LIFTING PLAN

NOTE: A LIFT PLAN MUST BE COMPLETED FOR EACH LIFT OR SERIES OF LIFTS FROM ONE LOCATION
Location on job / lift description:

Date of lift: Project # Type of crane

Crane Placement: Any deviation from level compact surface in area? On Asphalt

Electrical hazards in the area? None

Obstacles or obstructions to lift and swing? None

Swing direction and degree (boom swing) west to south

Lift arrangement: Planned lift path: Jib

Lift radius ft. [ ] 360o [ ] over front Erected [ ] Stored [ ]

(center pin of crane to center of lift) [ ] over rear [ ] over side Is Jib to be used: Yes [ ] No [ ]

Boom length ft. Length of jib: ft.

Boom angle at lift deg. Lift path cleared? Angle of jib: deg.

Boom angle at set deg. [ ] yes [ ] no Rated capacity of jib: lbs.

Rated capacity of crane: Load line: Whip line:

360o lbs. Number of parts cable: Number of parts cable:

Over side lbs. Size of cable: Size of cable:

Over front lbs. Length Length

Over rear lbs. lbs/ft lbs/ft

total weight: 0 lbs total weight: 0 lbs

Weight of lift Sling selection

Weight of load: lbs. Type of arrangement

Weight of lifting beam 0 lbs. Size 0 ea 0 cap 0 lbs

Weight of rigging lbs. Size 0 ea 0 cap 0 lbs

Weight of auxiliary rigging 0 lbs. Size 0 ea 0 cap 0 lbs

Additional weight: Shackle selection

Headache ball/ Load-block lbs. Size 0 ea 0 cap 0 lbs

Load line 0 lbs. Size 0 ea 0 cap 0 lbs

Whip line 0 lbs. Size 0 ea 0 cap 0 lbs

Jib deduction lbs. Wieght of rigging: 0 lbs

Allowance: Auxilliary rigging:

Unaccounted material 0 lbs. Come-a-long 0 ea 0 cap 0 lbs

Total weight: 0 lbs. Chainfall 0 ea 0 cap 0 lbs

Other 0 ea 0 cap 0 lbs

% of crane capacity*: #DIV/0! Weight of auxilliary rigging: 0 lbs

*(If load exceeds 75 % of rated capacity, sketch rigging plan, crane placement and swing path on reverse.)
Source of load weight:
Weights verified by: x

PRE-LIFT CHECK LIST YES / NO YES / NO

1. Matting acceptable? [ ] [ ] 8. Experienced operator? [ ] [ ]

2. Outriggers fully extended? [ ] [ ] 9. Experienced flagman? [ ] [ ]

3. Crane in good condition? [ ] [ ] 10. Qualified rigger? [ ] [ ]

4. Swing room? [ ] [ ] 11. Load chart in crane? [ ] [ ]

5. Head room checked? [ ] [ ] 12. Wind conditions:

6. Max counterweights used? [ ] [ ] 13. Crane inspected by:

7. Tag line used? [ ] [ ] 14. Functional test of crane by:

#DIV/0! Unaccounted Material= 10%

Special instructions or restrictions for crane, rigging, lift, etc.

1 Job supervisor 3 PM/Superintendent

2 Operator reviewed 4 IISN HSSE

* Multiple crane lifts require a separate lift plan for each crane. Any changes in configuration, placement, rigging, etc. require that a new plan be developed.