Project / Site
Description of goods to be lifted
Lift Supervisor full name
Signal person full name
Crane / Hoist Operator full name
Crane / Hoist Contractor
Has a pre-lift meeting taken place?
Have all other trades, tenants, occupants and neighbors been informed of lifting operations?
Have all involved personnel (including those named above) completed the required training relevant to their lift duties?
Have weather conditions been considered?
Wind conditions are safe and will be monitored over entire lift?
Are Hand Signal charts are on site?
Have signals have been reviewed between operator, signal person(s) and rigging person(s)?
Have materials to be hoisted been confirmed and has rigging methods been confirmed?
Has all rigging passed a visual inspection and is appropriate for the material being hoisted?
Full name of rigging inspector
Is crane swing rotation open and barricaded?
Is a tag line being used?
Detail why tag line is not in use for this lift?
Do the ground conditions appear to be acceptable for crane set up?
Are outriggers fully extended?
Has crane/hoist been inspected and deemed safe prior to this lift?
Are crane/hoist inspection records up to date?
A barricade demarcates the work area around all trucks equipment and personnel?
Have you assigned a designated spotter for this lift?
Full name of Spotter
Is there safe clearance between near power lines and every portion of the lifting operation, including crane/hoist, personnel and lift path?
We the undersigned that the above is a true and correct reflection of checks that occurred before this lift occurred.