Form 16-3

CRITICAL LIFT PLAN

For use of this form. see El\I 385-1-1 Section 16 Proponent is Crane HHWG

Date: Prepared By:

Location: USACE District:

A ”critical lift" is cleJin ed as ony n on -routin e cran e lift tequitiny aetoilecl plan n irig and additional or unusiuil sofety preco ution s.
Critical fists include. lifts made wh ere the load wriyht is greater than 75a› of the ratecl c apacity of the crane; /i/rs which require
loacl to be lifted, swung or ylaced out of the opetotot's view , lifts mode with m ore than on e clone,’ lifts involving non-routine /technicoll/
difficult iggii›q arronqeinent; hoisting personnel with a cran e or der tick; or any lift which the crane operator believes shots/d be
critical.

A. TOTAL LOAD E. CRANE PLACEMENT (Mobile Cranes On/y#

1. Load W eight I bs 1. Maximum Bearing Press ure PSF

3. Wt. of Main Block lbs 2. Ground Conditions Suitable for Load? YES / NO
4. Wt. of Lifting Beam ’c*e G•cuqd Co .d tior Ca'’c./ a*.'a.°s most .9e afiacned en Faye 3.
I
5. Wt. of Sling/S hackles bs 3. High Voltage or Electrical Haza rds? YES / NO
I
bs

7. Wt. of Hoist Rope lbs 4. Obstructions to Lift or Swing? YES / NO

TOTAL WEIGHT 5. Travel with Load Required? YES / NO

B. CRANE S. Shackle Size(s): F. OPERATOR

1. type of Crane Mobile Hydraulic Truck 6. Shackle Rated Capacity(s) QUALIFICATI
2. Maximum Crane Capacity I bs. ONS
3. Radius (Maximum) ft. 1. Certified
Operator?
4. Radius (Minimum) ft.
2. Option?
5. Boom Length (Maximum) ft.
3. Certified for
6. Boom Length (Minimum) ft. Type, Class
7. Crane Capacity (Max Radius) lbs. & Capacity?
8. Crane Capacity (Min Radius) lbs. 4. Designated in
writing by
9. Boom Angle (Maximum) deg. employer:
10. Boom Angle (Minimum) deg. G. PRE-LIFT
11. Gross Load of Crane lbs. CHECKLIS T
12. Lift is % of the Crane's rated capacity pxesj
13. If Jib/Ext. is to be used: 1. Crane
Inspected
Length ft.
2. Rigging
Offset ft. Inspected
14. Rated Capacity of Jib/Ext. lbs
3. Crane Set-up
C. HOIST ROPE /re/ri aux I Aux 2
1. # of Parts I
4. Overhead
2. Rope Diameter
Hazard
3. Capacity
Check
D. RIGGING
5. Swing Check
1. Hitch Type(s)
2. No. of Slings: Size: I
6. Counterweig
3. Sling Type: ht Check
4. Sling Assembly Capacity: lbs. 7. Operator
 Qualifications
8. Signal Person Qualifications YES/NO
9. Rigger Oualifications
10. Load Chart in Crane YES / NO
11. Load Test YES / NO
12. Tag Lines czx fcoj
13. Wind Conditions
14. Traffic Hazard Check
15. Site Control
16. Signatures
H. SIGNATURES
1. Crane Operator
2. Rigger
3. Signal Person
4. gift Supervisor
5. Other
6. Other