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Number: CSM - 019

Title: Critical Lift Template

Contractor Safety Revised: 08/21/2013

1. Applicability
Natural Gas
Products Pipeline
All Projects & Contractors

2. Scope
The Crane Critical Lift Template provides an in-depth evaluation and plan for all heavy and/or
complicated crane lifts and should be completed before attempting the lift.

3. Definitions
1. Competent Person OSHA defines a competent person as "one who is capable of
identifying existing and predictable hazards in the surroundings or working
conditions which are unsanitary, hazardous, or dangerous to employees, and who
has authorization to take prompt corrective measures to eliminate them".
2. Qualified Person OSHA defines a qualified person as one who, by possession of
a recognized degree, certificate, or professional standing, or who by extensive
knowledge, training and experience, has successfully demonstrated his ability to
solve or resolve problems relating to the subject matter, the work, or the project.
3. Critical Lift: A critical lift has one or more of the following conditions:

Load is over 75% of the cranes rated capacity for current configuration.

Load is more than 20 tons.

Lift is over operating systems (charged electrical equipment, pipelines, etc.)

Lift requires the use of two (2) or more cranes.

Hoisting of contractor employees on a suspended work-platform or man


4. Contractors Construction Supervisor: The contractors supervisor is responsible for

the completion of the critical lift.

5. Crane Operator: The operator who will be operating the crane and making the lift.

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Number: CSM - 019
Title: Critical Lift Template
Contractor Safety Revised: 08/21/2013

6. Rigging Supervisor: The contractors supervisor responsible for planning and

executing the rigging being used for the critical lift.

7. Contractors Safety Manager: The contractors site safety manager.

8. Contractors Construction Manager: The contractors construction manager

responsible for the contractors daily construction activities at the site.

4. Requirements
Review the Critical Lift Plan at the lift site just prior to making the lift.
Critical Lift Plan documentation

The lift plan must include:

o Current certification of the crane operator
o Type of crane(s; rubber tire, track stationary, does the crane require on site
assembly, including a copy of the most current certification
o Is a load test required?
o Type rigging that will be used, including rated capacity
o Most recent annual inspection records, which must include the name of the
person conducting the inspection and qualifications
o Conditions that may delay the lift
o Overhead hazards power lines, guidelines etc.
o Soil/ground conditions [are the any subsurface vaults USTs, duct-banks storm
water sewers, etc.
o A Communication Plan will radio or hand signals be used, how will other
affected stakeholders in the area notified
o Load details
o Will tag lines be used? If yes: how will they be used, is there sufficient room,
what are the hazards etc.
o Contingency plan what if something goes wrong? Mechanical failure, incorrect
load calculation resulting in exceeding 90% of crane capacity
o Written calculations of the lift, including the configuration of the rigging and load.

Safety precautions necessary for all employees in the area, including personnel
employed by other contractors.
All lifts out of water require additional calculations.

Review of crane inspection and maintenance documentation to ensure they are current.

A Pre-job briefing including all employees involved in making the lift.

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Number: CSM - 019
Title: Critical Lift Template
Contractor Safety Revised: 08/21/2013

The briefing of all other contractors superintendents who have employees working
within the area, if any.

Review and update of all associated JHAs/JSAs.

The contractor shall comply with all Federal, State, and Local laws and regulation regarding the
inspections, maintenance, and operation of the cranes within their fleet.

The OSHA rule prohibits hoisting personnel by crane or derrick except when no safe alternative
is possible. Based on the review of the record, OSHA determined that hoisting with crane- or
derrick-suspended personnel platforms constitutes a significant hazard to hoisted employees
and must not be permitted unless conventional means of transporting employees are not
feasible or unless they present greater hazards.


Project Name: Location:

Date: Company:

Submitted By: Approved By:

Crane Manufacturer: Model Number: Crane Inspection Date: Weather Condition:

Description of Load: Boom Length: Boom Angle: Degree of Swing:

Jib Length: Offset/Type: Max Operating Radius:

Crane Rated Cap: Total Weight: Percent of Chart:

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Number: CSM - 019
Title: Critical Lift Template
Contractor Safety Revised: 08/21/2013

Classification (check all that apply)

Load is over 75% of cranes capacity for current configuration
Lift is more than 20 tons
Lift is over operating systems(charged electrical equipment, pipelines, etc)
Lift uses two (2) or more cranes
Hoisting of Contractor employees on a suspended work-platform/man-basket


Construction Supervisor:

Construction Manager:

Safety Manager:

Crane Operator:

Rigging Supervisor:

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Number: CSM - 019
Title: Critical Lift Template
Contractor Safety Revised: 08/21/2013

Pre-Lift Meeting Attendees

Printed Name Signature

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Number: CSM - 019
Title: Critical Lift Template
Contractor Safety Revised: 08/21/2013


Weight Jib
Weight of Equipment Lbs. Erected: Stowed:
Weight of Headache Ball Lbs. Length of Jib Ft.
Weight of Load Block Lbs. Angle of Jib Deg.
Weight of Lifting Bar Lbs. Rated Cap of Jib (from Chart) Lbs.
Weight of Slings & Shackles Lbs. Sizing of Slings/Shackles
Weight of Jib Lbs. Sling Selection
Weight of Cable (Load Fall) Lbs. Type of Arrangement
Allowance for Unaccounted Material
in Equip. (10% of Equip Weight) Lbs. Number of slings in hookup Slings
Other (Water): Lbs. Cert. Attached or Number
Total Weight Lbs. Sling Length Ft.
Source of Load Weight
(Name Plate, Drawings, Calculated): Rated Capacity of Slings Lbs.
Weight Verified By: Shackle Selection
Crane Capacity Tons
Type of Crane: Shackles attached to load by
Crane Capacity Lbs. Number of Shackles
Lifting Arrangement: Cert Attached or Number
Max Distance Center
Load to Center Pin Ft. Crane Placement
Length of Boom Ft. Yes No
Angle of Boom @Pickup Deg. Smooth Solid Foundation in area?
Angle of Boom @Set Deg. Electrical Hazards in area?
Rated Capacity of crane under most severe lifting If Yes Explain:
Over Rear Lbs.
Over Front Lbs. Obstructions/Obstacles to Lift/
Over Side Lbs. Swing?
Rate Capacity of Crane for Lift Lbs. If Yes Explain:
Maximum Load on Crane Lbs.
Lift is % of Cranes Rated Capacity Underground piping/Cables?
If Yes Explain:

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Number: CSM - 019
Title: Critical Lift Template
Contractor Safety Revised: 08/21/2013

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Number: CSM - 019
Title: Critical Lift Template
Contractor Safety Revised: 08/21/2013


Pre-Lift Check List
Questions Yes No Questions Yes No
Matting Acceptable? Tag line Used?
Outriggers Fully Extended? Experienced Operator?
Crane in Good Condition? Experienced Flagman Designated?
Adequate Awing Room? Experienced Rigger?
Head Room Checked? Load Chart in Crane?
Maximum Counterweight Used? Wind Conditions?

Crane Inspected by: Date:

Functional Test of Crane By: Date:

Diagram Crane & Load Placement Diagram Rigging Configuration

(Draw in Space Below or attach copy) (Draw in Space below or attach copy)

Special Instructions or Restrictions for Crane, Rigging, Lift, Etc.


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