Critical Lift Permit HS-FR-10-06

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

Critical Lift Permit

• Centre/Location

• Date:

  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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Name of competent Person:

• Riggers and doggers hold the appropriate high risk licence

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Competent safety observer in place

  Yes

  No

  N/A

• Exclusion zones established to manage traffic and prevent unauthorised access

  Yes

  No

  N/A

• Effective communication protocols have been established

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Other (specify)

  Yes

  No

  N/A

Crane Requirements - Applicable Yes or No

• Lifting plan has been created

  Yes

  No

  N/A

• Crane Operator holds the appropriate high risk licence

  Yes

  No

  N/A

• Crane risk assessment is available and current

  Yes

  No

  N/A

• Crane log book is current

  Yes

  No

  N/A

• Crane load chart is available/displayed in the cabin

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Suspended loads will not be left unattended

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Other (Specify)

  Yes

  No

  N/A

Aerial Lift requirements - Applicable Yes or No

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

  Yes

  No

  N/A

• Local council has been notified

  Yes

  No

  N/A

• Works will be conducted outside of normal business hours

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Other (specify)

  Yes

  No

  N/A

Additional Permits Required - Yes or No (as required)

• Hot Work

  Yes

  No

  N/A

• Work at Height, Roof Access and BMU

  Yes

  No

  N/A

• Penetrations and Excavations

  Yes

  No

  N/A

• Fire System Impairment

  Yes

  No

  N/A

• Confined Space Entry

  Yes

  No

  N/A

Permit Approval

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

• This Permit is Valid from: Start Date

  Date

• This Permit is Valid Till: Expiry Date

  Date

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

• Permit Receiver:

  Sign

• Permit Issuer:

  Sign

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:

  Sign

• Permit Issuer:

  Sign