Form No:

SHE - 68

ELEVATOR WORK PERMIT

GENERAL
Name of the vessel:
Location of Work:
Permit Valid From :

MSCAGADIR
CREWELEVATOR

Date:
Weathercondition:
To:

hrs, Date

hrs, Date

Description of Work:
No.
A
1

Safety Checks

Has Stand-by meeting been carried out and Emergency escape procedure
(including emergency stop) discussed and understood?

Sea / Weather condition stable for planned maintenance work?

Has warning signs been posted at each entry level and elevator room control
panel; lock out /Tag out procedure applied? (Cover the call button with suitable
tape on each floor and preferably hang the warning sign board over the call button
to prevent accidental pressing)
Has appropriate announcement made on P.A System?

Yes

No

General
Has the risk assessment been carried out

Has communication procedure been established and Radio Trans receivers

available with all persons involved in the elevator maintenance team?

Is proper personal proactive equipment worn & flash light available?

B
1

If work Involves standing on top of the cage and climbing -up elevator shaft
Has the control position been changed to Manual operation(on top of the cage)and
Lock/Tug out practice been applied

Are at least two persons available for work ( one on the top of the cage and the
other to be stand-by)

Has safety harness (or safety belt) been worn by the person standing on the cage
and is the life line secured to a strong point.

C
1

For electrical and other works including entering the bottom of elevator shaft
Is the elevator locked in the position (by turning the emergency stop switch inside
the cage)?

Is the main power in control panel switched "OFF and warning sign posted?

I have checked and ensured that all necessary precautions are in place and it is safe to proceed with the job and will
re-check all above items in case of any interruption in work.
Chief / Second Engineer
Rank/Name

Signature

Time

Date

We are satisfied that all precautions have been taken and that all safety arrangements will be maintained for entire
duration of work. Any work interruption shall be reported to the CE/2E to re-check all safety precautions prior
resuming work.
Personnel attending work
Rank/Name

Signature

Time

Date

Rank/Name

Signature

Time

Date

Rev:00

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Form No:

SHE - 68

ELEVATOR WORK PERMIT

Safety Aspects of Elevator Maintenance

1

Hold a prior meeting before maintenance. Plan and discuss your work
scope and stick to it

Inform bridge and all crew members about maintenance work. Announce
and post notice Under maintenance - Do Not Use in door of all floor.

Never work alone , take at least one more person and establish
communication channel during work

Access to the top of the car shall be made through inside car emergency
escape on the ceiling.
Never attempt to get on top of the car directly from accommodation floor.

Once cabin escape door is open supply to control circuit is cut off. With
control
Supply cut off condition, please do the following :a.

Push the emergency stop switch

b. Go up to the cage top from the inside of the cage through the
emergency escape door.
c.

Turn the Auto Manual changeover switch to Manual

d.

Cancel the emergency stop switch.

Now car can only be operated from the top of the car by UP/DOWN
switch on emergency mode.

spring

These are general guide line , there may be slight variation in operation
depending on make and model.
Makers recommendation shall be strictly observed while carrying out any
maintenance on the elevator.

Rev:00

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