CRITICAL LIFTING PERMIT

PROJECT NAME: SMDC BLOOM RESIDENCES PHASE 3

CONTRACTOR/SUBCONTRACTOR: SUPERVISOR (Print Name and Sign) :

SPECIFIC WORK AREA: DATE:

SPECIFIC WORK PROCESS/ DESCRIPTION OF RIGGING AND LIFTING

(include estimate load weight)

TYPE OF CRANE: CAPACITY (TONS): BOOM LENGTH:

CRANE OPERATOR: SIGNAL MAN/RIGGER:

Print Name Print Name and Sign

INDIVIDUAL RESPONSIBLE FOR THE IMPLEMENTATION OF THIS PERMIT.
This person must be available at all times and be able to monitor the lifting procedure.

Print Name and Sign / Position

We hereby agree and will comply with all the safety precautions and procedures as specified in the ESH program.

ACTIVITY SUPERVISOR SUBCONTRACTOR SAFETY OFFICER

(Print Name and Sign) (Print Name and Sign)

CHECKED BY: APPROVED BY: NOTED BY:

GMCPMI
RCDC ESH Officer PROJECT MANAGER/PIC Construction Management