Appendix IV Contractor Crane Requirement.pdf

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Dismantle and Remove Milling Machine
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This is a Contract Requirement document for Crane, Multi-Purpose Machine, and Material Handling Equipment (MHE) Operations at Joint Base Pearl Harbor-Hickam (JBPHH), issued by Pearl Harbor Naval Shipyard and IMF (PHNSY&IMF), Code 400, effective January 20, 2026.

The document establishes comprehensive safety and operational requirements for all contractors using cranes, multi-purpose machines, or MHE to lift suspended loads at the facility. Contractors must submit an Initial Notification at least 15 working days before equipment entry and a complete Mobile Crane Entry Package at least 10 working days prior to operations. The package must include contractor identification, lift operation descriptions, equipment inspection records, operator medical certificates and qualifications, rigger qualifications, load charts, crane data sheets, ground loading plans, a Certificate of Compliance (P-1), and waterfront operational permits if applicable. For critical lifts—defined as those exceeding 75% of crane capacity, multi-crane operations, personnel lifts, operations near overhead power lines, or lifting submerged objects—contractors must provide detailed critical lift plans addressing load specifications, lift geometry, rigging procedures, environmental conditions, and compliance with 29 CFR 1926.1408-1411 for power line proximity. A final entry request must be submitted at least 3 working days before the desired entry date. On-site operations require strict compliance with mandatory safety rules including operator presence with suspended loads, centered hook positioning, barricaded tail swing zones, and adherence to ground loading limitations. All personnel must be qualified; crane operators must be certified by recognized sources, riggers must demonstrate formal apprenticeship or training completion, and signal persons must comply with 29 CFR 1926.1428. The document includes detailed accident and near-miss reporting procedures with immediate notification within 4 hours, scene preservation, root cause investigation, and formal reporting within 30 days using NAVFAC P-307 forms. Official definitions distinguish between Lower Threshold Crane Accidents (LTCAs), near misses, and rigging accidents based on operating envelope failures. The requirement applies to all contracts, task orders, and delivery orders and derives compliance standards from NAVFAC P-307, OSHA regulations, and ASME standards including B30.5 for mobile cranes, B30.9 for slings, and B30.26 for rigging hardware.

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20 January 2026 Code 410

Contract Requirement: Crane, Multi-Purpose Machine, and Material Handling Equipment (MHE) Operations at Joint Base Pearl Harbor-Hickam (JBPHH)

Encl: (1) NAVFAC HI QA/Safety Contractor & Rigging Crane Entry Package (NAVFAC

Hawaii Form 2026)

(2) Figure 10-3 Danger Zone for Cranes and Lifted Loads Operating Near Electrical

Power Lines (NAVFAC P-307) dtd Jan 2025

1. Purpose and Scope

All contractors performing work under contracts, task orders, or delivery orders issued by Pearl Harbor Naval Shipyard and IMF (PHNSY&IMF), Code 400, at JBPHH shall comply with the following requirements for the use of:

a. Cranes or

b. Multi-purpose machines, Material Handling Equipment (MHE) or other equipment used in a crane-like application to lift suspended loads.

These requirements are derived from NAVFAC P-307, Management of Weight Handling Equipment (WHE), and other applicable standards.

2. Pre-Operational Submittal and Approval Process

a. Initial Notification (15+ Working Days Prior) - The contractor shall notify the

Contracting Officer or Contracting Officer’s Representative (COR) at least fifteen (15) working days before any crane enters the activity or any MHE is used to lift suspended loads.

b. Mobile Crane Entry Package (10+ Working Days Prior) - The contractor shall provide a complete "Contractor Mobile Crane Entry Package" to the COR no less than ten (10) working days prior to the operation. The package must include:

i. Name of contractor and Point of Contact (POC)

ii. Description of contractor’s Lifting and Handling (L&H) operation(s)

iii. Date, duration, and location of contractor’s L&H operations(s)

iv. WHE or MHE annual and quadrennial inspection records

v. Copies of operator’s medical certificate and qualifications by a source that qualifies

Crane Operators

vi. Personnel designated and qualified by the Crane Contractor conducting weight handling operations to perform as a rigger shall be qualified in accordance with paragraph g.3.

vii. Copy of the load chart for the specific crane or MHE

viii. Crane Data sheet with but not limited to axle load and axle spacing.

ix. Job site ground loading conditions, outrigger load and cribbing plan.

x. Filled out Enclosure (1) Waterfront Crane/Vehicle Usage Request

Contract Requirement: Crane, Multi-Purpose Machine, and Material Handling Equipment (MHE) Operations at Joint Base Pearl Harbor-Hickam (JBPHH)

xi. Filled out Enclosure (1) Figure P-1 Certificate of Compliance. This involves certifying that the crane, MHE, or rigging equipment meets applicable OSHA and ANSI/ASME regulations, with specific citations for each.

xii. Waterfront operational permit, if applicable – (communicate with COR to obtain permit)

xiii. Critical lift plan(s) when critical lift is to be performed. Refer to 3.d. This plan shall include the following as applicable:

1. The size, weight, and center of gravity of the load to be lifted, including crane

(or other machine) equipment and rigging equipment that add to the weight. The OEM's maximum load capacities for the entire range of the lift shall also be provided.

