CRITICAL LIFT PLAN Page 1 of 2

1.0 General
Location:
Date of lift
Description of the object to be raised:
Lift description:
Diagram of Crane Lift and Load Placement Attached? ____ Yes ____No
Diagram of Rigging and Load Attached? ____ Yes ____No
Does this lift Involve Lifting Personnel? ____ Yes ____No

2.0 How weight of the object was obtained 3.0 Stability of Ground Area
Certified scale weight (lbs) Soil or pavement bearing capacity:
Scale weight ticket number: Source of soil or pavement information:
Calculated independently by more than one source: Size of mats:
Source 1: Number of mats:
Weight (lbs): Any underground installations? ____ Yes ____No
Source 2: Ratio of soil bearing capacity to actual
Weight (lbs):

3.0 Load Calculations 4.0 Crane Information

Load condition ____ New ____Used Type of crane _____________________
Crane capacity (tons)
Weight empty ( Load or Basket) (lbs) Max. dist. center of load to center pin (ft)
Weight of contents (lbs) Rated capacity in tons of crane
Weight of aux. block or headache ball (lbs) Over Rear (tons)
Weight of main block (lbs) Over Front (tons)
Weight of lifting beam/bar (lbs) Over Side (tons)
Weight of slings and shackles (lbs) Length of Boom (ft)
Weight of jib (erected or stowed) (lbs)
Weight of hoist rope (extra) (lbs) 5.0 Jib Use
Weight of excess load material (lbs) Erected_____ Stored ____
Allowance for Unaccounted Material (lbs) Is Jib to be used ? ____ Yes ____No
Others (lbs) Length of Jib (ft):
Total Weight (lbs) 0 Angle of Jib (deg):
Rated Capacity of Jib (from chart) (tons):
Total Weight (tons) 0
Source of Load Weight Information
(NamePlate,Drawings,Calculated)

Weights Verified By:

5.0 Lifting Arrangement

Radius at pick up (ft) Maximum Rated Capacity of crane at this
Radius at set down (ft) Radius and Boom Angle for this lift (tons):
Crane capacity at radius (tons): Maximum Load (tons) on Crane is:
Crane capacity over side (tons): Percent of lift to cranes rated capacity
Crane capacity over rear (tons): Clearance between boom and lift (ft):
Crane capacity over front (tons): Clearance to surrounding facilities (ft):
Boom angle at pick up (deg): Clear path for load movement ____ Yes ____No
Boom angle at set down (deg):
CRITICAL LIFT PLAN Page 2 of 2

7.0 Cable- Hoist Rope 8.0 Rigging

Size of Cable (diameter in inches) Type Sling Arrangement or Hitch arrangement _________________
Number of Parts of Cable Number of Slings in hook-up
Lift capacity based on parts/load (tons): Sling Length (ft):
Rated capacity of slings (lbs):
Shackle size
Shackle capacity (tons)
Number of shackles
Shackle attached to load by

9. 0 Crane Placement 10.0 Pre-Lift Checklist YES NO

Any deviation from smooth solid foundation in the area? Crane inspected
___________________________________________ Crane set up
___________________________________________ Matting acceptable
___________________________________________ Outriggers fully extended
Electrical Hazards in the Area ? Load chart in crane
___________________________________________ Rigging inspected
___________________________________________ Swing room checked
___________________________________________ Hoist height checked
Obstacles or Obstructions to Lift or Swing ? Head room checked
___________________________________________ Crane counterweight used
___________________________________________ Load test performed
___________________________________________ Operator qualified
Obstacles in travel? Signal system established
___________________________________________ Flagman (Safety Spotter) qualified
___________________________________________ Rigger qualified
___________________________________________ Tag lines ready and used
Swing Direction and Degree ( Boom Swing ) Wind and climate acceptable
___________________________________________ Traffic controlled
___________________________________________ Tailboard
___________________________________________ Site controlled
Special Instructions or Restrictions for Crane, Rigging or lift, Etc:
____________________________________________________________________________________
____________________________________________________________________________________

11.0 Critical Lift Approvals

Crane inspectors signature and date
Rigging inspectors signature and date
Lift supervisors signature and date
Project engineer signature and date
Project managers signature and date
Signal men names
Crane operator name