Information
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Client / Site / Location
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Scope of Work
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Crane Number
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Conducted on
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Prepared by
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Document No.
1.0 - Operator
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1.1 - Operator understands manufacturer's Operator's Manual and Load Chart?
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1.2 - Operator's manual is readily available in the cab?
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1.3 - Operator is complying with the crane's rated capacity and is not attempting to exceed?
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1.4 - The load weight has been verified by customer and operator?
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1.5 - Operator will maintain 2 full wraps of rope on the hoist drum?
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1.6 - Operator has performed a Daily Inspection?
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1.7 - Federal Motor Carrier Pre-Trip Inspection completed?
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1.8 - Crane Pre-Lift Inspection?
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1.9 - Hoist line has been inspected and is free of defects, knots, or kinks?
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1.10 - Operator's Daily Log Book is current?
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1.11 - Job Ticket has been signed by customer?
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1.12 - Operator has valid NCCCO card and is in hand?
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1.13 - Operator has full view of load at all times or has qualified signal person in place?
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1.14 - Current registration card is in the driver's cab?
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1.15 - Current insurance card is in the cab?
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1.16 - Current Interstate Fuel Tax (IFTA) sticker?
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1.17 - Current Federal Motor Carrier sticker?
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1.18 - Crane has a current annual inspection and a copy is in the cab?
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1.19 - Operator has a valid CDL and medical card on his person?
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1.20 - Road Permit ( if required) is in the cab?
2.0 - Operation
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2.1 - Crane windows are intact, free of damage, and all latches are in place?<br>
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2.2 - All manufacturer's warnings on crane are legible?<br>
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2.3 - Crane load chart is clearly visible?
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2.4 - OSHA 1926.1402 ground condition requirements are met and controlling entity has verified no underground installations ?
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2.5 - An ABC fire extinguisher is properly secured and easily accessible in the cab?
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2.6 - Crane's built-in leveling device is in good working order?
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2.7 - The crane houses a stocked first-aid kit?
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2.8 - Anti-two block is in place and operational?
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2.9 - Hook latch is in place and working?
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2.10 - All spreader bars are clearly marked with their ID#, capacity chart, current inspection, and are free of visible damage?
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2.11 - All chokers are in good condition with legible manufacturer tags or labels?
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2.12 - All tools and maintenance parts are stored in tool boxes and not loose in or around the cab?
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2.13 - Personal items do not interfere with the access to or operation of the crane, within the cab space?
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2.14 - Cribbing is strong enough to prevent crushing, 3 times larger than float, and properly in place?
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2.15 - The reverse alarm is working and effective?
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2.16 - Headache ball and hoisting block is labelled with capacity and weight?
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2.17 - Crane is setting upon fully extended outriggers and floats?
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2.18 - Crane is setup level (+/- 1%)?
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2.19 - The crane has operable windshield wipers, defrosting, and defogging equipment?
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2.20 - The crane air horn and/ electric horn are in working order?
3.0 - Observation
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3.1 - Air brake is engaged?
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3.3 - A signal-person is in place when there is a danger to persons from moving equipment, swinging loads, buckets, booms, etc?
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3.2 - The work area is level, firm, free of obstructions, and the crane is secure?
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3.4 - Fuel tanks contain shipping document, NFPA diamond, Flammable label, and Diesel label?
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3.5 - Crane has adequate clearance from structures and electrical sources (>20') to operate safely? (360 degrees all directions)
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3.6 - If any portion of the crane, boom, or load can come within 20' of the power source, a qualified spotter is designated and in place?
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3.7 - 20' Rule meeting has been conducted and documented? (Designate Spotters and define everyone's responsibility)
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3.8 - All crane personnel are wearing high-visibility clothing and proper PPE? (Safety vest or high-viz shirt, safety toed boots, leather work gloves, safety glasses, and hard hat.)
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3.9 - Cleanliness of crane's exterior is satisfactory?
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3.10 - Cleanliness of crane's interior is satisfactory?
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3.11 - Crane operator maintained his position while load is suspended?
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3.12 - Operator is engaged and focused on the operation and free from distractions?
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3.13 - The proper barricades and labels are in place to warn others of the potential hazards?
4.0 - Customer Input
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4.1 - Was the crane on time?
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4.2 - Has our crane operator been polite and courteous?
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4.3 - Has the rest of our crane team been polite and helpful?
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4.4 - Has our crane team had the necessary tools and rigging for the job to be performed safely?
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4.5 - Has our equipment functioned properly and in good working order?
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4.6 - Has our crane team worked together and displayed teamwork?
Customer Comments
Inspector comments
Signatures
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Operator Signature
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Inspector Signature