2. The lift geometry, including the crane (or other machine) position and configuration, boom length and angle, height of lift, and radius for the entire range of the lift. This shall include any matting/cribbing and ground preparation, as required. Applies to both single and multiple-crane/machine lifts.

3. A rigging plan, showing the lift points, rigging equipment, and rigging procedures.

4. The environmental conditions under which lift operations are to be stopped.

5. For lifts of personnel, the plan shall demonstrate compliance with the requirements of 29 CFR 1926.1431.

6. For barge mounted mobile cranes, barge stability calculations identifying crane placement/footprint; barge list and trim based on anticipated loading; and load charts based on calculated list and trim specific to the barge the crane is mounted on. The amount of list and trim shall be within the crane OEM’s requirements.

7. For lifts in the vicinity of overhead power lines (i.e., if any part of the crane or other machine, including the fully extended boom of a telescoping boom crane or machine, or the load could approach the distances noted in Encl (4) Figure 10-3 Danger Zone for Cranes and Lifted Loads Operating Near Electrical Power Lines during a proposed operation, the plan shall demonstrate compliance with

29 CFR 1926.1408-1411.

c. Final Entry Request (3+ Working Days Prior) - Once the Mobile Crane Entry Package is approved, the contractor shall submit the final request for mobile crane entry no less than three (3) working days prior to the desired entry date.

3. On-Site Operational Requirements

a. General Safety Compliance - The contractor shall comply with all JBPHH and PHNSY&IMF regulations. The following rules are mandatory:

i. Operator Presence: The operator will not leave the crane cab with a load suspended.

ii. No Side Loading: The crane hook must be positioned directly over the load at all times.

iii. Tail Swing: A physical barricade must be positioned to prevent personnel from entering the crane’s tail swing radius.

iv. Stability: "Lift-off" of tires (when on rubber) or outriggers is strictly prohibited.

v. Ground Loading: Adhere to all ground loading limitations. If conditions are questionable, work must stop until the contractor and Contracting Officer mutually determine it is safe to proceed, which may require an engineering study before the crane enters or sets up at the location.

vi. Certification Posting: The approved Certificate of Compliance (Enclosure 1) shall be posted conspicuously in the cab of the crane/vehicle.

vii. Rigging Gear Certification: Provide written certification that all rigging gear meets applicable 29 CFR 1926 regulations.

b. Applicable Industry Standards - The contractor shall comply with all applicable ANSI, ASME, or other consensus standards, including but not limited to: ASME B30.5 (Mobile Cranes), B30.9 (Slings), B30.26 (Rigging Hardware), and ANSI/ITSDF B56.6 (Rough- Terrain Forklifts).

c. Floating and Barge-Mounted Cranes - Floating cranes and barge-mounted mobile cranes require third-party certification from an OSHA-accredited organization (or a third-party certification from a state accredited organization for those states with OSHA approved state plans). They must be equipped with a load indicating device, a wind speed indicator, and a marine list/trim indicator. Operations shall follow the rules of 29 CFR 1926.1437.

d. Critical Lift Requirements - A written Critical Lift Plan is required for any lift meeting the criteria below. The plan must include details on load weight, lift geometry, rigging, and environmental stop-work conditions. A lift is considered CRITICAL if it involves:

i. Lifts over 75% of the capacity of the crane, hoist or other machine (lifts over

50% of the capacity of a barge-mounted crane’s hoists) at any radius or lift.

ii. Lifts using more than one crane, hoist, or other machine.

iii. Lifting personnel (lifts of personnel suspended by rigging equipment from multi-purpose machines, MHE, or equipment shall not be permitted).

iv. Operating near overhead power lines (see 29 CFR 1926.1408-1411 and Enclosure 2).

v. Erecting mobile, tower, derrick, or floating cranes.

vi. Lifting submerged or partially submerged objects. The following lifts are not considered critical:

1. Removal of valves, rotors, pipes, etc., from dip tanks for cleaning or coating purposes.

2. Lifting boats of known weight from the water if the boats are of open design with bilge compartments accessible for visual inspection; the boats have label plates indicating weights; and the boats have pre-determined lifting points established by the OEM or the activity engineering organization.

