Title Page

  • Crane Company

  • Conducted on

  • Unit Number

  • Job Number

  • Prepared by

  • Personnel

  • Was proper PPE used

  • JSA

Crane

  • Daily crane inspection

  • Monthly crane inspection

  • Annual crane inspection

Support equipment

  • Tractors and trailers

  • Other equipment

Set up and pre-lift

  • Job start signed

  • Crane is appropriate for the job

  • Crane has adequate access

  • Crane set up on stable surface

  • Outriggers properly extended and set

  • Rear structure of the crane properly barricaded

  • Multiple crane used

  • Reviewed lift plan and load calculations with crew

  • Proper rigging for load

  • Completed Rigging inspection prior to lift

  • Qualified signal person identified

  • Qualified rigger identified

  • AD director identified

  • Lift director identified

  • Suspended Personnel platform

  • Powerlines identified and proper precautions taken

Performance and additional findings

  • Performance

  • Any additional findings

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