Appendix IV Contractor Crane Entry Package-fillable.pdf

NAVFAC HI QA/Safety Contractor Crane Entry Package

1. Contractor Crane Operations Flow Chart

2. Contractor Crane Certificate of Compliance (Figure P-1) - Provided by Contractor and posted in cab of crane. Prior to entering the job site

3. Contractor Crane Pre-Entry Package Checklist – Contractor provides information in this package and submits to NAVFAC to obtain permission for crane entry.

4. Procedures for Performing Multi-Purpose Equipment (MPE) lifts

5. Contractor Activity Hazard Analysis (AHA) – A detailed AHA will be completed by the contractor and submitted to NAVFAC prior to the start of work. The AHA will be reviewed at the Preparatory/Initial Control Phase Meetings.

6. Crane & Rigging Gear Accident Report/Instructions – To be completed by contractor when a WHE mishap occurs.

7. Sample Rigging Diagram/Sketch – Constructed by contractor on Pre-Entry Checklist or as an attachment.

NAVFAC HI FORM 2016

Enclosure (1)

APPENDIX P – CONTRACTOR CRANE (OR ALTERNATE MACHINE USED TO LIFT SUSPENDED

LOAD) AND RIGGING GEAR REQUIREMENTS

FIGURE P-1

Enclosure (2)

CERTIFICATE OF COMPLIANCE

This certificate shall be signed by an official of the company that provides cranes (or multi-purpose machines, MHE, or construction equipment used to lift loads suspended by rigging gear) or rigging gear for any application under this contract. Post a completed certificate on each crane or alternate machine (or in the contractor’s on-site office for rigging operations) brought onto Navy property.

CONTRACTING OFFICER’S POINT OF CONTACT

(Government Representative)

PHONE

PRIME CONTRACTOR/PHONE CONTRACT NUMBER

CRANE OR ALTERNATE MACHINE SUPPLIER/PHONE

(if different from prime contractor)

CRANE OR ALTERNATE

MACHINE NUMBER (i.e., ID number)

CRANE OR ALTERNATE MACHINE MANUFACTURER/TYPE/CAPACITY

CRANE OR ALTERNATE MACHINE OPERATOR'S NAME(S)

I certify that

1. The above noted crane or alternate machine and all rigging gear conform to applicable OSHA regulations (host nation regulations for naval activities in foreign countries) and applicable ASME B30 or other standards. The following OSHA regulations and ASME or other standards Apply: Applicable 29 CFR parts 1910,1915,1917,1919,or 1926/ASME B30.2/B56.6/B30.9/B30.10/B30.26/ANSI B30.5/EM385-1-1/PCSA #2 and NAVFAC P-307/P300

2. The operators noted above have been trained and are qualified for the operation of the above noted crane(s) or alternate machine(s).

3. All safety devices and operator aids are enabled and functioning properly and the operators noted above have been trained not to bypass safety devices and operator aids during lifting operations.

4. The operators, riggers and company officials are aware of the actions required in the event of an accident as specified in the contract.

5. Signal persons used in construction work are qualified in accordance 29 CFR 1926.1428

6. Riggers are qualified in accordance with NAVFAC P-307, paragraph 11.1.k.

7. All personnel working on the job site have been trained to not stand under a load or in the fall zone of a suspended load unless specifically allowed by USACE EM 385-1-1.

COMPANY OFFICIAL SIGNATURE DATE

COMPANY OFFICIAL NAME/TITLE

POST ON CRANE (OR ALTERNATE MACHINE)

(IN CAB OR VEHICLE)

(or in the contractor’s on-site office for rigging operations)

Enclosure (3)

CONTRACTOR CRANE PRE-ENTRY CHECKLIST

Crane Company:

Estimated Date of Entry:

Crane Type/Manufacturer/Model/Serial Number/Crane Number: Estimated Time of Entry:

2 Date of Annual Inspection Expiration (attach copy)

Name & phone number of Government Contracting Official (or designated local representative)

Name

Phone #

Prepared by: Date: NAVFAC CCO:

