Critical Lift Plan

Date: __________________

Location of Lift: _________________________________________________________

Description of Object to Be Raised: _________________________________________

_______________________________________________________________________

Lifting Equipment Make & Model: __________________________________________

Lifting Equipment Rated Capacity: ______________tons

Load
Total Weight of Lift: _______________ pounds or ________________tons
Weight Of Rigging: ______________________ pounds
How Was Weight of Object Obtained? _______________________________________
If lift is an existing item, weight calculations will include modifications, liquid remaining,
insulation, sludge, scale, sediment, etc.

Set Up
Boom Angle: ________________ degrees
Distance From Pin: ________________ feet
Crane Capacity at Set up Configuration: ___________pounds or __________tons
Load Including Rigging is What Percent of Rated Crane Capacity _____________%

Equipment and Lift Relationship

Maximum Operating Radius _______________________feet
Planned Operating Radius _________________________feet
Allowable Load (from load chart) _______________ tons or ______________ pounds
Ratio of Lift to Allowable Load __________________ percent
Clearance between Boom and Load _________ feet ______________ inches
Clearance to Existing Facilities ____________ feet
Clearance to Energized Power Lines _____________feet

Ground Stability
Surface Type _________ bare ground _________asphalt __________ concrete
Surface Bearing Capacity ______________ tons per square foot
Type of Support Used ________mats _________ cribbing
Mats will be used on all surfaces; additional cribbing may be required
Size and Number of Supports _________________________
Do Underground Installations Need Special Treatment _______yes _______no

Page 1 of 2
Weather
Lift Will Not Proceed if Wind Exceeds ________________ mph
Precipitation Type ______ rain __________ snow _________ none
Cloud Type overcast ___________ clear ___________
Lift Conducted _______during daylight _______ with artificial light

Lift Area Restriction

Area Barricaded _________yes ________no
Equipment swing Radius Barricaded ________yes _______no
Warning Signs Required _________yes _________no
Unnecessary Personnel Removed from Area _______yes ______no
Energized Lines Isolated __________ yes _________ no

Communication
Operator View is Unobstructed (pick to set) _________yes ______no
Communication Used _________ hand signals _________ radio ____________ other
Explain Other ________________________________________________

Pre-lift Safety Meeting

Type of Critical Lift
___________ Load Exceeds 75% of Load Chart Capacity for Lifting Equipment
___________ Two or More Cranes/Booms Required for Lift
___________ Specialized Hoisting Rigging Equipment Used
___________ Load Suspended or Moved Over Loaded Lines
___________Other (specify) _________________________________________

Items Discussed ____________________________________________________

__________________________________________________________________

__________________________________________________________________

Crane Operator ___________________________________________

Crane Rigger _____________________________________________
Crane Oiler ______________________________________________
Signal Person ____________________________________________
Crane Inspected By _______________________________________
Rigging Inspected By _____________________________________
Client Representative _____________________________________
Designated Lift Leader ____________________________________

Page 2 of 2