BOOM TRUCK - LIFT PLAN FORM (THIS LIFT PLAN FORM SHALL NOT BE USE FOR ANY OTHER TYPES OF CRANE LIFTS) LOCATION: Jexuweclah Gus Com reasiur- state. OPfesteDATEOFLIFT: §=— _22-I I-20) SUBCONTRACTOR: ere aallod i Win. Dig 8 Peunae LOADTOBELITED: _Installabor. Of Seccerity G@bir~ ‘TYPE OF BOOM TRUCK CRANE: WITH WINCH (ABW) KNUCKLEBOOM[Y} BOOM TRUCK CAPACITY: 6 Ton (ATED SWL FROM LOAD CHART TOTAL BOOM LENGTH: S Mtr Za a2 38 a | ‘A) OPERATING BOOM LENGT! ] Cee Mec —= | B) LIFT RATED CAPACITY: araste. {Ton (swL) ©) WEIGHT OF THE LOAD 70 B) LIFTED: OS tm D) WEIGHT OF SLING & SHACK 1S: O25 Ton E) TOTAL LOAD WEIGHT 70 BE IFTED (C+D): _ O° 6.25 F) LIFT RATED CAPACITY 3: 22-4F'/, %0r DOOM TRUCK SHALLNOT BE ABOVE 75% OF ANC SW) (LET RATED CAPACITY 1N% IS "£18 X 1007) OOM TRUCK PLACEMENT/PRELIFT CHECKS: sie | cna | ELECTRICAL HAZARD IN AREA? ADJACENT. TO EXCAVATIONS? OUTRIGGER FULLY EXTENDED? 1 YES no YES no [et ves [ef No PRE- LIFT CHECKS YES NO 1) WORK PERMIT REQUIRED | 2) COMPETENT OPERATOR “| 3) COMPI ‘TRIGGER a ' 4) BOOM TRUCK INSPECTED & APPROVED | 5) INSPECTION CERTIFICATE VALID, a 6) CERTIFIED RIGGING TACKLES et OUTRIGGER PADS PLACED CORRECTLY? 7) LIFTING GEARS COLOR CODED ves [vj No 8) BOOM TRUCK CHECK LIST COMPLETED Mw 9) WIND SPEED oS Knots TAG LINES TIDE-IN PREPARED BY (COMPETENT RIGGER): het inh fe eh _22-11-2, a L CHECHED BY ( OPERATOR): I slamin Khar _22-11-3; REVIEWED BY JBCON RIGGING SUPV: Adam UPPak _22-1'-2) - VERIFIED BY JO} PERFORMER: Fe el BD-tl-31 a is