3. Lifting submerged or partially submerged objects that meet the following criteria: the object is verified to not contain fluid in pockets and/or voids that is unaccounted for in the weight of the object; the object is verified or known to not be stuck by suction or adhesion by corrosion, marine growth, excessive surface tension, mud, etc.; and the object is verified to be clear of obstructions, such as other objects in the water, or underwater cables.

vii. Lifts involving binding conditions.

viii. Lifts of hazardous materials. Hazardous materials, e.g., poisons, corrosives, and highly volatile substances. This does not include palletized unit loads of ordnance, nor materials such as oxygen, acetylene, propane, diesel fuel, or gasoline in cans, or tanks that are properly secured in racks or stands designed for lifting and transporting by crane.

ix. Any lift with non-routine rigging, sensitive equipment, or unusual safety risks.

e. Accident and Near Miss Reporting and Investigation

i. Immediate Notification (Within 4 Hours) - The contractor shall notify the

Contracting Officer of any WHE accident and Near Miss including Lower Threshold Crane Accidents (LTCAs) as soon as practical, but no later than four (4) hours after the event.

ii. Scene Preservation - The contractor shall secure and preserve the accident scene until released by the Contracting Officer.

iii. Investigation and Corrective Action –The contractor shall investigate to establish the root cause(s) of any WHE accident or Near Miss. However, for a Near Miss, the Contracting Officer may waive the investigation requirement depending on the significance of the event. Except for an LTCA, crane operations shall not proceed until the cause is determined and corrective actions have been implemented to the satisfaction of the Contracting Officer. For an LTCA, the evolution may be allowed to continue, with supervisor authorization and correction of the immediate cause.

Upon completion of the job or evolution, the contractor shall stop operations and follow normal accident protocol (i.e., investigation to determine causes and required corrective actions).

iv. Formal Report (Within 30 Days) - The contractor shall provide a formal accident or near-miss report to the Contracting Officer within 30 days using the appropriate form from NAVFAC P-307, Section 12.

v. See Section 4 below for official definitions of "Crane Accident," "LTCA," "Near

Miss," and "Rigging Accident."

f. Personnel Qualifications - The contractor shall certify all personnel qualifications via the Certificate of Compliance (Enclosure 1).

i. Crane Operator – Shall be qualified by a recognized source (e.g., union, government agency, or accredited testing organization). Proof of current qualification is mandatory. Additional details regarding crane types and qualifications are provided below.

1. Mobile, Truck-Mounted, and Articulating Boom Cranes: For mobile cranes, commercial truck mounted cranes, and articulating boom cranes with OEM rated capacities of greater than 2000 pounds, the crane operator shall be designated as qualified by a source that qualifies crane operators (i.e., a union, a government agency, or an organization that tests and qualifies crane operators). Proof of current qualification shall be provided.

2. Operator Training and Physical Qualifications: The contractor shall certify via Encl (2) P-1 Certificate of Compliance that the operator is qualified and trained for the operation of the crane or machine to be used, including physical qualifications of the applicable ANSI, ASME, or other appropriate industry/national/international consensus standards (e.g., ASME B30.5 for mobile cranes, ANSI A92.2 for aerial lifts/platforms with hoists or “sign trucks”).

ii. Signal Person – Shall be qualified in accordance with 29 CFR 1926.1428 when NAVSEA Standard Item 009-040 is invoked by the contract.

iii. Rigger – Shall be certified as qualified by one of the following methods:

1. A formal apprenticeship program;

2. Completion of training from a recognized source; or

3. A signed statement of compliance.

4. Official Accident Definitions (from NAVFAC P-307) – This section defines the official terminology for accidents and near misses related to weight handling operations, as required for reporting.

a. Clarifications on Weight Handling Equipment Accident and Near Miss Reporting

i. Lower Threshold Crane Accidents (LTCAs):

1. Collision accidents resulting in only superficial cosmetic damage (e.g., scratched paint, scuffs, paint transfer) that would not normally require repair are categorized as LTCAs. Reporting LTCAs helps recognize events at the lowest level.

2. A collision is NOT an LTCA if it causes dents or deformation (regardless of repair needs), or if it involves lifts of high-value/sensitive equipment, molten metals, nuclear materials, or hazardous materials.

