Beneficiary: ……………….. Project: …….

Rev 0 Lifting permit 2023

ACTIVITY TYPE NORMAL COMPLEX

Site - Area DATE TIME STARTING FINISHING
Location of the activity PERMIT NO.
ANTREPRENOR CONTRACTOR

Contractor responsible Subcontractor responsible

TEAM
THE TEAM MEMBERS ARE AUTHORISED YES / NO The activity was understood YES / NO
PROPER PPE (HIGH VIS) YES / NO Training was performed YES / NO

DIMENSIONS H= W= L= CENTER OF GRAVITY WAS ESTIMATED YES / NO

REAL WEIGHT kg ACTUAL CENTER OF GRAVITY WAS INDICATED YES / NO

LOAD CALCULATED WEIGHT kg SUPERIOR LIFTING POINT YES / NO

SHARP EDGES YES / NO ARE NEEDED MORE LIFTING YES / NO
MULTIPLE, UNUSUAL, SPECIAL SAFE HANGING PROCEDURE YES / NO

Crane The equipment is certified YES / NO

Forklift The load is in safe condition YES / NO

Other euipment accessories weight to
Guiding ropes YES / NO Weight of lifting devices kg
EQUIPMENT
The hook is in good conditon YES / NO Lifting devices angle °
There are accessories to the load YES / NO Tandem lifting YES / NO
Crane diagram YES / NO Unloading surface Leveled / horizontal / bended
/vertical

Leveled surface YES / NO Distance to nearest electrical cable m

Acces/Egress routes are free YES / NO There are unauthorised person in the operation area YES / NO
The area is restricted with barriers YES / NO There are other equipment in the operation area YES / NO
Location
Visibility YES / NO YES / NO
Flamable materials
Lifiting area is clear YES / NO Weather conditions vant= m/s precipitatii = YES / NO
Works in the area YES / NO Emergency plan YES / NO
 Beneficiary: ……………….. Project: …….

Rev 0 Lifting permit 2023

PERESENTATION OF THE ACTIVITY WHICH WILL BE PERFORMED

Have been checked, acknowledged and agreed by lifting team all aspects linked with present activity for which the works could be performed in safe conditions

Participants
Lifting responsible Site manager Crane operator Slingers/Banksmam

Name Surname

Sigature

Name Surname

Signature