Daily Crane and Hoisting Permit

• Document No.

• Crane Permit

• Client / Site

Identification

• Project Name

• Location
  Address

• Date and time

  Date

• Controlling Contractor

• Subconcractor

• Crane Contractor

Attachments

• Are the Crane Operators certifications on site and up to date?

  Yes

  No

  N/A

• Are the Signal Persons certifications on site and up to date?

  Yes

  No

  N/A

• Is there a Qualified Rigger on site.?

  Yes

  No

  N/A

• Is a copy of the Hand Signal Charts on site?

  Yes

  No

  N/A

Pre-Lift Checklist

• Have the weather conditions been considered?

  Yes

  No

  N/A

• Have the general safety precautions been reviewed?

  Yes

  No

  N/A

• Has the stability of the ground been assured?

  Yes

  No

  N/A

• Has all rigging equipment been inspected?

  Yes

  No

  N/A

• Is swing rotation open and barricaded?

  Yes

  No

  N/A

• Are outriggers fully extended?

  Yes

  No

  N/A

• Is a tag line going to be used?

  Yes

  No

• What is the reason for no tag line?

• Are crane inspection records on site?

  Yes

  No

  N/A

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

  Yes

  No

• Do not proceed with lifting operations. Contact Henry Bros. Co. Safety representative.

Approvals (Signature Required)

• By signing below you acknowledge this as a Pre-Lift Meeting and give approval for the lift to proceed.

• HBC Superintendent

  Sign

• Contractor Lift Supervisor

  Sign

• Crane Operator

  Sign

Additional Information

• Notes

• Progress Photos

  Media