Title Page
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Site conducted
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Ref number
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Matrix Representative
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Contractor Company Name
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Driver/Operator Name
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Location
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Method Statement / Risk Assessment Ref.
Checklist
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Lift Plan available
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Expiry Date
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Safe Working Area Established
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Crane Appointed Person (BS7121) Present / Certificates viewed
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Lift Supervisor (BS7121) Present / Certificates viewed
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Operators license viewed
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Slinger / Signaler present / Certificates viewed
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Banksman present / Certificates viewed
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Dily checks completed
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HI-AB certified
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Slings in date
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Add Photo of Sling with serial number
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Add Photo of Sling Cert
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Chains in date
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Add Photo of Chain with serial number
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Add Photo of Chain Cert
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Method Statement signed by working party
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Add Photo
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Risk Assessment signed by working part
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Ground suitable / Not liable to subsidence (spreader mats / plates used etc.)
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Other equipment / Comments:
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Sign Off
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Matrix Networks
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Lifting Contractor / Operator
