YFC PROJECTS PVT LTD.

PROJECT: - LEISURE VALLEY ADARSH AWASH

YOJNA GTR. NOIDA UTTAR
PRADESH

PERMIT TO WORK – SINGLE LIFTING PERMIT

Contractor YFC PROJECTS PVT. LTD.
Contract Title LEISURE VALLEY ADARSH AWASH
YOJNA GHT. NOIDA UTTAR PRADESH

SECTION – A: Details of Lifting Crew, Crane Configuration & Load Calculation

Permit No. Date Time
Location Activity being performed

Contractor/Sub-contractor

Part - 1: Details of Lifting Crew

Name of Lifting Engineer:

Name of Operator:
Name of Slinger-
Signaller

Part – 2: Crane Details

Crane make, model & year: Max. rated Capacity:
Maximum boom length: Maximum radius:
Outrigger full extension (in mtr.):Percentage of de-ration in crane capacity:

Automatic Safe Load Indicator: Over Hoist Cut-off Limit Switch:

Part – 3: Load Details

Load description: Lifting points on Load:
Load rigging manner:
Load dimension:

Load weight:
Part – 4: Load Calculation ( % of Load chart referred/followed)
Crane boom length: , Crane boom radius: , Rope diameter(mm):
No. of falls: , % of de-ration in capacity: , Counter weight:
SWL (after de-ration):
, Load weight: , Rigging weight:
Hook block weight: Total weight to be lift:
Outriggers ext. (in mtrs) Safety margin in crane capacity: (SWL of crane on
lifting configuration – Load to be lifted)
Part 5 : Receipt
I (Name as Lifting Engineer/Supervisor) hereby declare that the load calculation as mentioned in Part
– 4 of this permit shall not exceeds in any circumstances and work shall be performed in safe manner. In
addition, the checklist along with lifting sketches as mentioned in section B of this permit shall be
followed and also attached. All measures have been adopted to ensure safe lifting operation including
rigging. Revision
All safety
No.00 devices of the crane are in proper working condition. Section A shall
Revision be treated as
Date:23/11/2023
invalid without section B.
Name: Signed Time Date
 4 Are crane outriggers fully extended and placed on metal plate
5 Are condition of lifting gears free from any type of defects
6 Is the lifting appliance operator cabin in good condition with no hindrance
for lifting
7 Is adequate means of communication between lifting crew arranged
8 Is underground utilities presents, if yes, mentioned measures to overcome
& crane stability (mentioned in Method Statement)
9 Is any power cable/OHE cable available, if yes, then measures to
encounter that (mentioned in Method Statement)
10 Safe means of access arranged
11 Safe working platform arranged
12 Measures for working at height adopted
13 Traffic diversion along with provision of traffic marshal arranged
14 Is wind velocity checked & under acceptable limit as recommended by
manufacturer
15 Is copy of approved method statement available
16 Is Automatic Safe Load Indicator and cut-off switch in working condition
17 All certificate & document like TPI, Load chart etc. available
18 Is proper arrangement of illumination done & level of lux maintained
19 Is rigging done by taking consideration of CG of load w.r.t crane hook
20 Swing area of crane properly barricaded
21 Other system of crane like control lever, fail safe device, boom, winch etc.
are in good condition or working properly
22 Is tag line to control the load is provided
Any other measures
Part – 7: Lifting Sketch
(this sketch shall be site specific and reflects all major hazards/obstruction along with crane
placement, rigging, dimension etc.)
Part - 8: Final Authorization
I (Name as Site In-charge) hereby declare that the load calculation as mentioned in Part – 4 of section
A and measures as mentioned in part 6 of section B shall be ensured. In addition, arrangement for safe
lifting, public safety, traffic diversion, working at height, means of access etc. has been adopted.

Name: Signed Time Date

Part - 09: Clearance (By Lifting Engineer)

I declare that activity has been completed and all persons/material have been withdrawn and site is safe.

Name Signed Time Date

Part 10 : Cancellation (Being the Authorized Person as at Part no. 8)

I acknowledge receipt of the clearance of this Permit.
This permit is now cancelled

Name: Signed Time Date

Revision No.00 Revision Date:23/11/2023