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LIFTING CALCULATION FORM

Owner : PT. PERTAMINA (PERSERO)


PMC : WorleyParsons Ltd.
Contractor : RDMP Balikpapan JO
Project : RDMP Balikpapan Project
Location : Balikpapan, Indonesia
DATE :
PERMIT TO WORK NUMBER :
WORKING AREA (ISBL/OSBL) :
SUB-UNIT AREA :

A. EQUIPMENT/MATERIAL DESCRIPTION
NO. DESCRIPTION REMARKS
1 Equipment/Material Description :
2 Tag No. :
3 Dimension
- Diameter (mm) :
- Width (mm) :
- Height (mm) :
- Length (mm) :
4 Equipment/Material Weight (Ton) :

B. CRANE DATA
NO. DESCRIPTION MAIN CRANE (TON) TAILING CRANE (TON) REMARKS
1 Crane Type (Crawler/Mobile) : :
2 Crane Capacity : :
3 Boom Length (meter) : :
4 Fly/Luffing Jib Length (meter) : :
5 Working Radius (meter) : :
6 Safe Working Load/SWL (Ton) : :
7 Hock Block Capacity (Ton) : :
8 Crane Configuration (Standard, SSL, etc.) : :
9 Super lift weight (Ton) : :
10 Super lift Radius (meter) : :

C. LIFTING ACCESSORIES
NO. DESCRIPTION MAIN CRANE (TON) TAILING CRANE (TON) REMARKS
1 Wire/Webbing Sling : :
- Capacity (Ton) : :
- Length (meter) : :
2 Spreader beam/bar : :
- Capacity (Ton) : :
- Length (meter) : :
3 Shackle : :
- Capacity (Ton) : :
- Type : :
- Brand : :
4 Chain Block : :
- Capacity (Ton) : :
- Brand : :

D. LIFTING CALCULATION
NO. DESCRIPTION MAIN CRANE (TON) TAILING CRANE (TON) REMARKS
1 Equipment/Material Weight (Ton) : :
2 Hock Block Weight (Ton) : :
3 Wire/Webbing Sling Weight (Ton) : :
4 Spreader beam/bar Weight (Ton) : :
5 Schackle Weight (Ton) : :
6 TOTAL ERECTION WEIGHT (Ton) : :
7 SAFE WORKING LOAD/SWL (Ton) : :
8 SAFE FACTOR
- Safety Factor : :
- Utilization Rate (%) : :

E. GROUND BEARING PRESSURE


NO. DESCRIPTION MAIN CRANE (TON) TAILING CRANE (TON) REMARKS
1 Crane Weight (Ton) : :
2 Total Erection Weight (Ton) : :
3 TOTAL WEIGHT (Ton) : :
4 Steel Plate Area for Crane (m2) : :
5 Ground Bearing Pressure (Ton/m2) : :

ATTACHMENT shall be attached before lifting activity and this attachment shall be attached in permit to work document :
1. Marking Area on Plot Plan
2. Crane certificates
3. Lifting Gear certificates
4. Operator and Rigger certificates
5. Load Chart
ATTACHMENT shall be attached before lifting activity and this attachment shall be attached in permit to work document :
1. Marking Area on Plot Plan
2. Crane certificates
3. Lifting Gear certificates
4. Operator and Rigger certificates
5. Load Chart

PREPARED BY SUB-CONTRACTOR : DATE :


1. Construction SI (Each Discipline)
2. HSE

REVIEWED BY CONTRACTOR : DATE :


1. Construction SI (Each Discipline)
2. HSE

APPROVED By PMC : DATE :

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