HASSYAN WATER PROJECT

Critical Lift Plan PTW PROCUDERE

Contractor Name: _______________________ Date of Lift: _____________________ Work Permit Number:

Area Name: _______________________ Specific Work Location: _________________
A) Load Description & Weight B) Weights (See “Notes” Below):

__________________________ _________Tons Load Handling/Boom Stowed Erected N/A Weight:

Attachments Tons
C) Crane Information (See “Notes” Below): Swing-Away Jib: ______
EPC Inspection Sticker Yes No Other Jibs: ______
Hook Block (Main): ______
Inspection Sticker Expiry Date: __________
Auxiliary Boom Head: ______
Equipment ID #: ____________________
Headache Ball: ______
Crane Model: ______________________
Lifting/Spreader Beam Needed? Yes No ______
Crane Type: _______________________
Current Inspection Sticker for Beam? Yes No
Cranes Rated Capacity: ____________Tons Slings, Shackles, etc.: _____________ ______
Total Gross Capacity of Hook Block as Reeved: Other: ________________________________ ______
_____________________ Tons
Weight of Load Handling Devices (Section B)/Tons

Net Weight of Load to be Lifted (Section A)/Tons

Lbs/Kgs
Total Weight of Load to be Lifted/Tons

D) Crane Configuration (See “Notes” Below): E) Rigging (See “Notes” Below):

Required Boom Length: __________ m Hitch Arrangement: ______________________________________________

Boom Angle: _________ degrees Sling Type(s): __________________________________________________

Required Counterweight: _________tons Sling Size(s): ____________________________________________[in/cm]

Sling Length(s): ___________________________________________[m]
Operating Radius: _______________ m Shackle Size: _______________ in/cm & Capacity: _____________ Tons
Lift Quadrant-Front, Rear, 360°, Side, etc.:
_________________________________ Capacity of Above Configuration: ___________________________ Tons
F) Maximum Crane Capacity in Above Configuration Per Load Chart: ______________Tons, Percent of Load Chart Capacity: ______%
G) Other Surface Requirements Needed? (Other Than Mandatory Outrigger Pads) Is the Ground Level? YES NO
100% Ground Compaction? YES, NO Mats? YES, NO Other? ______________________________

H) Wind Speed: ________kph (Shall not exceed 38 kph or manufacturer’s specifications)

I) Electrical Power Lines Within Boom Radius? YES NO Explosive Hazards Within Boom Radius? YES NO

Attention: A Pre-Lift Toolbox Talk is Mandatory CAN CRANE MAKE LIFT? YES NO
Positions: Name (Signature) Emp # Certificate # Approved by: Lifting Supervisor/Engineer

Crane Operator:
Name:
Rigger:
Cert. #
PTW Receiver:
Signature

Notes: 1. Attach sketch (s) of lift site, noting obstacles to movement of load, boom or tail swing.
2. All units of weight shall be listed in the same units of measure as Crane Load Chart.
3. All units of measure shall be listed in the same units of measure as Crane Range Diagram.
4. Attach copy of Crane Load Chart, Range Diagram
5. Certain weights may be deducted from Load Chart capacities based on manufacturer’s specifications.