JABAL OMAR DEVELOPMENT

PROJECT - MAKKAH
MAN BASKET WORK PERMIT
PERMIT NO. COMPANY:
START DATE: FINISH DATE: TIME FROM: TO:
LOCATION: AREA
CRANE TYPE: CRANE # MAN BASKET SWL MAN BASKET #
3RD PARTY STICKER # 3RD PARTY STICKER#
PART A DESCRIPTION AND TYPE OF WORK TO BE PERFORMED
(Provide details concerning duties, location, surrounding obstruction and potential hazards.)

PART B CRANE REQUIREMENTS

Y N N/A Boom Angle Indicator Y N N/A Boom Extension Indicator
Y N N/A Anti Two Block device or damage prevention features Y N N/A Wire rope, lifting bridle, and associated hardware; safety factor of 5

Y N N/A Brakes, Pawls, or dogs in good condition Y N N/A Controlled (Power) load lowering (no free fall)
Y N N/A Controlled (Power) boom (not live) Y N N/A Uniformly level (1 percent of level grade)
Y N N/A Outriggers extended and set Y N N/A Automatic safe working load indicator
Crane gross capacity Net capacity (after all deductions)
25 Percent of net capacity
PART C BASKET REQUIREMENTS
Y N N/A Designated by a qualified engineer Y N N/A 3rd Party Certified and Inspection Sticker placed
Y N N/A Suspension system to minimize tipping Y N N/A Safety factor of five (5) of basket design
Y N N/A Perimeter guarding Y N N/A Inward swinging gate
Y N N/A Grab rails entire perimeter Y N N/A Overhead protection
Y N N/A Smooth interior surfaces Y N N/A Capacity and weight indicators
Y N N/A Platform identification markings Y N N/A Radios needed for lift
Number of workers permitted for work Total weight of basket, rigging, workers, and materials
PART D TESTING AND INSPECTIONS
Y N N/A Work basket Y N N/A Per work shift
Y N N/A Trail run at all work locations Y N N/A Test lift (200 percent of basket capacity) at each crane setup
Y N N/A Crane level after test lift Y N N/A Crane supports after test lift
PART E PRE-LIFT MEETING
Y N N/A Operator’s responsibility and duties reviewed Y N N/A Signal person’s responsibilities and duties reviewed
Y N N/A Person(s) to be lifted, responsibilities and duties reviewed Y N N/A Supervision aware of responsibilities and duties reviewed
Y N N/A Review job safety analysis with all participants Y N N/A

Rigger: Crane Operator:

Signature Date: Signature Date:

Task Supervisor: Nesma Area Safety Supervisor:

Signature Date: Signature Date: