Utico LIFTING PERMIT

(USE OF MOBILE CRANE)

UTICO/MC/004
REV.

Project: Permit No: Date:

Company:  UTICO  Sub: Location:

Crane:  Own  Hire Registration No.
Make / Model: Capacity: Ton

Kind of Activity:
SECTION 1 - SAFETY REQUIREMENTS (TO BE COMPLETED PRIOR TO ISSUE PERMIT)
YES NO N/A
 Competency certificates crane is valid
 Competency certificate operator is valid.
 License operator is valid.
 Registration crane is valid.
 All lifting gear (Chain slings, web slings, shackles, wire rope etc) have valid test certificates.
 Plant induction check list completed.
 Banksman are trained and they have valid competency certificate.
 Crane erection / working area is suitable for the job.
 Crane operators, Riggers and all other personnel involved in the operation had attended safety induction /
Tool Box Talk and they are aware of the task, Risk and Safety precautions.
Note: Copies of all certificates / License to be handed over to Safety Department.
Name of work-in-charge: …………………………………… Signature: …………………… Date: ………………………
SECTION 2 – CHECKS PRIOR / DURING CRANE SETUP
YES NO N/A
 Inspection of crane and Lifting gear has been carried out and they are in good condition.
 Ground is compacted and firm to set mobile crane.
 All outriggers are stable and set firmly on the ground.
 Checks made for underground service at point of out rigger and surrounding area.
 Mobile crane is away (2m) from excavation slope or pit.
 Mobile crane is not obstructing on 360o slew and overhead hazards.
 Mobile crane is not working under tower crane and suspended load.
 Mobile crane is setup with outrigger fully extended.
 All outriggers are placed stable / secured and set firmly on the ground on proper boards / mats.
 All tyres are clear of ground and as per manufacturer instructions Lifting of load
 Load is within safe working load of crane and radius
 Offloading area is checked and explained to operator and Riggers.
 Surrounding areas are cleared and barricaded and access restricted to all unauthorized trades while crane
in operation
SECTION 3
I, the undersigned inspected and checked above mentioned requirements in section I & II and I will fully comply to it prior to start of activity.

Site Supervisor / Engineer Crane Operator H&S Representative

Name:

Signature:

SECTION IV - APPROVAL
Site Manager / Site Engineer H&S Representative
Name: Name:

Signature: Signature:

This permit is valid from Hrs to Hrs on .

NB: - This permit is valid only for one day, return this form to HSE department 1 hour after completion of works.
- Permit can be extended for work not finished and signed only by Site Manager and OHS Representative with checks made in section II
- This permit is not valid for lifting personnel or man basket.

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