• Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location

Critical Lift Permit

  • Centre/Location

  • Date:

  • Company Name:

  • Permit Receiver:

  • Contact Phone Number:

  • Location of Work:

  • Permit Issuer Name

  • Vicinity Centres Position:

General Requirements

  • Appropriate SWMS or risk assessment in place

  • A competent person has been assigned as the person in charge of lifting operation

  • Name of competent Person:

  • Riggers and doggers hold the appropriate high risk licence

  • Pre-lift meeting with relevant stakeholders will be held and recorded

  • Emergency plan has been established and includes evacuation, notification to emergency services (including contract numbers) medical response

  • Competent safety observer in place

  • Exclusion zones established to manage traffic and prevent unauthorised access

  • Effective communication protocols have been established

  • Lifting equipment (e.g. slings, chains, shackles) has been checked by a competent person

  • Clearance requirements with regards to power lines and other services/structures have been identified and communicated

  • Weather conditions, including wind speed, are suitable for the lift

  • Other (specify)

Crane Requirements - Applicable Yes or No

  • Lifting plan has been created

  • Crane Operator holds the appropriate high risk licence

  • Crane risk assessment is available and current

  • Crane log book is current

  • Crane load chart is available/displayed in the cabin

  • Crane pre-start check shall be completed prior to operation

  • The crane standing area has been assessed as suitable by a competent person

  • Suspended loads will not be left unattended

  • For pick and carry operations the path of travel has been assessed and deemed suitable by a competent person - Yes or N/A

  • Other (Specify)

Aerial Lift requirements - Applicable Yes or No

  • Risk team has been notified with a minimum of 7 days' notice

  • Local council has been notified

  • Works will be conducted outside of normal business hours

  • Isolation of centre malls (four levels) under the direct flight zone has been completed

  • Notification to major tenants completed including any restrictions during the operation

  • Aircraft landing area has been identified and assessed as suitable by a competent person

  • The relevant regulatory authority (e.g. WorkSafe) has been notified

  • Other (specify)

Additional Permits Required - Yes or No (as required)

  • Hot Work

  • Work at Height, Roof Access and BMU

  • Penetrations and Excavations

  • Fire System Impairment

  • Confined Space Entry

Permit Approval

  • Copy of SWMS or risk assessment attached? (Check box if YES)

  • This Permit is Valid from: Start Date

  • This Permit is Valid Till: Expiry Date

  • I understand the permit requirements and the controls specified shall be implemented and monitored for effectiveness throughout the works:

  • Permit Receiver:

  • Permit Issuer:

Permit Close Out

  • I have checked the worksite and confirm that the works are complete/ceased and the site has been made safe:

  • Permit Receiver:

  • Permit Issuer:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.