Lifting Plan

Cranes and Other Lifting Equipment - > 2,000 lbs

Building/Site: _________________________________ Address: ______________________________________ Date: ____/____/_______

Lift Description:
________________________________________________________________________________________________________

Date of Lift: ____/____/_______ to ____/____/_______ Time of Lift: _____:_____ to _____:_____

Competent Person: ________________________________ Lift Supervisor: _________________________________________________

Crane Information

Manufacturer: ____________________________________ Owner: _____________________________________________________

Model Number: ___________________________________ Crane Operator: _____________________________________________

Crane Description/Type: ____________________________ Hoisting License #:

____________________________________________

Rated Capacity: _______________ lbs/tons Last Annual Inspection: ____/____/_______

Gross Weight: _______________ lbs/tons Inspection Company: __________________________________________

Area of Operation: ________________________________

Insurance Coverage for Equipment, Liability and Negligence: ___________________________________________________

Company and Representative
Lifting Plan to the following
- Crane Operator: __________________________________ - Riggers: __________________________________________________
Company and Representative Signature Company and Representative Signature

- Engineers: __________________________________ - General Contractor: ________________________________________

Company and Representative Signature Company and Representative Signature

Lifting Sketch to the following

Lift Supervisor: ______________________________________________ Crane Operator: ____________________________________________

Company and Representative Signature Company and Representative Signature

General Contractor: _______________________________________________________

Company and Representative Signature

Maximum Operating Radius to be used during Lift: ___________ (ft)

Crane Configuration
Main Boom Jib(s) to be used? ____Yes ____ No

No. of Sections: _______ number of Sections: _______

Boom Size: _______ Jib Size: _______

Boom Length: _______ Jib Length: _______

Boom Type: _______ Jib Type: _______

Hoisting (Main Boom): _______ Job Offset Angle: _______

Main Boom (Line size/dia): _______ Jib Load Radius (max): _______

Internal
 Load Radius (max): _______

Capacity at Lift Point (max): _______ Jib Capacity @ Lift Point (max): _______

Main Boom (Length): _______ Jib Boom (Length): _______

Main Boom @ Pick Angle (Deg): _______ Jib Boom @ Pick Angle (Deg): _______

Main Boom @ Set Angle (Deg): _______ Jib Boom @ Set Angle (Deg): _______

Crane LMI working yes_______ No _______

Outrigger positions : _______

Lift-Weight Data and Calculations

Load weight (max): _______ lbs Rigging – Lifting Beams (#): _______

Load Line weight (max): _____lbs/ft @100’ _______ lbs Rigging Slings (#): _______

Load Block (weight): _______ lbs Type: ______________ Capacity: ______________

Certificate : _______ ID : _______

Crane Components (weight): _______ lbs Rigging Shackles (#): _______

Crane Components Lift Load (weight): _______ lbs Type: ______________ Capacity: ______________

Certificate : _______ ID : _______

Total weight plus factor of 1.10% _______ lbs Capacity of the Lift _______%

Load center of gravity :

Pre Lift Checklist

Crane Inspection Performed by: _______________________________________________

Site Inspection Performed by: _______________________________________________

- Safe Entry and Exit - Underground Pits, Tunnels and Utilities
- Electricity (underground or overhead) - Obstacles
- Overhead Hazards, Barriers and Signage - Swing Clearance
- Grade/Slope - Caution Tape/Guards for Crane Swing

Weather Conditions
- Detailed Description: __________________________________________ Wind Speed: ______mph Wind Gusts: ______
mph

Crane Operator Name: ____________________________________________ Hoisting License#: ____________________________

Qualified Signal Person(s) is: _______________________________________________

Rigging Inspection by Qualified Rigger: _____________________________________

Tag lines to be used?  _____ Yes _____ No _____ N/A

o (1 side) (2 side) Length of Line: _________ (ft) Line Diameter: _________ (in)

Internal
Description of use:
______________________________________________________________________________________________________

Pre Lift Meeting (all Contractors/Subcontractors)

- Post Pre Lift meeting modifications (detailed):

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

Additional graph paper should be used for more detail

Internal