3. The LTCA categorization may only be used for ordnance lifts if engineered protection/safety features are present.

b. Dropped Load Exceptions:

i. The fall of minor, loose debris (e.g., paper signs, tie wraps, gravel stuck to a pallet) is not considered a dropped load if there is no potential for injury or damage.

ii. These events may be reported as a Near Miss. Final classification is at the discretion of the Navy Crane Center.

c. Near Misses - A Near Miss is an unplanned event during a weight handling operation that did not result in a definable accident but easily had the potential to do so. A near-miss report is intended to learn from lower-level situations to avert a more severe event.

The investigation should be commensurate with the significance of the event.

d. Crane Accidents

i. Operating Envelope - The definition of a crane accident is based on the concept of an

"operating envelope." The Operating Envelope: An "operating envelope" is established around any crane operation and consists of the following elements:

1. The crane itself.

2. The operator.

3. All rigging personnel (riggers, signal persons, crane walkers).

4. Other personnel involved (supervisors, mechanics, tagline handlers).

5. The rigging gear between the hook and the load.

6. The load.

7. The crane’s supporting structure (ground, rails, etc.).

8. The lift procedure.

ii. Crane Operation: The use of a crane, loaded or unloaded, once an operating envelope is established. This includes setup, breakdown, and repositioning of the crane or hook.

iii. Definition of a Crane Accident: A crane accident occurs when any element within the operating envelope fails to perform correctly during a crane operation, resulting in any of the following:

1. Personnel Injury or Death (Minor injuries that are inherent in any industrial operation, including strains and repetitive motion related injuries, shall be reported by the normal personnel injury reporting process of the activity in lieu of these requirements.) Personnel injuries occurring within the operating envelope not directly related to the weight handling operations shall be reported as unplanned occurrences in addition to the normal personnel injury reporting process of the activity.

2. Material or Equipment Damage.

3. Dropped Load (includes any part of the load or rigging gear and any item lifted with the load or rigging gear).*

4. Derailment.*

5. Two-Blocking.*

6. Overload (includes load tests when the nominal test load is exceeded).*

7. Overturned Crane.*

8. Collision (avoidable contact between the load, crane, and/or other objects).

Avoidable contact is defined as contact that would have been prevented with proper lift planning and execution. Simply briefing that contact will occur is not sufficient.

Note: Events marked with an asterisk (*) are defined as accidents and must be reported as such, regardless of whether they result in material damage or personal injury."

e. Rigging Accidents

i. Operating Envelope: A rigging accident is defined by its own "operating envelope."

The Rigging Operating Envelope: This includes:

1. The rigging gear or miscellaneous equipment itself.

2. The user of the gear (including MHE operators).

3. Other personnel involved in the operation.

4. The load.

5. The gear's supporting structure (padeyes, building structure, etc.).

6. The load’s rigging path.

7. The rigging or lift procedure.

ii. Definition of a Rigging Accident: A rigging accident occurs when any element in the rigging operating envelope fails to perform correctly, resulting in any of the following:

1. Personnel Injury or Death. (Minor injuries that are inherent in any industrial operation, including strains and repetitive motion related injuries, shall be reported by the normal personnel injury reporting process of the activity in lieu of these requirements.) Personnel injuries occurring within the operating envelope not directly related to the weight handling operations shall be reported as unplanned occurrences in addition to the normal personnel injury reporting process of the activity. Material or Equipment Damage that requires the damaged item to be repaired to perform its intended function This does not include superficial damage such as scratched paint, minor lagging damage, or normal wear on rigging gear.

2. Dropped Load (includes any part of the load or rigging gear).

3. Two-Blocking of cranes and powered hoists.

4. Overload (includes overload of supporting structures and exceeding load test tolerances).

NAVFAC HI QA/Safety Contractor & Rigging Crane

Entry Package

1. Contractor Crane & Rigging Entry Control Package (CCECP) Flow Chart

2. Certificate of Compliance P-1 Shall be fully filled out and signed the machine shall be posted on the machine in clear view while in the job site.

3. Crane Contractor provides information requested in the CCECP then submits to NAVFAC Contractor Crane Equipment Specialist (CCO) for acceptance prior to allowing the machine/crane entry to the installation.

4. Certifications - Qualifications Operator licenses, medical certificates,drivers license (CDL), Rigger & signalman qualification and letter of designations, machine annual certification/inspection, machine/crane (actual load charts) that will be used to load counterweights and the primary lift.

5. Rigging Equipment Procedures are the same when rigging gear is used on Multi-Purpose Machines, Fork Lift, Excavator for hoisting. Company lift plan may be submitted.

6. Rigging Diagram Sketching - showing type of rigging and working load limits for each piece of rigging gear, including sling angle stress. Rigging gear should also show how the rigging gear is connected to the load.

