & ENVIRONMENTAL PREPARATION | ||||
| 1. Is the vessel securely moored? | ☑ |
[ Q2_RMK ] | ||
| 2. Is oil boom wrap around hose intact? | ☑ |
[ Q5_RMK ] | ||
| 3. Gas Monitoring Required? | ☑ |
[ Q6_RMK ] | ||
| 4. Is ventilation to the area adequate? | ☑ |
[ Q8_RMK ] | ||
| 5. Are lighting & access route adequate? | ☑ |
[ Q9_RMK ] | ||
| 6. Housekeeping maintained & flammables removed? | ☑ |
[ Q10_RMK ] | ||
| 7. No hot work allowed in nearby area? | ☑ |
[ Q26_RMK ] | ||
| 8. Emergency Assembly Point identified? | ☑ |
[ Q27_RMK ] | ||
| 9. Oil loading area barricaded & stoppers provided? | ☑ |
[ Q30_RMK ] | ||
| EQUIPMENT, PUMPS & PIPELINES | ||||
| 10. First Aid Kit and Oil Spill kit available? | ☑ |
[ Q4_RMK ] | ||
| 11. Oil removal pump kept in confined space? | ☑ |
[ Q7_RMK ] | ||
| 12. Fire equipment available with fire team? | ☑ |
[ Q11_RMK ] | ||
| 13. Portable fire extinguisher at pumping station? | ☑ |
[ Q12_RMK ] | ||
| 14. Inspection of all equipment's/pumps done? | ☑ |
[ Q14_RMK ] | ||
| 15. Electric cables properly insulated? | ☑ |
[ Q15_RMK ] | ||
| 16. Inspection of pipelines/joints/leaks done? | ☑ |
[ Q16_RMK ] | ||
| 17. Drip trays provided under joints? | ☑ |
[ Q17_RMK ] | ||
| 18. Oil tray placed below pump with oil boom? | ☑ |
[ Q19_RMK ] | ||
| 19. Tank connection secured and sealed? | ☑ |
[ Q21_RMK ] | ||
| 20. Availability of equipment in good condition? | ☑ |
[ Q24_RMK ] | ||
| PERSONNEL & COMMUNICATION CONTROLS | ||||
| 21. Permit received from competent authority? | ☑ |
[ Q1_RMK ] | ||
| 22. Job Hazard Assessment done? | ☑ |
[ Q3_RMK ] | ||
| 23. Method/clarity of communication established? | ☑ |
[ Q13_RMK ] | ||
| 24. Continuous supervision at inlet/outlet points? | ☑ |
[ Q18_RMK ] | ||
| 25. Procedure for emergency shutdown in place? | ☑ |
[ Q20_RMK ] | ||
| 26. Is the oil removal team trained? | ☑ |
[ Q22_RMK ] | ||
| 27. Are the workers in proper PPE? | ☑ |
[ Q23_RMK ] | ||
| 28. Proper signage for warning displayed? | ☑ |
[ Q25_RMK ] | ||
| 29. Pre-job Meeting done? | ☑ |
[ Q28_RMK ] | ||
| 30. Induction training provided to truck drivers? | ☑ |
[ Q29_RMK ] | ||
| SECTION 3: PPE + SECTION 4: EMERGENCY READINESS | ||||
☑ S.C.B.A set |
☑ E.E.B.D |
☑ Stretcher |
☑ Safety Helmet |
☑ Dust mask |
☑ Coveralls |
☑ Cotton gloves |
☑ Fire suit |
☑ Fire Blanket |
☑ First Aid Box |
☑ Harness (truck) |
☑ Latex gloves |
☑ Fire Extinguisher |
☑ Fire Hose |
☑ Sand bucket |
☑ Filter mask |
☑ Safety Goggles |
☑ Wet Gel Blanket |
☑ Safety Harness |
☑ Mech. Blowers |
☑ Ear plug |
☑ Disposal suit |
☑ Ladder |
☑ Rope |
|
| SECTION 7: JOINT INSPECTION & AUTHORISATION MATRIX | ||
| A. PERMIT APPLICANT | B. HSE APPROVAL | C. PERMIT CONTROLLER / PM-GM |
|
I am satisfied that all precaution has been taken and all safety arrangements will be maintained for entire duration of work.
Name: VISHAL PANDEY
Designation: Ship / Yard Supervisor Signature: |
I am satisfied with safety precautions and hereby give permission to commence work.
Name: VISHAL PANDEY
Designation: Safety Officer / HSE Manager Signature: |
Approval by Plot Manager (PM) / General Manager (GM).
Name: VISHAL PANDEY
Designation: PM/GM Signature: |
| SECTION 6: SPECIAL INSTRUCTIONS / ACKNOWLEDGEMENT |
|
1. अगर कहीं भी DO NOT ENTER लिखा हुआ हो तो कभी भी अन्दर न जाये और नाही किसी को जाने दे जब तक आपके पास परमिट न हो| 2. नियर मिस कभी भी छुपाने की कोसिस न करे उसे फौरन सेफ्टी ऑफिसर को रिपोर्ट करे | 3. पाइपलाइन/मसिनेरी पार्ट्स खोलने से पहले अपने टूल्स और अन्य वास्तु को चेक करना जरुरी है | 4. अगर आपको डी बंकरिंग परमिट मिल गया है और कहीं बंद जगहे में काम करना हो तो बंदस्थान की अलग से अनुमति लेना आनिवार्य है| 5. किसी भी टैंक की सफाई करने से पहले बंदस्थान की अनुमति परमिट लेना आनिवार्य है |
I have read and understood all instructions above and have explained them to all workers engaged in the work.
Mukadam Signature: _____________________ Date: 2026-08-10 |
| SECTION 7: PERMIT RETURN | |||||
| ✓/X | STATUS | PERSON | NAME | SIGNATURE | TIME |
☑ |
Permit is closed, job is completed | Mukadam | VISHAL PANDEY | 08:00 AM | |
| Safety Officer | VISHAL PANDEY | ||||
| SECTION 10: EMERGENCY CONTACT NUMBERS | |||
| SL. NO. | DESIGNATION | NAME | CONTACT NO. |
| 1 | HSE MANAGER | ROCKY SINGH | 7990404108 |
| 2 | PLOT MANAGER | PRAVIN SHIYAL | 79846 07070 |