GENERAL INFORMATION

Narrative of crane/equipment lift including location, heaviest lift, and first lift of the day (first lift could be the counterweight installation):

5 Duration crane will be on the job site (i.e.. four days, two weeks)

Include a valid Certificate of Compliance (P-1) indicating that the crane complies with applicable OSHA regulations and ASME B30 standards? (attach copy)

7 What is the weight of the heaviest load to be lifted? lbs.

8 What is the weight of the rigging gear? (Please include WLL of slings, shackles and attachments in sketch) lbs.

DEDUCTIONS:

For telescopic forklifts and excavatpors, use block (g) for the wieght of the forklift attachment or the weight of the excavator bucket, blocks (a) thru (f) do not apply.

*******Please be reminded that the lift is limited by the lowest capacity******** (e.g. If hoist line, or hook capacity is the lesser value, then it is used)

Parts Line Used: parts

(Line Pull Each: lbs.) X (No. of Parts line) = _Hoist Line Capacity

COUNTERW EIGHT:

a. Main Block lbs.

b. Aux. Block lbs.

c. Jib (Stowed) lbs.

d. Jib (Erected) lbs.

e. Whip Ball lbs.

f. Excess Wire Rope lbs.

g. O ther lbs.

TO TAL

DEDUCTIO NS (a-f) lbs.

10 What is the total weight of this lift? (7+8+Total Deductions) TOTAL lbs.

11 What is the Gross Capacity, based off line pull or radius? (whichever is less) lbs.

12 What Percentage of crane capacity is this lift? Total × = ÷ Gross Cap % =100

This block is Not Applicable to Telescopic Forklifts and Excavators.

What is the main boom length planned for the lift? If Jib is used, indicate the length and offset.

MAIN JIB OFFSET

14 What is the maximum radius planned for the lift? Boom Angle? Radius Angle

Boom Length Radius

Load Weight

Rigging Gear

Main Block

Aux Block

Jib Stowed

Jib Erected

Whip Wire Rope O ther Total

Gross Cap %

Lift#2

Lift#3

Lift#4

Lift#5

16 If Jib is used, has crane been load tested in that configuration? (attach copy)

17 Include a copy of the cranes Range Diagram for the planned boom configuration. (attach copy)

18 Include a copy of the Load Chart Page (e.g. page 26) for the planned boom configuration. (attach copy)

19 Complete the rigging sketch (item 31) for all lifts. (please include chaffing gear points in sketch) (company form is acceptable)

20 Complete job site sketch (item 34), include underground utilities or overhead power lines. (company form is acceptable)

Include a valid medical certificate signed by a licensed physician (N/A for forklift and excavator operators), and proof of operator qualification from an accredited source that qualifies crane operators (union, governmental agency, in-house program, or an organization that tests and qualifies crane -operators?) Verify qualification for each back-up operator (if provided) on the Certificate of Compliance (P-1.) (attach copy)

22 Include proof of rigger and signalman qualifications and a copy of Photo I.D. (attach copy)

YES NO N/A

Has Airfield/FAA Clearance been obtained? Use Notice Criteria Tool at FAA Website:

<https://oeaaa.faa.gov/oeaaa/external/gistools/gisAction.jsp?action=showNoNoticeRequiredToolForm>

24 Does the crane have a wind speed indicating device (EM385, 16.A.08.l)?

25 For mobile cranes, does the crane have a functioning anti-two block system (EM385-1-1, )

26 For crawler crane, does the plan indicate area restrictions for operation?

For mobile crane mounted on barge, is crane equipped with load indicating device, wind indicating device, marine type ‘list and trim’ indicator (in 1/2 degree increments)? Does plan include a revised load chart?

