Title Page
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Crane Company
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Conducted on
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Unit Number
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Job Number
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Prepared by
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Personnel
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Was proper PPE used
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JSA
Crane
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Daily crane inspection
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Monthly crane inspection
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Annual crane inspection
Support equipment
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Tractors and trailers
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Other equipment
Set up and pre-lift
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Job start signed
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Crane is appropriate for the job
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Crane has adequate access
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Crane set up on stable surface
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Outriggers properly extended and set
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Rear structure of the crane properly barricaded
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Multiple crane used
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Reviewed lift plan and load calculations with crew
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Proper rigging for load
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Completed Rigging inspection prior to lift
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Qualified signal person identified
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Qualified rigger identified
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AD director identified
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Lift director identified
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Suspended Personnel platform
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Powerlines identified and proper precautions taken
Performance and additional findings
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Performance
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Any additional findings