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Critical Lift Plan Form

______________________ _________________________ ____ _______________ Print Name Signature Date Supervisor: ______________________ _________________________ ____ _______________ Print Name Signature Date

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Sagun Almario
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129 views2 pages

Critical Lift Plan Form

______________________ _________________________ ____ _______________ Print Name Signature Date Supervisor: ______________________ _________________________ ____ _______________ Print Name Signature Date

Uploaded by

Sagun Almario
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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All critical lift plans must be approved by Project Management

CRITICAL LIFT PLAN

Location : ___________________ Job No:_____________ Date Prepared: ___________________

Date of Lift: ______________________ Item to be Lifted: ___________________________________

(If lift involves multiple cranes, attach a lift plan for each crane.)

On separate sheets, provide diagrams for:

• Crane and load placement; including crane center pin, load maximum radius, obstructions, load at
closest point to boom

• Rigging configuration; Load and slings up to hook, including load attachment points.

COMPONENT WEIGHTS

Load Block _______________________lbs.


Spreader bar _______________________lbs.
Slings & Shackles _______________________lbs.
Jib _______________________lbs.
Headache Ball & Hook _______________________lbs.
Cable (Load Line) _______________________lbs.
Other _______________________lbs.
Weight of Load to be Lifted _______________________lbs.
Total Load to be Lifted _______________________lbs.
Source of Load Weight (Mgf, Engineer, Truck Ticket, etc.) _______________________________
______________________________________________________________________________________

CRANE

Size / Type/ Configuration ________________________________________________________


Manufacturer ___________________________________________________________________
Serial Number ____________________________________________________________________
Vendor__________________________________________________________________________

Item to be Lifted: _______________________________________________________

Maximum Radius: Crane Center Pin to Center of Load _________________ft.


Length of Boom _________________ft.
Angle of Boom at Pick-up _________________degrees
Angle of Boom at Set _________________degrees
Rated Capacity of Crane at Maximum Radius _________________lbs
Reference # of Chart used ________________
Maximum Allowable Wind Speed (reference crane _________________mph
manufacturer’s manual and suppliers specifications)
Maximum Actual Load of Crane _________________lbs.
Lift is ____________% of Crane’s rated Capacity
Load Line: Diameter____________ No. of Parts ____________ Capacity _____________

SLINGS
Type (Material) _________________
Size _________________ inch
Length _________________ft, in.
Rated Capacity per Sling _________________lbs
Sling Angle(s) _________________degrees
d/D Ratio (is de-rating required) _________________
Number of Slings _________________
Condition _________________
SHACKLES
Body Diameter _________________in.
Capacity _________________lbs.
Shackles Attached to Lobby or Collector Ring? _________________yes/no
Number of Shackles _________________

COMMENTS:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Prepared by: _____________________ _______________________ _____________________

Approved by:
Operator: ________________________ ______________________ _____________________
Rigger: _______________________ ________________________ ____________
Crane Comp. Person ___________________ ________________________ ______________
Supervisor: _______________________ ________________________ __________________
Print Name Signature Date

Perform Pre-Lift Checklist day of Lift

Item to be lifted: ____________________________________________________________________

PRE-LIFT CHECKLIST
YES NO
Ground Conditions Acceptable? _______ ________
Matting Acceptable? _______ ________
Crane in Good Condition? _______ ________
Is the Crane Level? _______ ________
Lift and Swing Path is Clear of Obstructions? _______ ________
Lift and Swing Path is Clear of Electrical Hazards? _______ ________
Personnel are Clear of Swing Path? _______ ________
Softeners for Slings? _______ ________
Lifting lugs on load Checked? _______ ________
Rigging per Plan and in Acceptable Condition? _______ ________
Tag Line Used? _______ ________
Operator Certified? _______ ________
Climatic Conditions Acceptable? (wind, ice, etc) _______ ________
Lift is being made per the lift plan? _______ ________

If any of the above items requires action, list special instructions or restrictions for Crane, Rigging, etc.
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
_________

Approved By:

Operator: ______________________ ________________________ ____ _______________

Rigger: ______________________ _________________________ ____ _______________


Print Name Signature Date

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