CRANELIFTPLAN

1.PROJECTDATA Page1of2

PROJECTNAME: LOCATION: CONTRACTOR:

JOBNUMBER: WORKORDERBY DATE:

MainCraneLiftingPoints: MAINBOOM JibPoint

LiftAccomplishmentDate:
WORKPERFORMED:

2.CRANEDEFINITION 3.LOADDATA
Manufacturer: A.LiftDescription:
Model:
SerialNo.: 1.EquipmentNumber/Name:
CraneDescription: 2.Dimensions(L/W/H):
RatedCapacity: 3.TotalGrossWeight:
AreaofOperation: 4.FromLocationtoLocation:
CraneYearlyInspection B.MaximumOperationRadiustobe
Date: usedDuringLift(ft.)
4.CRANECONFIGURATION
MAINBOOM JibtobeUsed Yes No
No.Sections: No.Sections:
BoomSize: JibSize:
BoomLength: JibLength:
BoomType: JibType:
HoistingFromMainBoom: JibOffsetAngle:
MainBoomPartsofLine: JibCapacityofLine@Parts:
MainBoomLineSize(Dia) JibMaxLoadRadius
CapacityofLine@Parts: JibMaxCapacityofLiftPoint
Max.LoadRadius JibLengthofBoom
MainBoomMax.Capacity JibAngleofBoomatPick
ofLiftPoint (Deg)
LengthofMainBoom JibAngleofBoomatSet(Deg)
AngleofMainBoomat GroundCompact&Stable Yes No
Pick(Deg) TypeofSurfaceSize:
AngleofMainBoomatSet StructuralSupportsRequired Yes No
(Deg)
5.LIFTWEIGHTDATAANDCALCULATIONS
WeightofLoadtobeLifted Other: #
Max.LoadLineWeight DownHaulWeight: #
LoadBlockWeight # JibStowed: #
RiggingLiftingBeams QTY: # WeightofCraneComponents #
RiggingSlings QTY: # TotalWeightofLiftedLoad
Type: Capacity: # andCraneComponents #
RiggingShackles QTY: # TotalWeightPlusFactorof: #
Type: Capacity: # PERCENTCAPACITYTHISLIFT %
 PRELIFTWORKSHEET

Note:Tobefilledoutbeforealift Page2of2
6.LIFTADMINISTRATIONCHECKLIST

HaspreliftmeetingbeenheldwithSignalPerson/Riggers/Operator/SiteSupervisor Yes No
OperatorassignedfortheLift(Name) Print: Sign:
OperatorCertificationCard(MUSTBECURRENT) Yes No
Signalpersondesignated(Name) Print: Sign:
Communicationswillbeheldby:HandRadio,BothorOther(Pleaseinsertonline)
HasJHAbeencompleted? Yes No
Hasswingclearancebeenchecked? Yes No
Hasareabeencheckedforsafeentryandexit? Yes No
Taglinesaretobeused:Description: Diameter Length Location:
PreLiftHuddleConducted/PermitSecured Yes No
PotentialHazardstobeAddressed:
Weather: Yes No Ifyes,pleaseexplain:

Electricity: Yes No Ifyes,pleaseexplain:

WhatistheWindSpeed?: 20 MPH - consider shutting down lift 25 MPH - cancel lift

SurroundingObstacles: Yes No Ifyes,pleaseexplain:

7.SIGNATURESOFPLANDEVELOPERS&REVIEWERS

Personresponsibleforlift:(Operator)
Print Signature Date

ALONLiftPlanSupervisor:
Print Signature Date

ELCRESTRepresentative:
Print Signature Date

Other:
Print Signature Date

CriticalLifts:
1.Anyliftoveranoperatingunit,shelterorbuilding.
2.Anyliftwithaloadgreaterthan50tons.
3.Anyliftinwhichthecombinationofweightandliftradiuswillloadthecraneintheuseabove75%ofitsratedcapacity
4.Anyliftrequiringtheuseofmorethanonecrane.
5.Anyliftinwhichasignificantriskofpersonnelinjuryorequipmentdamageispossible.