LIFTING PLAN

Project Name:
Client: Date:
WORK PERFORMED:

Crane Definition Load Data

Manufacturer: Lift Description:
Model:
Serial No.: Equipment number/name:
Crane Description: Dimension (L/W/H):
Rated Capacity: Total Gross weight:
Area of operation: From location to location:
Crane yearly inspection date: Maximum operating radius to
be used during lift:

Crane Configuration Jib to be used ( ) Yes ( ) No

Main Boom No. sections:
No. Sections: Jib size:
Boom Size: Jib length:
Boom Length: Jib type:
Boom Type: Jib max. Load Radius:
Hoisting from main boom: Jib max. capacity of lift point:
Max load radius: Jib length of boom:
Main boom max. capacity of lift Ground compact & stable:
point: Type of surface size:
Length of main boom:

Lift weight data and calculations

Weight of load to be lifted: Weight of crane components:
Total weight of Lifted Load &
Rigging-Lifting Beams Qty: Crane components:
Rigging-Slings Qty:
Type: Nylon Capacity:
Rigging-Shackles Qty:
Type: Capacity:

Lift Administration Checklist (Mandatory):

Has pre-lift meeting been held with signal person/riggers/operator/site supervisor ( ) Yes ( ) No
Operator assigned for the lift,(name)
Operator Certification Card Current (must be current) ( ) Yes ( ) No
Signal person designated, (name)
Communication will be held by, (please insert on line)
Has swing clearance been checked ( ) Yes ( ) No
Has area been checked for safe entry and exit ( ) Yes ( ) No
Tagline has to be used, description: ( ) Diameter, ( ) Length ( ) Yes ( ) No

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Potential hazards to be addressed:

Weather ( ) yes, ( ) no If yes please explain

Electricity ( ) yes, ( ) no If yes please explain

What is wind speed: ( )15mph consider shutting down lift ( )20mph cancel lift
Ground: ( ) yes, ( ) no If yes please explain

Signature of plan developers and reviewers:

Person responsible for lift: (operator)

Print Signature Date
Site Supervisor:
Print Signature Date
Client Representative:
Print Signature Date
Other:
Print Signature Date
Critical Lifts:
1. Any Lift, above 15 tons, over an operating unit, shelter or building
2. Any lift, with a load greater than 50 tons.
3. Any lift, in which the combination of weight and lift radius will load the crane in the use above 80% of its rated
capacity
4. Any lift, requiring the use of more than one crane
5. Any lift in which a significant risk of personnel injury or equipment damage is possible

Sketch/Drawing:

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