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Lifting Plan: Name & Signature Name & Signature

This document outlines the lifting plan requirements for a lifting work permit. It requires details of the lift including weight, risks, safety measures, lifting equipment, crane capacity, and signatures. For lifts under 5 tons without risks, only sections 1, 2, 3, 5, 6, and 7 are required. Lifts over 5 tons or with risks require all sections, including load charts and calculations to ensure the lift is within 75% of crane capacity. Safety measures like barricades, sketches, load tests, and valid certifications must also be confirmed.

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955 views

Lifting Plan: Name & Signature Name & Signature

This document outlines the lifting plan requirements for a lifting work permit. It requires details of the lift including weight, risks, safety measures, lifting equipment, crane capacity, and signatures. For lifts under 5 tons without risks, only sections 1, 2, 3, 5, 6, and 7 are required. Lifts over 5 tons or with risks require all sections, including load charts and calculations to ensure the lift is within 75% of crane capacity. Safety measures like barricades, sketches, load tests, and valid certifications must also be confirmed.

Uploaded by

nguyễn thuong nghia
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
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Lifting Plan Work Permit No.................................

Date of Lifting work.................../...................../…….............. Lifting area..................................... Name of Material/Equipment load ..................................


1. Lifting Details
1 . Weight of Material/Equipment load less than 5 tons and without risk Need to prepare Lifting Details in No 1,2,3,5,6,7
2 . Weight of Material/Equipment for lifting less than 5 tons but have risk Need to prepare Lifting Details in No.1 , 2 , 3 , 4 , 5 , 6 ,7
3 . Weight of Material/Equipment for lifting more than 5 tons Need to prepare Lifing Details in No. 1, 2, 3, 4, 5, 6, 7
Risk of Lifting work : Lifting is over personnel, operating facilities, pipelines or critical equipment, Two cranes are used for pipe lifting/Lifting of personnel in a Man–basket.
2. Define Safety Measures by Permit requestor
Crane parking and stay at safe zone. ( In case parking arcoss gutter shall be approve by EPC Package Manager)
There is no anything obstruct to lifting in a radius that may cause side effects.
Crane parking area have to strong & not collapsed, In the case of unsafe, additional measures are prescribed .………………………………………………………………………………………………
In the case of a tailing type (more than 1 crane), there is a document showing the form of the lifting plan separated by each crane.
In the case of connecting the Jib Boom for use in lifting work must have a mechanical engineer to calculate the jib boom. (Must be to the work permit)
3. List of lifting equipment ( Shall be passed inspection by EPC) X

Weight of Material/Equipment load (W)…………………Tons


List of lifting equipment
Steel Sling Webbing Sling Hook Chain Lifting bar Chain block Other Other Other Other
Size
capacity load (Tons)
Weight/each
Number
Total weight
Total weight of lifting equipment (S*)…………………Tons
Total weight (N*) = (W) + (S*) .............................Tons
4. Lifting Condition

Crane Capacity ……...…….…………Tons Height at the point of placing or lifting the device (H)…..….…...……....m

Length of Boom(B) ………………..….m Radius (R)……….……....m

MAX. Load from load chart at (R) and (H) .…......…...……...….Tons (Compare with Load Chart)

Lifting capacity rate = Total Weight (N*) x 100 = ...........................%


MAX. Load from load chat

Which must not exceed Lifting capacity rate 75% of Crane Capacity
Calculate and verify the accuracy of the information completely. Certify and Approve calculation results
Name & Signature Name & Signature
Permit Requestor....................................................................... Date…........./........../.......... EPC Lifting Supervisor/Mechanical Engineer....................................................................Date........../........../..........
5. Inspect safety measures at working area before strart working(Filled by EPC Lifting Supervisor/Mechanical engineer)
Weight of Material/Equipment for lifting : (TOTAL WEIGHT)
Total weight (N*) = (W) + (S*) .............................Tons
Lifting Condition:
Crane Capacity ……...…….....…………Tons Radius (R)………......……....m Length of Boom(B) ………….....…….m
Height at the point of placing or lifting the device (H)….......….....m MAX. Load from load chart at (R) and (H) .…..............….Tons (Compare with Load Chart)
Total Weight (N*) x 100
Lifting capacity rate = MAX. Load from load chat %...................... = ( Which must not exceed Lifting capacity rate 75% of Crane Capacity)

6. Safety Measures for lifting work (Attachment relate to lifting work)


Barricading off areas of overhead work to prevent persons from ‘straying’ into an area where overhead work and Tied the rope at the lifting equipment for control direction.
Lifting sketch to identify crane parking area and working radious of crane (In case of Weight of Material/Equipment for lifting more than 5 tons but have risk)
Load Chart
No piece of equipment is to be operated closer than 15 feet (4.5 metres) to voltage lines of 220 volts or more.
Load test report for crane, sling, shackle, etc. (under witness by Company)
Man basket calculation and test report
In the case of trestle placement in non-road areas always make a trestle with a steel plate.
Valid crane certificate
Crane operator license
Crane & Haib Operator inpsection Engine Hydraulic pump Lube oil Air pump Hydraulic oil (Remarks: / Normal X Abmormal )
7. Signature of Crane operation (Passed the training as required by law and the signal man must wear a reflective jacket while lifting work.)
Crane Operator Signal man for Crane Operator Crane Rigger

Name & Signature Name & Signature Name & Signature


…………………………………………. Date.........../............/.............. ………………………………………… Date.........../............/.............. ………………………………………… Date.........../............/..............
Sub Contractor Supervisor (Lifting supervisor) EPC HSSE Manager EPC Construction Manager

Name & Signature Name & Signature Name & Signature


…………………………………………. Date.........../............/.............. ………………………………………… Date.........../............/.............. ………………………………………… Date.........../............/..............

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