28 For floating crane, does plan include maximum allowable list?

29 Is fall protection required for any part of the job?

CRITICAL LIFTS

NAVFAC P307 Complex lifts include (a) hazardous materials (b) large and complex geometric shapes (c) lifts of personnel

(d) lifts exceeding 75% of the cranes hoist or radius planned for use; 50% for a mobile crane mounted on a barge (e) lifts of submerged or partially submerged objects (f) multiple crane or multiple hook lifts on the same crane (g) lifts of unusually expensive or one-of-a-kind equipment or components (h) lifts of constrained or potentially constrained loads (binding conditions) (i) lifts made in the vicinity of overhead power lines . Additional lifts IAW EM 385 1-1 (a) Lifts of personnel using a forklift are considered complex/critical lifts. (EM 385-1-1, 16.A.01.f) (b) load tests (c) on rubber lifts (d) lifts where center of gravity could change (e) assembly of crane booms Refer to EM385-1-1 and NAVFAC P-307 for Critical/Complex lifts.

YES NO

31 Is this a critical lift? If Yes, complete Items 32-37.

32 Critical lift briefing sign off sheet will be completed on the job site.

Please describe circumstances that classify this operation as a critical lift. (Refer to EM 385-1-1 section 16.H; P-307 11.1.g) (e.g., Lift #1 is hazardous material and it’s over 75% of the cranes capacity)

Include in rigging/job site sketch the exact dimensions of lo a d a n d t he height to be lifted or lowered. (company form is acceptable)

Include boom angle for complex/critical lifts Boom Angle

36 Describe the ground conditions.

What type of communication will be used? hand voice radio signals will be relayed

Print and Sign

Operator____________________________________________________________

Rigger in Charge_____________________________________Date_____________

Signalman___________________________________________________________

Lift Supervisor________________________________________________________

Other_______________________________________________________________

Other_______________________________________________________________

Other_______________________________________________________________

Other_______________________________________________________________

Other_______________________________________________________________

Other_______________________________________________________________

RIGGING DIAGRAM/SKETCH (Draw or Attach)

Construct rigging diagram below to show the lift points, description of the rigging procedures and hardware requirements (i.e.

hooks, shackles, slings, eyebolts, spreader bars) including Working Load Limits (WLL) and angles of any applied slings etc. See Enclosure 7 for sample:

RIGGING DIAGRAM/SKETCH (Draw or Attach)

Construct rigging diagram below to show the lift points, description of the rigging procedures and hardware requirements (i.e.

hooks, shackles, slings, eyebolts, spreader bars) including Working Load Limits (WLL) and angles of any applied slings etc. See Enclosure 7 for sample:

35 Jobsite Sketch: (Draw in location of utilities and their proximity to construction site, include such things as; proposed excavations, location of heavy equipment, scaffolding, material storage areas, etc.)

Enclosure (4)

PROCEDURES FOR CONDUCTING MULTI-PURPOSE

EQUIPMENT (MPE) LIFTS

1. Contractor to post Certificate of Compliance (P-1) in cab of MPE prior to entering job site.

2. NAVFAC P-2 Inspection will be conducted by a government representative prior to lift.

Inspections will be maintained on file for one year by NAVFAC.

3. A government accepted Activity Hazard Analysis shall be available on-site and available for review by NAVFAC.

4. Contractor to provide equipment operator qualifications (ensure operator is trained to perform such lifts).

5. Contractor to provide rigger qualifications.

6. Contractor to ensure MPE load chart is posted in cab and available for review by

NAVFAC.

7. Contractor to ensure equipment operator’s daily inspection report is completed if required and made available for review by NAVFAC.

8. Contractor to notify NAVFAC ET prior to the first lift, lifts over 20,000 LBS, lifts of hazardous material and complex/critical lifts.

