CRANE LIFT PLAN

Site/ Station Date

SET-UP CHECKLIST (To be prepared by Crane Operator and Rigger)
Inspection Criteria Result
1. Documents for operator, rigger, lifting gears and crane including load chart attached? ☐YES ☐NO
2. Pick-up and drop paths identified and area lifting sketch plan attached? ☐YES ☐NO
3. Rigging equipment including accessories inspected and correctly color-coded? ☐YES ☐NO
4. Daily operator’s inspection checklist completed and safe to proceed? Copy attached? ☐YES ☐NO
5. Work Safety Briefing/ Toolbox talk conducted? Attached copy? ☐YES ☐NO
6. Is the lift area around the crane controlled/barricaded and with appropriate signage? ☐YES ☐NO
7. Crane set-up on level ground and outriggers fully extended? ☐YES ☐NO
8. Safe clearance for live electrical power lines and away from fire hazards? ☐YES ☐NO
All items above must be fulfilled before any lifting activity starts. DO NOT PROCEED IF NOT COMPLIED… Separate form for each crane.

CALCULATIONS
Wind Speed A –boom length
Quadrant of Operation (meters) - max
Front ☐ R-Side ☐ B – swing radius
Rear ☐ L-Side ☐ (meters) - max
List of Accessories C – load weight
Description Capacity (tons) - max
D- weight of hook
& gears (tons)
Total Weight
(C+D) tons
MAXIMUM WEIGHT CAPACITY
@ Set-up (tons)
-per load chart
CURRENT % CRANE CAPACITY
% - per load chart:
Description of Load
CRANE DETAILS
Crane Type: Crane Maker Crane Model
rd.
Capacity: License Plate: 3 Party Validity:
Comments:
(Counterweight, etc.)
SIGN-OFF SECTION
Designation Name ID or Iqama Certificate No. Signature
Rigger
Crane Operator
Lifting Supervisor
HSE Staff
Area In Charge