Information

  • Jobsite/Project Name:

  • Location:
  • Conducted on:

  • Conducted by/Operator:

  • Make / Model:

  • Hour Meter Reading:

  • Unit / Machine Number:

  • Photo of Equipment:

  • Crane has adequate access around site?

  • Jobsite provided with adequate material staging area?

  • Adequate room for crane assembly/disassembly?

  • Weather Conditions

  • Pre-planning meeting conducted before assembly/disassembly?

  • Qualified person supervised assembly/disassembly?

  • Crane selected is appropriate for load capacity and reach?

  • Crane operator training verified?

  • Crane's annual inspection available?

  • Crane setup on stable surface - Compacted soils, Drained, Firm?

  • Outriggers extended - Wheels off ground?

  • Blocking/Cribbing adequate size (Size = 3x float size)?

  • Crane setup level?

  • Swing radius barricaded to prevent access - employee training?

  • Lift route planned to prevent worker exposure to falling loads?

  • Work Zone Defined

  • Marked boundary

  • or 360 max radius

  • Crane could get within 20' of powerline?

  • or Distance per table

  • Powerline voltage

  • Distance

  • Letter or notification from power company verifying powerline voltage received?

  • Safety Measures In Place

  • Pre-Planning meeting

  • Non-Conductive tag lines in place?

  • Elevate warning lines, or

  • Barricades, plus

  • A spotter, or

  • Range limiter, or

  • Warning device, or

  • Insulating link?

  • Employee training provided for powerline hazards?

  • Qualified riggers present - Training verified?

  • Rigging equipment appropriate for load to be lifted?

  • Slings, spreader bars or chains checked for certifications?

  • Rigging inspected?

  • Qualified signal person present - training verified/documented?

  • Hand signals posted at Jobsite?

  • Daily Pre-lift meeting conducted?

  • Competent person performed daily inspection and at each shift change?

  • Competent person performing and documenting monthly inspection?

  • Crane suspended personnel platform in use?

  • If yes, has the design/use been verified - Trial run per 1926.14 conducted?

  • Airport/Helipad locations nearby?

  • Multiple crane use - Coordinate procedures

  • Multiple crane use - Critical lift plan in place?

REPAIR

  • In case of broken part(s), take photo(s)

SIGNATURE

  • Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.