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 are 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. Note: All diving activities must be authorised by the KPA Harbourmaster, prior to the Permit being authorised.

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

SECTION 3: Permit Dates
TO

SECTION 4: Permit Conditions
Permit Applicant must tick yes to all of the following
Permit Applicant to tick yes, no or NA to the following:

SECTION 5: Permit Applicant Statement of Acknowledgement

By signing this document, the Applicant:

  • Agrees that they are responsible for the works being undertaken and that they and their contractors will work in a safe manner at all times; and
  • Confirms that the company they represent and contractors they use at the Port of Broome will; have safe systems of work in place, use equipment that is certified (when required) and fit for purpose, (iii) be competent in the type of work being undertaken and (iv) hold all required permits and licences.
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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