V-HSF028 Site Crane Permit To Lift

• Site Conducted

  Select

• Date and Time of Visit

  Date

• Task/Method Statement No. (If Applicable)

• Appointed Person

• Description of Works

Choose type of lift (tick one lift only)

• Standard Lift

• Contract Lift

• Complext Lift

Choose Position (tick one option below)

• Single Crane Position (Complete Part 1 Only)

• Multiple Crane Positions (Complete Parts 1 and 2)

Load Details

• Maximum weight

• Maximum size of load

• Maximum radius

• Maximum lift height

• Other (e.g. unusual centre of gravity, lifting points etc.)

Crane Details

• Capacity and type

• Maximum available boom lengths

• Maximum boom length to be used for lift

• Counterweight required

• Hook block reeving (no. of falls)

• Outrigger spread (centre to centre) (m x m)

• Outrigger pad size (without mats)

• Maximum outrigger load

Site Surface Conditions

• Access for crane

• Access for transport

• Lifting position

• Laydown area

• Safe ground bearing capacity under outrigger

• Assessed by

• Proximity Hazards: provide details and attach sketch (overhead lines, public road, drains, ground conditions etc). A temporary works design for the lifting platform must be in place and signed off prior to setting up/commencing lifting operations. (Permit part 2 shall be completed for all crane positions/repositions of the crane).

  Media

Crane accessories required (state the type and rated capacity (safe working load))

• Wire Ropes

• Chains

• Web Slings

• Shackles

• Beams

• Outrigger Mats (State Size)

• Others (including specialist equipment)

Operational Requirements?

• Such as road closures/possessions/site clearance

Permit

• Valid From

  Date

• Valid To

  Date

Crane Team

• Appointed Person

  Sign

• Appointed Person's CPCS Card Number and Expiry Date

• Crane Supervisor

  Sign

• Crane Supervisor's CPCS Card Number and Expiry Date

• Crane Operator

  Sign

• Crane Operator's CPCS Card Number and Expiry Date

• Signaller/Slinger

  Sign

• Signaller/Slinger's CPCS Card Number and Expiry Date

Where contractors are required to complete this form, assistance shall be given by the site management authorised person who shall agree the details entered on the form and sign below.

• Lifting operations must not commence until this form has been signed by the site management authorised person

  Sign

Arrangements for multiple crane positions

• I agree that the crane described in Part 1 may be repositioned within the constraints defined in the lift plan, provided that each time it is set up in a new position the items in the list below are checked and signed for by the crane supervisor. When the crane is being operated by a contractor, each entry shall be countersigned by a site management person authorised by the project manager. The signature(s) shall be entered on this form prior to allowing the crane to operate in the new position.

  Sign