9. Contractor to demonstrate equipment is properly configured prior to lift.

10. Contractor to provide proof from OEM that equipment is authorized for such lift, and lifts are made IAW OEM.

Enclosure (5)

Activity Hazard Analysis (AHA)

ACTIVITY/WORK TASK:

PROJECT LOCATION: Risk Assessment Code (RAC) Matrix CONTRACT NUMBER:

DATE PREPARED:

Severity Probability PRIME CONTRACTOR:

SUBCONTRACTOR:

Frequent Likely Occasional Seldom Unlikely

PREPARED BY (Name and Title):

Catastrophic E E H H M GDA (Name and Title): Critical E H H M L

Marginal H M M L L Review each “Hazard” with identif ied safety “Controls” and determine (RAC)

E = EXTREMELY HIGH Identify the RAC (Probability/Severity) as E, H, M, or L for each “Hazard”

H = HIGH RISK

“Severity” is the outcome/degree if an incident, near miss, or accident did occur and identif ied as: Catastrophic, Critical, Marginal, or Negligible after controls are in place M = MODERATE RISK

L = LOW RISK “Probability” is the likelihood to cause an incident, near miss, or accident did occur and identif ied as:

Frequent, Likely, Occasional, Seldom, or Unlikely after controls are put in place.

Job Steps Hazards Controls RAC

Equipment to be Used Training Requirements and Competent or Qualified Personnel name(s) Inspection Requirements RAC

Enclosure (5)

Instructions for completing Contractor Activity Hazard Analysis

1. Activity/Work Task – Insert work/task this AHA is written for i.e. excavation, scaffold building, foundation preparation.

2. Enter Project Location

3. Enter Contract Number

4. Enter Date Prepared

5. Enter Prime Contractors name

6. Enter Sub Contractors name

7. Enter name and title of person who prepared the AHA

8. Enter name and title of person who reviewed AHA

9. Job steps is the complete sequence of work, not general statements to complete the entire activity

10. Hazards is the known safety risks associated with completing the task

11. Controls is the safety measures in place to reduce the hazard to the lowest level possible

12. Risk Assessment code is where Severity and Probability intersect, place that letter E, H, M, or L in the RAC column

13. List all equipment to be used to complete this activity i.e. crane, backhoe, vehicle, all heavy equipment

14. List the training requirements required by EM 385, Safety Spec 01356 or OSHA that apply to this task.

– List competent person(s) required for specific tasks in EM 385

– List qualified person(s) required for specific tasks in EM 385

– List CPR/First Aid training and qualification dates

15. List all inspection requirements of EM 385, Governmental Safety Requirements Specifications or OSHA 29 CFR 1926

IAW EM 385 01.A.13 Contractor-Required AHA “Work will not begin until the AHA for the work activity has been accepted by the GDA” The AHA shall be reviewed and modified as necessary to address changing site condition, operations or change of competent/qualified person’s

Enclosure (6)

FOR OFFICIAL USE ONLY (when filled in)

CRANE AND RIGGING ACCIDENT REPORT

Accident Category: Crane Accident Rigging Accident Reporting Activity:

UIC:

Copy To: Navy Crane Center Bldg. 491 NNSY Portsmouth, VA 23709 Fax: 757-967-3808

Activity Responsible for the Accident:

UIC:

Report No:

Accident Location: Accident Date: Time:

BOS Contractor: Yes No If Yes, Contract No:

Contractor Equip. Yes No

Crane No: Crane Type: Category: Crane OEM:

Crane Capacity: Hoist Capacity: Weight of Load on hook: Weather:

Complex Lift or Complex Non-Crane Rigging Operation? Yes No

Lost Work Days? Yes No Fatality or Permanent Disability? Yes No Material/ Property Cost Estimate:

Accident Type (check all that apply):

Personal Injury Overload Two Blocked Power Line Contact

Dropped Load Derail Crane Collision Damaged Crane

Damaged Rigging Gear Damaged Load Load Collision Other: Specify Cause of Accident (check all that apply):

Improper Operation Equipment Failure Inadequate Visibility

Improper Rigging Switch Alignment Inadequate Communication

Track Condition Procedural Failure Other: Specify Responsibility (check all that apply):

Crane Walker Rigger Operator Signal Person

Maintenance Management/Supervision Other: Specify Crane Function:

Travel Hoist Rotate Luffing Telescoping Other N/A Is this accident indicative of a recurring problem? Yes No

If yes, list Accident Report Nos.:

ATTACH COMPLETE AND CONCISE SITUATION DESCRIPTION AND CORRECTIVE/PREVENTIVE ACTIONS TAKEN AS ENCLOSURE (1). Include root cause and contributing factors. Assess damages and define responsibility. For equipment malfunction or failure, include specific description of the component and the resulting effect or problem caused by the malfunction or failure. List immediate and long term corrective/preventive actions assigned and respective codes.

INCLUDE: Printed Name, Code and Date.

Preparer: Phone: E-mail: Code: Date:

Concurrence Code: Date:

Concurrence WHE Program Manager (if Applicable) Code: Date:

Certifying Official (Crane Accident Only):

FOR OFFICIAL USE ONLY (when filled in)

BRIEF DESCRIPTION:

ROOT CAUSE AND DETAILED DESCRIPTION:

CORRECTIVE ACTIONS:

CRANE AND RIGGING ACCIDENT REPORT INSTRUCTIONS

This form is designed for e-mail transmission, and with enclosures shall be the official document. Electronic submission will be accepted but the names of the preparer, concurring personnel, and certifying official (for crane accidents only) shall be filled in. The e-mail address is m_nfsh_ncc_accident@navy.mil.

1. Accident Category: Indicate either crane accident or rigging accident.

2. Reporting Activity/UIC: The activity and unit identification code responsible for reporting the accident.

3. Activity Responsible for the Accident/UIC: Self-explanatory.

4. Report No.: The activity assigned accident number (e.g., Activity UIC-FY-CA-01).

5. Accident Location: The detailed location where the accident took place (e.g., building 213, dry dock 5).

6. Accident Date: The date the accident occurred.

7. Time: The time (24 hour clock) the accident occurred (e.g., 1300).

8. Is the responsible party a BOS Contractor? Check yes or no. If yes, enter contract number.

9. Was the crane/equipment owned by a contractor? Check yes or no.

10. Crane No.: The activity assigned crane number (e.g., PC-5), if applicable.

11. Crane Type: The type of crane involved in the accident (e.g., mobile, bridge), if applicable.

12. Category: Identify category of crane (i.e., 1, 2, 3, or 4), if applicable.

13. Crane OEM: The original equipment manufacturer of the crane (e.g., Samsung, Grove, P&H), if applicable.

14. Crane Capacity: The certified capacity of the crane (e.g., 120,000 pounds), if applicable.

15. Hoist Capacity: The capacity of the hoist involved in the accident at the max radius of the operation, if applicable.

16. Weight of Load on Hook: The weight of the load on the hook, if applicable.

17. Weather: The weather conditions at time of accident (e.g., wind, rain, cold).

18. Complex lift: Was the crane or rigging gear being used in a complex lift? Check yes or no.

19. Lost Work Days? Check yes or no.

20. Fatality or Permanent Disability: Check yes or no.

21. Material/Property Cost Estimate: Estimate total cost of damage resulting from the accident.

22. Accident Type: Check all that apply.

23. Cause of Accident: Check all that apply.

24. Responsibility: Check all that apply.

25. Crane Function: Check all functions in operation at time of accident. Check N/A if a rigging gear accident.

26. Is this a recurring problem? Check yes or no. If yes, list Accident Report numbers.

27. Preparer: Printed name must be provided.

28. Concurrences: Printed name must be provided.

29. Certifying Official (Crane Accidents Only): Printed name must be provided.

Enclosure (1)

Brief Description: No more than one paragraph summarizing the resultant incident.

Root Cause and Detailed Description: Provide the relevant background in a descriptive timeline of preconditions leading up to the event, as well as a detailed description of the event.

Corrective Actions: List all short term and long term corrective actions that are taken to prevent recurrence of the incident. Short Term Corrective Actions are those actions taken that will allow return to work in short time frame. Long Term actions are more ‘programmatic’ in nature and typically include: process revision, changes in training, ‘mistake proofing’, etc.

NOTE: This report may be generated utilizing activity approved software provided all information required above is included.

mailto:m_nfsh_ncc_accident@navy.mil

Enclosure (7)

Sample Rigging Diagram/Sketch