Company Name Doc No

Rev
Crane Work Permit Dated

Permit Requested by: Work Area:

Date : Time: [from] [to]
Work to be done:
Name of Crane Operator: Operator Competency Verified: Yes / No
Crane Capacity : Load Weight:

CHECKS BEFORE ISSUING PERMIT Yes/No/NA

Are hazards and risks related to work determined and controls implemented?
Is tool box training conducted on hazards, risks and controls for the work?
Are adequate PPE’s available and found in good condition?
Is material movement path restricted for people movement?
Is EOT crane checked and found in good operating condition?
Is material to be lifted inspected and required lifting tools determined?
Are Lifting tools checked and found in good condition?
Are special attachments for lifting required; and are available and checked?
Are lifting points or rigging method determined?
Is material movement path restricted for people movement?
Is material unloading location identified and prepared?
If material needs to be suspended, is area barricaded properly?

AUTHORIZATION AND ACCEPTANCE

I hereby confirmed that I have verified the above information and ensured that necessary actions have been taken.
It is safe to carry out the work defined above and permit information have been communicated to the workers.
I accept responsibility for this work.
Name of Person incharge : Signature:

Name of Authorizing Person: Signature:

CLOSURE AND CANCELATION

I confirmed that work has been completed / partially completed, checked by myself and area left in safe and tidy
condition.
Name of Person incharge : Signature:
I have checked the completed / partially completed work and hereby close / cancel this permit.
Name of Authorizing Person: Signature: