Location on job / lift description:

Date of lift: Project #

Type of crane
Crane Placement: Any deviation from level compact surface in area? On Asphalt
Electrical hazards in the area? None
Obstacles or obstructions to lift and swing? None
Swing direction and degree (boom swing) west to south
Lift arrangement: Planned lift path: Jib
Lift radius ft.
[ ] 360
o
[ ] over front Erected [ ] Stored [ ]
[ ] over rear [ ] over side Is Jib to be used: Yes [ ] No [ ]
Boom length ft. Length of jib: ft.
Boom angle at lift
deg. Lift path cleared? Angle of jib: deg.
Boom angle at set
deg. [ ] yes [ ] no Rated capacity of jib: lbs.
Load line: Whip line:
360
o
lbs. Number of parts cable: Number of parts cable:
Over side lbs. Size of cable: Size of cable:
Over front lbs. Length Length
Over rear
lbs. lbs/ft lbs/ft
total weight: 0 lbs total weight: 0 lbs
Weight of lift Sling selection
Weight of load: lbs. Type of arrangement
Weight of lifting beam 0 lbs. Size 0 ea 0 cap 0 lbs
Weight of rigging lbs. Size 0 ea 0 cap 0 lbs
Weight of auxiliary rigging 0 lbs. Size 0 ea 0 cap 0 lbs
Additional weight: Shackle selection
Headache ball/ Load-block lbs. Size 0 ea 0 cap 0 lbs
Load line 0 lbs. Size 0 ea 0 cap 0 lbs
Whip line 0 lbs. Size 0 ea 0 cap 0 lbs
Jib deduction lbs. Wieght of rigging: 0 lbs
Allowance: Auxilliary rigging:
Unaccounted material 0 lbs. Come-a-long 0 ea 0 cap 0 lbs
Total weight: 0 lbs. Chainfall 0 ea 0 cap 0 lbs
Other 0 ea 0 cap 0 lbs
% of crane capacity*: #DIV/0! Weight of auxilliary rigging: 0 lbs
Source of load weight:
Weights verified by: x
PRE-LIFT CHECK LIST YES / NO YES / NO
1. Matting acceptable? [ ] [ ] 8. Experienced operator? [ ] [ ]
2. Outriggers fully extended? [ ] [ ] 9. Experienced flagman? [ ] [ ]
3. Crane in good condition? [ ] [ ] 10. Qualified rigger? [ ] [ ]
4. Swing room? [ ] [ ] 11. Load chart in crane? [ ] [ ]
5. Head room checked? [ ] [ ] 12. Wind conditions:
6. Max counterweights used? [ ] [ ] 13. Crane inspected by:
7. Tag line used? [ ] [ ] 14. Functional test of crane by:
#DIV/0! 10%
Special instructions or restrictions for crane, rigging, lift, etc.
1 Job supervisor 3 PM/Superintendent
2 Operator reviewed 4 IISN HSSE
* Multiple crane lifts require a separate lift plan for each crane. Any changes in configuration, placement, rigging, etc. require that a new plan be developed.
LIFTING PLAN
NOTE: A LIFT PLAN MUST BE COMPLETED FOR EACH LIFT OR SERIES OF LIFTS FROM ONE LOCATION
Unaccounted Material=
*(If load exceeds 75 % of rated capacity, sketch rigging plan, crane placement and swing path on reverse.)
(center pin of crane to center of lift)
Rated capacity of crane: