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Standard Lift Plan Form 16-2 Fillable

This document is a standard pre-lift plan checklist used to ensure safety when lifting loads with cranes, derricks, hoists or other powered equipment. It contains sections to check considerations related to the crane, load, rigging, personnel, and area preparation. The checklist includes over 30 specific yes/no questions to verify key factors like lift capacities, load weights, rigging inspection, personnel roles, and travel paths are addressed before conducting lifts. Completing the form requires sign off from the crane operator, rigger, signal person and others involved to confirm all items were reviewed.

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1K views

Standard Lift Plan Form 16-2 Fillable

This document is a standard pre-lift plan checklist used to ensure safety when lifting loads with cranes, derricks, hoists or other powered equipment. It contains sections to check considerations related to the crane, load, rigging, personnel, and area preparation. The checklist includes over 30 specific yes/no questions to verify key factors like lift capacities, load weights, rigging inspection, personnel roles, and travel paths are addressed before conducting lifts. Completing the form requires sign off from the crane operator, rigger, signal person and others involved to confirm all items were reviewed.

Uploaded by

dvggfdhdbdfvb
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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FORM 16-2

Standard Pre-Lift Plan (LHE)/Checklist

Date: Job #: Location: _______________________


Time: Completed By (Competent Person): _____________________________

Note: Applies to Cranes, Derricks, Hoists and Power-Operated equipment that can be used to hoist,
lower and/or horizontally move a suspended load (includes excavators, forklifts, Rough Terrain
equipment, etc., when used with rigging).

Crane Considerations Yes No


1 Are the lifts within the crane’s rated capacities? (based on boom height, radius)
2 Boom deflections considered?
3 Have all potential crane boom obstructions been identified?
4 Have environmental considerations been addressed? (wind, weather, lightning)
5 Have electrical hazards been addressed (overhead /underground)
- Clearance distances established?
- Is a spotter required?
- Public Utility contact required?
6 Crane swing radius properly barricaded and personnel advised of hazards?
Comments:

Crane Considerations Yes No


1 Weights and Centers of Gravity (COG) have been determined?
2 Anything inside/outside the loads that could shift during the lift?
3 Does rigging need protection from the loads?
4 All anchor bolts, hold-downs, or fasteners have been removed?
5 Potential for binding: are load cells required to verify the loads are free?
6 Attachment points rated to take load weight?
7 Are the loads structurally capable of being lifted? (bending/twisting issues)
8 Is a Critical Lift Plan required per EM 385-1-1, Section 16.H?
Comments:
Rigging Yes No
1 All rigging has been inspected by a Qualified Rigger?
2 Have sling angles been calculated?
3 Are shackles correctly sized for the sling eyes?
4 Are softeners needed?
Comments:

Personnel Yes No
1 The roles, responsibilities and qualifications for personnel have been defined?
(Operator, Lift Supervisor, Rigger, Signal Person)
2 A Pre-Lift meeting has been conducted?
3 Personnel trained per the EM?
Comments:

Area Preparation Yes No


1 The locations for the load landings has been selected and prepared?
2 Blocking and/or cribbing available to set the loads on?
3 Travel paths have been determined and cordoned off?
4 Other personnel in the area have been notified of the lifts?
5 Have ground bearing support questions been addressed?
Comments:

Crane Operator: ___________________________________ Date: __________

Rigger(s): _________________________________________ Date: __________

Signal Person: ___________________________________ Date: __________

Other: _________________________________________ Date: ________

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