FY-20 Local Standard Item 099-77SW (Attachment A).pdf

ATTACHMENT A

WORK AUTHORIZATION FORM CONTINUATION SHEET

1. USS 3. WAF NO. REV

**COFFERDAM REQUIRED**

The restrictions below control the installation and removal of the cofferdam to protect the work.

Prior to authorization of work which will break a boundary to sea a cofferdam is required at:

Hull opening nomenclature: _____________________

Docking plan drawing number: __________________

Item number: ________________________________

Frame number: _______________________________

☐ Port ☐ Starboard Check one.

Distance off centerline: _________________________

Commanding Officer Permission required for single barrier to sea: ☐YES ☐NO

Cofferdam No. __________ is installed: __________________________ _________

FWP/PCP Number: ___________________ DIVING SUPERVISOR DATE

COMMANDING OFFICER PERMISION GRANTED FOR SINGLE BARRIER TO SEA: ☐YES ☐N/A

AUTHORIZED TO START WORK: __________________________ _________

WATCH/DUTY OFF DATE

DIVING SUPERVISOR DATE

REPAIR ACTIVITY DATE

READY FOR COFFERDAM REMOVAL: ___________________________ _________

REPAIR ACTIVITY DATE

AUTHORIZED TO REMOVE COFFERAM: ___________________________ _________

WATCH/DUTY OFF DATE

COFFERDAM REMOVED: ___________________________ _________

DIVING SUPERVISOR DATE

CHECK IF CONTINUED ON ANOTHER SHEET

Sheet _____