NOAO – NORTH

CRITICAL LIFT PLAN FOR MOBILE CRANES

DOC#:       Refer to #1000-AD-015-0010 Crane SOP
Date: (Date of lift) Prepared By:      
Location:       Other:      

A "critical lift" is defined as any non-routine crane lift requiring detailed planning and additional or unusual safety precautions. Critical lifts
include: lifts made where the load weight is greater than 75% of the rated capacity of the crane; lifts which require load to be lifted, swung or
placed out of the operator's view; lifts made with more than one crane; lifts involving non-routine/technically difficult rigging arrangement;
hoisting personnel with a crane or derrick; or any lift which the crane operator believes should be critical.

A. TOTAL LOAD
1. Load Weight       lbs.
2. Wt. of Aux. Block       lbs.
3. Wt. of Main Block 455 lbs.
4. Wt. of Lifting Beam       lbs.
5. Wt. of Sling/Shackles       lbs.
6. Wt. of Jib/Ext.       lbs.
7. (erected/stowed)
Wt. of Hoist Rope       lbs.
8. Other:       lbs.
9. TOTAL WEIGHT ** Expression is lbs.
Note: Source of load weight (Drawing, Calcs, etc.) must be attached on Page 2

B. CRANE
1. Type of Crane Grove RT58D 20 Ton
2. Maximum Crane Capacity 40,000 lbs.
3. Radius (Maximum) 65.00 ft.
4. Radius (Minimum) 10.00 ft.
5. Boom Length (Maximum) 70.00 ft.
6. Boom Length (Minimum) 28.00 ft.
7. Crane Capacity (Max Radius) 2,260 lbs.
8. Crane Capacity (Min Radius) 40,000 lbs.
9. Boom Angle (Maximum) 75.00 deg.
10. Boom Angle (Minimum) 27.00 deg.
11. Gross Load of Crane       lbs.
12. Lift is ** Expression is faulty **0% of the Cranes
rated
13. If capacity
Jib/Ext. is to be used:
Length 23.00 ft.
Offset       ft.
14. Rated Capacity OF Jib/Ext. 1,200 lbs.
C. HOIST ROPE Main Aux 1 Aux 2
1. # of Parts 6 X 19            
2. Rope Diameter 5/8"            
3. Capacity 17.7 t            
D. RIGGING See Attached Drawings/Diagrams
1. Hitch Type(s)      
2. No. of Slings:      Size:      
3. Sling Type (material):      
4. Sling Assembly Capacity:       lbs.
5. Shackle Size(s):      
6. Shackle Rated Capacity(s)       lbs.

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E. CRANE PLACEMENT (Mobile Cranes Only)

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1. Maximum Bearing Pressure      

Note: Bearing Pressure Calculations must be attached
2. Ground Conditions Suitable for Load? YES/NO
Note: Ground Condition Calculations must be attached
3. High Voltage or Electrical Hazards? YES/NO
Note: If Electrical Hazards are present they must be attached
4. Obstructions to Lift or Swing? YES/NO
Note: If Obstructions are present they must be attached
5. Travel with Load Required? YES/NO
6. Other?      
F. OPERATOR QUALIFICATIONS
1. Certified Operator? YES/NO
2. Certified Rigger/Signal Person YES/NO
3. Certified for Type, Class & Capacity? YES/NO
G. PRE-LIFT CHECKLIST (YES) N/A (NO)
1. Crane Inspected (completed & signed            
2. Rigging Inspected            
3. Crane Set-up            
4. Overhead Hazard Check            
5. Swing Check            
6. Counterweight Check            
7. Operator Qualifications            
8. Signal Person Qual. & in place            
9. Rigger Qualified            
10. Load Chart in Crane            
11. Load Test            
12. Tag Line            
13. Wind Conditions            
14. Traffic Hazard Check            
15. Site Control            
16. Signatures (documented)            
H. SIGNATURES
1. Crane Operator
2. Lift Supervisor
3. Rigger
4. 1st Signal Person
5. 2nd Signal Person
6. Other: specify

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CRITICAL LIFT PLAN FOR MOBILE CRANES

LOAD CALCULATIONS
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CRITICAL LIFT PLAN FOR MOBILE CRANES

BEARING PRESSURES & GROUND CONDITIONS
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CRITICAL LIFT PLAN FOR MOBILE CRANES

LOAD CHART
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CRITICAL LIFT PLAN FOR MOBILE CRANES

OPERATOR, RIGGER, SIGNAL PERSON QUALIFICATIONS
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Rigging/Signal Person Certified –

Class Expiration
Name Date Retaken Date Sign if working on lift Date of Lift
Abraham Daniel 1/11/2018 1/11/2021

Ball William 10/1/2018 10/1/2021

Blaine Keith 1/11/2018 10/1/2018 10/1/2021

Donaldson John 1/11/2018 10/1/2021

Dunlop Patrick 10/1/2018 10/1/2021

Evatt Matt 1/11/2018 1/11/2021

Hawes Mike 10/1/2018 10/1/2021

Joyce Richard 10/1/2018 10/1/2021

Lane Steve 10/1/2018 10/1/2021

Lavoie Tammie 10/1/2018 10/1/2021

Moreno Victor 1/11/2018 1/11/2021

Reddell Larry 1/11/2018 1/11/2021

See Mark 1/11/2018 1/11/2021

Sprayberry David 10/1/2018 10/1/2021

Stephens Stanley 10/1/2018 10/1/2021

Stephenson Devin 10/1/2018 10/1/2021

Stupak Bob 1/11/2018 1/11/2021

Wortman Fred 1/11/2018 1/11/2021

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CRITICAL LIFT PLAN FOR MOBILE CRANES

OPERATOR, RIGGER, SIGNAL PERSON QUALIFICATIONS
Show here or attach operator qualifications

Mobile Crane Certified –

Class Expiration
Name Date Retaken Date Sign if working on lift Date of Lift

Moreno Victor 1/12/2018 1/12/2021

Blaine Keith 1/12/2018 1/12/2021

See Mark 1/12/2018 1/12/2021

Abraham Daniel 1/12/2018 1/12/2021

Wortman Fred 1/12/2018 1/12/2021

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CRITICAL LIFT PLAN FOR MOBILE CRANES

SITE PLAN
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