Diving Permit

This form is for the purpose of obtaining permission to conduct diving in Port limits and to ensure that hazards associated with this work activity are controlled. All diving operations to be carried out in accordance with AS/NZS 2299.1 (2015) and any other relevant Authorities requirement or Australian Standard- THIS PERMIT WILL ONLY BE ISSUED TO DIVERS WHO ARE CONDUCTING THE WORK

SECTION 1: Applicant Details
SECTION 2: Description of Location and Activity

SECTION 3: Permit Dates
TO

SECTION 4: Permit Conditions

Attach to this permit a copy of Dive Cert. AS/NZS 2815 and valid medical.

Permit Applicant to tick yes, no or NA to the following:

SECTION 5: Permit Applicant Statement of Acknowledgement

I acknowledge the requirements of the Kimberley Ports Authority to identify and control risks and work in a safe manner at all times. I confirm the company I represent/undertaking the work has satisfactory documented safe systems of work in place and that all permits and licences required are current. Once the permit is authorised ensure that section 8 is completed prior to commencement of activity.

Signature:
Use your mouse or finger to draw your signature above.

 

All supporting documents must be emailed separately to operations@kimberleyports.wa.gov.au
 
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