CM CBA 106—Crane Operations Construction Safety User Manual

Lift Plan Form

Ref no: PG-DL-LP-01
A lift plan should be completed prior to mobilization of equipment and rigging Date:

Location:____________________________________________________ Date of Lift:______________________________________

Load Description:______________________________________________________________________________________________
Lift Description:________________________________________________________________________________________________

A. Weight E. Sizing of Slings

1. Equipment Condition ________New ________Used 1. Sling Selection
2. Weight Empty_____________________________________ a. Type of Arrangement______________________________
3. Weight of Headache Ball_____________________________ b. Number of Slings in Hook-Up______________________
4. Weight of Block___________________________________ c. Sling Size______________________________________
5. Weight of Lifting Bar_______________________________ d. Sling Length____________________________________
6. Weight of Slings and Shackles_________________________ e. Rated Capacity of Sling___________________________
7. Weight of Jib______________________________________ 2. Shackle Selection
 Erected  Stored a. Pin Diameter____________________________________
8. Weight of Headache Ball on Jib_______________________ b. Capacity_______________________________________
9. Weight of Cable (Loud Fall)__________________________ c. Shackle Attached to Load by________________________
10. Allowance for Unaccounted d. Number of Shackles______________________________
Material in Equipment_____________________________
11. Other___________________________________________ F. Crane
1. Type of Crane_____________________________________
Total Weight 2. Crane Capacity____________________________________
3. Lifting Arrangement
Source of Load Weight________________________________ a. Maximum Distance—Center of Load
Weights Verified by___________________________________ to Center Pin of Crane____________________________
b. Length of Boom_________________________________
B. Jib c. Angle of Boom at Pick-Up_________________________
Erected ________________ Stored_______________ d. Angle of Boom at Set_____________________________
1. Is Jib to be Used?__________________________________ e. Rated Capacity of Crane under Most Severe Lifting
2. Length of Jib______________________________________ Conditions (from Chart)
3. Angle of Jib_______________________________________ 1. Over Rear___________________________________
4. Rated Capacity of Jib_______________________________ 2. Over Front___________________________________
(From Chart)_____________________________________ 3. Over Side____________________________________
4. From Chart—Rated Capacity
C. Crane Placement of Crane for This Lift___________________________
1. Any Deviation from Smooth Solid 5. Maximum Load on Crane_______________________
Foundation in the Area?_____________________________ 6. Lift is __________% of Crane’s Rated Capacity
Suitable steel plate/mats to be provided. All exception to be
approved. G. Pre-Lift Checklist Yes No
2. Electrical Hazards in the Area?________________________ 1. Matting Acceptable  
__________________________________________________ 2. Outriggers Fully Extended  
3. Obstacles or Obstructions to Lift or Swing? 3. Crane in Good Condition  
__________________________________________________ 4. Swing Room  
4. Swing Direction and Degree (Boom Swing)______________ 5. Head Room Checked  
__________________________________________________ 6. Maximum Counterweights Used  
7. Tag Line Used  
D. Cable 8. Experienced Operator  
1. Number of Parts of Cable____________________________ 9. Experienced Signal person (Designated)  
2. Size of Cable______________________________________ 10. Experienced Rigger  
Special Instructions or Restrictions for Crane, Rigging, 11. Load Chart in Crane  
Lift, and so on ( Contractor supervisor will be present all 12. Wind Conditions__________________________________
time for crane operations. A dedicated Mechanical 13. Crane Inspected by________________________________
Engineer will ensure that lifts are carried out as per P&G 14. Functional Test of Crane b
requirements)______________________________________

Diagram Crane and Load Placement Diagram Rigging Configuration

0) Multiple crane lifts require a separate lift plan for each crane. 2) Any changes in the configuration of the crane, placement, rigging, lifting scheme, and so on,
or changes made in any calculations require that a new lift plan be developed.
Signature and name Signature and name Signature and name Signature and name
___________________________ ______________________ ____________________ _______________________
(Contractor Construction Manager ) (Contractor Safety Manager) (P&G Safety Manager) (P&G Construction Manager)

106-1 September 2005