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: Crane Placement: Project # Any deviation from level compact surface in area? Electrical hazards in the area? Obstacles or obstructions to lift and swing? Swing direction and degree (boom swing) Lift arrangement: Lift radius ft. [ Planned lift path: [ ] 360o [ ] over front ] over side On Asphalt None None west to south Jib Erected [ ] Stored [ ] Is Jib to be used: Length of jib: Lift path cleared? [ ] yes [ ] no Angle of jib: Rated capacity of jib: Whip line: Number of parts cable: Size of cable: Length lbs/ft 0 lbs total weight: 0 lbs Yes [ ] No [ ] ft. deg. lbs. Type of crane

(center pin of crane to center of lift) Boom length Boom angle at lift Boom angle at set Rated capacity of crane: 360o Over side Over front Over rear lbs. lbs. lbs. lbs. ft. deg. deg.

] over rear [

Load line: Number of parts cable: Size of cable: Length lbs/ft total weight:

Weight of lift Weight of load: Weight of lifting beam Weight of rigging Weight of auxiliary rigging Additional weight: Headache ball/ Load-block Load line Whip line Jib deduction Allowance: Unaccounted material Total weight: 0 0 lbs. lbs. 0 0 lbs. lbs. lbs. lbs. 0 0 lbs. lbs. lbs. lbs.

Sling selection Type of arrangement Size Size Size Shackle selection Size Size Size 0 ea 0 ea 0 ea 0 cap 0 cap 0 cap Wieght of rigging: Auxilliary rigging: Come-a-long Chainfall Other 0 ea 0 ea 0 ea 0 cap 0 cap 0 cap 0 lbs 0 lbs 0 lbs 0 lbs 0 lbs 0 lbs 0 lbs 0 lbs 0 ea 0 ea 0 ea 0 cap 0 cap 0 cap 0 lbs 0 lbs 0 lbs

% of crane capacity*:

#DIV/0!

Weight of auxilliary rigging:

*(If load exceeds 75 % of rated capacity, sketch rigging plan, crane placement and swing path on reverse.)
Source of load weight: Weights verified by: PRE-LIFT CHECK LIST 1. Matting acceptable? 2. Outriggers fully extended? 3. Crane in good condition? 4. Swing room? 5. Head room checked? 6. Max counterweights used? 7. Tag line used?

x
YES [ [ [ [ [ [ [ ] ] ] ] ] ] ] / NO [ [ [ [ [ [ [ ] ] ] ] ] ] ] 8. Experienced operator? 9. Experienced flagman? 10. Qualified rigger? 11. Load chart in crane? 12. Wind conditions: 13. Crane inspected by: 14. Functional test of crane by: YES [ [ [ [ ] ] ] ] / NO [ [ [ [ ] ] ] ]

#DIV/0!
Special instructions or restrictions for crane, rigging, lift, etc.

Unaccounted Material= 10%

Job supervisor

PM/Superintendent

Operator reviewed

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.