Critical Lift Plan
Date: __________________
Location of Lift:
_________________________________________________________
Description of Object To Be Raised:
_________________________________________
_______________________________________________________________________
Lifting Equipment Make
& Model: __________________________________________
Lifting Equipment Rated Capacity: ______________tons
Load
Total Weight of Lift: _______________ pounds or
________________tons
Weight Of Rigging: ______________________ pounds
How Was Weight of Object
Obtained?_______________________________________
If lift is an existing item, weight calculations will
include modifications, liquid remaining, insulation, sludge, scale, sediment,
etc.
FALL PROTECTION SAFETY TRAINING VIDEO
Set Up
Boom Angle: ________________ degrees
Distance From Pin:________________ feet
Crane Capacity at Set Up Configuration: ___________pounds or
__________tons
Load Including Rigging is What Percent of Rated Crane
Capacity _____________%
Equipment and Lift Relationship
Maximum Operating Radius _______________________feet
Planned Operating Radius _________________________feet
Allowable Load (from load chart) _______________ tons or
______________ pounds
Ratio of Lift to Allowable Load __________________ percent
Clearance Between Boom and Load _________ feet
______________ inches
Clearance To Existing Facilities ____________ feet
Clearance To Energized Power Lines _____________feet
Ground Stability
Surface Type _________ bare ground _________asphalt
__________ concrete
Surface Bearing Capacity ______________ tons per square foot
Type of Support Used ________mats _________ cribbing
Mats will be used on all surfaces; additional cribbing may be required
Size and Number of Supports _________________________
Do Underground Installations Need Special Treatment
_______yes _______no
Weather
Lift Will Not Proceed if Wind Exceeds
________________ mph
Precipitation Type ______ rain __________ snow _________
none
Cloud Type overcast ___________ clear ___________
Lift Conducted _______during daylight _______ with
artificial light
Lift Area Restriction
Area Barricaded _________yes ________no
Equipment swing Radius Barricaded ________yes _______no
Warning Signs Required _________yes _________no
Unnecessary Personnel Removed From Area _______yes ______no
Energized Lines Isolated __________ yes _________ no
Communication
Operator View is Unobstructed (pick to set) _________yes
______no
Communication Used _________ hand signals _________ radio
____________ other
Explain Other
________________________________________________
Pre-lift Safety Meeting
Type of Critical Lift
___________ Load Exceeds 75% of Load Chart Capacity For
Lifting Equipment
___________ Two or More Cranes/Booms Required for Lift
___________ Specialized Hoisting Rigging Equipment Used
___________ Load Suspended or Moved Over Loaded Lines
___________ Other (specify)
_________________________________________
Items Discussed
____________________________________________________
__________________________________________________________________
__________________________________________________________________
Crane Operator ___________________________________________
Crane Rigger _____________________________________________
Crane Oiler ______________________________________________
Signal Person ____________________________________________
Crane Inspected By _______________________________________
Rigging Inspected By _____________________________________
Client Representative _____________________________________
Designated Lift Leader
____________________________________
