Elkhorn Construction, Inc

Title: Critical Lift Plan

Safety Manual
Effective Date: 12-15-2008
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.
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

Document No: 2B-00xx

Revision 1

Page 1 of 2

Elkhorn Construction, Inc

Title: Critical Lift Plan

Safety Manual
Effective Date: 12-15-2008

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 ____________________________________

Document No: 2B-00xx

Revision 1

Page 2 of 2