Lift Plan Worksheet

• Project

• Job Number

• Conducted on

  Date
• Location
  Address

• Prepared by

Crane Information

• Manufacturer

• Model

• Serial #

• Crane Rating

• Crane Inspection Date

• Notes & Photos

  Notes

Lift Team Info

• Crane Operator

• Signal Person Assigned

• Communication Method

• Did Pe-Lift Meeting Between All Necessary Team Members Occur?

  Yes

  No

• Notes

  Notes

• 
  
  
  
  
  
  
  
  

Pick Location

• Pick Locations:

Location

• - Where?

• - Weight / Distance

• Notes

  Notes

Pre-Lift Checklist

• Crane Inspected by Operator?

  Yes

  No

• Rigging Inspected?

  Yes

  No

• All Permits Obtained?

  Yes

  No

• Are Wind Conditions Acceptable?

  Yes

  No

• Are Weather Conditions Acceptable?

  Yes

  No

• Are Power Lines Obstructing Any Lifts?

  Yes

  No

• Is Operator's Certification Card Current?

  Yes

  No

• Are Lift Areas Acceptable for Entry and Exit of Jobsite?

  Yes

  No

• Other Special Considerations

  Notes

Signatures

• Operator

  Sign

• Engineer

  Sign

• Supervisor

  Sign

•