Crane and Hoisting Permit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date
• Location
  Address

• Personnel

Approvals and Documentation

Identification

• Controlling Contractor:

• Subcontractor:

• Crane Contractor:

Approvals (Signature Required)

• Date:

  Date

• Site Superintendent:

  Sign

• Contractor Lift Supervisor: ( This individual must be present during the lift)

  Sign

• Operator:

  Sign

Attachments (Add photos)

• Operator Certifications:

  Attached

  Not Attached

• Add media

  Media

• Signal Person Certifications:

  Attached

  Not Attached

• Add media

  Media

• Qualified Rigger Training Documentation:

  Attached

  Not Attached

• Add media

  Media

Pre-Lift Checklist

• Hand Signal charts are on site?

• Have weather conditions been considered?

• Has the stability of the ground been assured?

• Have the general safety precautions been reviewed?

• Has a Pre-lift meeting taken place?

• Has all rigging equipment been inspected?

• Is swing rotation open and barricaded?

• Are crane inspection records up to date?

• Are outriggers fully extended?

• Is a tag-line going to be used?

  Yes

  No

• Reason for no tag line?

• Will any section of the crane operation or lift structure be within 20 feet of a power line?

  Safe

  At-Risk

• Stop lifting operation and contact controlling contractor safety representative.