a arta oT i Critical Lift Plan Each Poe OF Partsipatiag Citing Equipment Shall Have Separate Crieat Lit Plan Gegantnaion Vane ry) Date of Litt 5 2 a vided Work Permit Required? YESO“SOD ore Specific Work Location: Lond Handing Dorion See Nia Ba 3 Load Handling Boom ee oe ibs Hook Block (Mainy A) Load Description & Weight (From USER): PRECAT VAMNAL | (Joco 2. inspection Sticker Expiry Date: _¢ 2. ID=__SSMeepug | 4. Crane Model. 2/2 B4(7RR _ | Headache Ball: 3.Crane Types RAWLER. Auiliagy Boon HE 3 Eguipn 6. Crane Raed Capac: 2 Srecemi bes | stings, Shashles Code = applicabley: My | Other: TIS LAE eee =e Line Pull Capacity: JZ pee lee kus | B Above) Zoco_ Wes 7. Crane Operati Bs Weight of Load Handling Davices (Se 9. ofPansof tine: 4g i for at amecomeiecan Gl [+ Weight of Load w be Lifted Section 4 (qorwe. lefkss A goon | 5 dota Gross Weight (Sections A = B _Qeaeran. veihes 1D) Crane Configuration (See "Note Belo): [E) Rigging (See "Note Below: a URewuied Boo Lena gg fe LU Arann — ok 2G BRPDA 2 pag deuroes | 2 Sling Typels ey RE S209 4 WHEEL ROMER 307, 3. Sling Sizats)s_ 3. Required Coumersveight” Proce. Yh kes a nga Ree ae maha eee ___ pn (qm le Size: inom & Capacity: 7g, Fae _J6s'kys aon (Dest, Wappliabler 2f Paxaer — Wigs] Toul Goss Weigh Capa 4. Opera S.Lif Letags 1) Wind Speed Shall Not Exeeed GI 7.027 Limits for Manbaskets or G1 7.028 Limits/Manufacturer's Specifications for Loads "yesENOD] ei PowerLings With ‘Boom Radius? YES C1 NOT Eplosion Fire High Heat Hazards Within Boom Ras ‘a Nightiime Crane Lift? YES C) NO []_Jf Ves, Do You Have Wri Its This "9 Approval From) Fa i Pads) Mats? YESG-XOC Is the Ground Level? VESEPSOD | Proper Ground Compaction? YESEF-SOL) Excavation Hazards Conteoled? VESEXOO Other _gyegyp ys VESGSOD | ity Manager? YES] NO fl. ae att A Pre-Lifi Safety Meeting is Mandator CAN CRANE MAKE LIFT? YES@-NO Positions: ‘Name (Signature) Badge = Certificate = | Approved by Rigger-I tor 2K ° i te SHAEL. 458380 NARI? | se (prin, MSM AEL or iam = Badg ZAR PETG Cans Opes Donte yralay...2aeseyecag Gye . “Cenificae—_ aL Rootnae USER Het | iy Cc. Super isor : eet Notes ths vaox Ate oF ta, boon. oF ng ee 2. AMfenitsaf weigh shal be i e45 Ceane oad Chia PDD Concurrence aie of meastne as Crane Range ( Diagram. and Savers Not ‘ond Chart capacities based on manufacturer's speciation All vis oF hall be iste inthe 4. Aitash eops of Crane Load Char. Re 5. Certain weights may be dda anh (when required by GI 2.702)