Lifting Operations

• Site conducted

• Conducted on

  Date

• Prepared by

• Location

Roles and Responsibilities of Team members.

• Site Supervisor:

• Rigger:

• Signal Person:

• Lift Director:

Rigging Decisions (Confortable making decisions for lift planning)

• Sling Selections:

  Yes

  No

  N/A

• Hitch Types:

  Yes

  No

  N/A

• Sling Lenghts:

  Yes

  No

  N/A

• Rigging Hardware:

  Yes

  No

  N/A

• Sling Inspections:

  Yes

  No

  N/A

Crane Capacity

• Operator is responsible for their equipment, Particular Load Charts and limitations of that equipment. i.e. (Boom deflection, Equipment capacity, equipment set up, line pull). If applicable

• Has the Lift Plan Short Form been completed by the operator?

  Yes

  No

  N/A

Type of Equipment:

• Crane (Lift Plan short form needed)

• Telehandler

• Excavator (Lift Plan short form needed)

• Loader

• Skidsteer

Lift Plan

• Do you have a lift plan? (If Yes, please describe.)

Risk Assessment

• Has a task that kill risk assessment been completed? (Required)

  Yes

  No

  N/A

• T5/Toolbox Lead person:

Area Visual

• Any obstruction within lifting zone?

  Yes

  No

  N/A

• Is Crane-Set up area safe? i.e. (level surface, stable ground, area is cordon).

  Yes

  No

  N/A

• Items to be lifted:

• Other Equipment used:

• Personnel (First Name, Last Name):

Zone Set up

• Area to be zoned off. (Description of general area)

• Authorized employees allowed in the zone (Two Maximum) First Name, Last Name.

• Operator(s) acknowledge personnel in the zone?

  Yes

  No

  N/A

Load Position

• Description of load movement:

• Obstructions/Obstacles within the swing radius: (If yes, please describe below)

  Safe

  At Risk

  N/A

• List obstacles:

• Description of final landing zone position:

Rigging Requirements

• Sling Load Limits

• Sling Configurations:

• Load Ratings:

• Sling Type: i.e. (Wire rope, Nylon, Strap, Chain)

• Clevis Size:

• Clevis Load Limit:

• Attachment Placement:

Spotter

• Name: Firs Name, Last Name

• Location oriented to load: i.e. (Catwalk, platform, ground, man-lift)

• Visibility: i.e. (Eye contact with operator)

  Yes

  No

  N/A

• Radio Communication:

  Good

  Fair

  Poor

  N/A

• Hand Signals: Is everyone aware of hand signals being used?

  Yes

  No

  N/A