ACWA POWER Zarqa Project

PERMIT TO WORK LIFTING

Exact Location Permit No.
Work in
Agency
charge
Location of works

Description of
works
Certificate
No. Type Capacity Description
YES NO N/A

List of
machineries,
tools& tackles

Precaution to be completed by work in-charge / Supervisor

The following are to be required and completed YES NO N/A
1 Is there a lifting plan for huge/heavy/complex lifting job
2 Has the weight of the load been documented or accurately
calculated?
3 Have lifting lugs that will be used to lift the load been
designed for that purpose?
4 Has the load been checked for loose or unsecured items,
which might fall off during the lift?
5 Are lifting lugs used with the correct shackle?
6 Are the lifting lugs visibly free of defects or damage?
7 For a one-crane lift, is the crane hook over the centre of
gravity at the initial pick?
8 Have the capacities of the slings and shackles been checked
for the load?
9 Have the slings and shackles been visually inspected for
defects or damage?
10 Have the sling angles been considered when checking the
capacity of the slings and shackles?
11 Is the crane supported by approved crane mats?
12 Operator/signal man/rigger have trained for lifting work
13 Has the soil been inspected and determined to be adequate?
14 Is the proper tag line used?
15 Has the radius of the lift been checked by a tape measure?
16 Is the lift area free of operating process equipment, piping, or
live electrical lines?
17 Has the area under the lift been barricaded (Exclusion zone)

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 ACWA POWER Zarqa Project

or everyone warned to stay away?

18 Is the wind below 9 m/s?
19 Is there is a possibility for boom or equipment interference,
has a rigging layout or clearance study been made?
20 Has one person been designated “Signalman-in-Charge” for
the lift?
21 Was a Job safety analysis done and submitted together with
this permit.
Safety precaution to be required and completed

Permit validity
This permit is valid from: am/pm on / /
Until: am/pm on / /
Issue of permit- authorisation/ receipt
Comment of site engineer /Sub contractor Comment of site in-charge from machinery
from work agency dept./work in-charge dept.
I have examined the area specified and
permission is given for the work to start,
subject to the conditions stated above.

Name: Name:

Signed: Date: Signed: Date:

Comment of Safety dept. Comment of chief engineer

Name: Name:

Signed: Date: Signed: Date:

Renewed of works/ permit
Time work will be renewed to : am/pm on / /
Site engineer Site in-charge Safety dept.

Completion of works/ closing of permit

Time work completed/ suspended: am/pm on / /
Site engineer Site in-charge Safety dept.

Notes: this form being triplicate is kept respectively one copy for construction party, machinery
dept. and Safety dept.

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