7. Contractor Crane & Rigging Entry Control Package- Shall be submitted to the GOV Core Rep & Contractor Crane Equipment Specialist for review, once accepted scheduling date time and location accordingly for Government Oversight.

8. Hoisting Equipment 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 briefed at the job site with the GOV Rep. or alternate CCO & reviewed at the Preparatory/Initial Control Phase Meetings.

9. Crane & Rigging Gear Accident Report/Instructions – To be completed by contractor when a WHE mishap occurs in accordance with NAVFACP-307 Section 12

10. Sample Rigging Diagram/Sketch – Constructed by contractor on Pre-Entry Checklist or as an attachment. - AHA filled out with required safety and controls listed.

11. Contractor familiarization with NAVFAC P-307 Section 11, 7, 8, 9, 10, 12, 14 recommended.

19.

NAVFAC HI FORM 2026

Encl (1) - C410 KTR Crane Operations Requirement

APPENDIX P – CONTRACTOR CRANE ALTERNATE MACHINE & RIGGING OPERATION USED

TO LIFT SUSPENDED LOAD 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 POC & UIC #

(Gov. Contract Official Representative UIC)

PHONE

PRIME CONTRACTOR/PHONE CONTRACT NUMBER

CRANE SUBCONTRACTOR and MACHINE SUPPLIER/PHONE (subcontractor company)

CRANE or machine Serial Number

CRANE OR ALTERNATE MACHINE MANUFACTURER/TYPE/CAPACITY

MACHINE OPERATOR / RIGGER 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)

APPENDIX P – CONTRACTOR CRANE ALTERNATE MACHINE & RIGGING OPERATION USED

TO LIFT SUSPENDED LOAD 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 POC & UIC #

(Gov. Contract Official Representative UIC)

PHONE

PRIME CONTRACTOR/PHONE CONTRACT NUMBER

CRANE SUBCONTRACTOR and MACHINE SUPPLIER/PHONE (subcontractor company)

CRANE or machine Serial Number

CRANE OR ALTERNATE MACHINE MANUFACTURER/TYPE/CAPACITY

MACHINE OPERATOR / RIGGER 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)

Company Name and the designated qualified Crane Rigger / Signalers P-1 Contniuation.

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)

Job Site/ Facility POC Name & phone number Official ( local representative and UIC code)

Name:

UIC Code & Phone #:

Prepared by: Date: NAVFAC CCO: WES N

GENERAL INFORMATION

Narrative of crane / equipment lifts - Planed lift of the day, heaviest load possible, including location, Crane Counterweight installation con-fig. identified on next page CTW #1, type of standard or rigid dunnage (size for heavy lifts).

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

Include a valid Certificate of Compliance (P-1) to identify Competent / Qualified Riggers, 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 forklift and excavator, use block (g) for the weight of the forklift attachment or the weight of the excavator bucket. Blocks (a) thru (f) do not apply.

Please be reminded that the lift are limited by the lowest capacity (If hoist line, or hook capacity is the lesser value, that is the Gross Capacity to be used) parts lbs.) X (No. of Parts line) = _Hoist Line Capacity

Parts Line Used:

(Line Pull Each:

TOTAL COUNTERWEIGHT:

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

ExpirationDate:

Encl (1) - C410 KTR Crane Operations Requirement wes.naganuma Highlight

Enclosure (4)

What is the main boom length planned for the lift? (Item 10 & 11) If Jib is used, indicate the length and offset. For telescopic forklifts list the maximum length of the boom used for the lift.

Boom Lenght

JIB OFFSET

14 What is the maximum radius for the planned lift? (Item 10 & 11) Radius Angle

Boom Length

Load MAX Radius Weight

Rigging Gear

Main Block

Aux Block

Jib Stowed

Jib Erected

Whip Wire Rope O ther Total

Gross Cap %

CTW#1

Lift#2

Lift#3

Lift#4

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 Operator's Certification, CDL, DOT Medical Certificate by a registered physician (N/A for forklift and excavator operators), Rigger qualifications and a Certificate of Compliance (P-1.) with their names.

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?

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

Does the crane have a functioning anti-two block system? (EM385-1-1, 16.E.03)

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 crane's main or whip hoist at any radius / 50 percent for barge mounted or mobile cranes gross capacity (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 (j) load test. NAVFAC P-307 Section 10 Critical/Complex lifts \.

YES NO

31 Is this a critical lift? If Yes, complete Items 32-37 If not do not fill in items 31 -37

Enclosure (5)

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 NAVFAC P-307)

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 the wind speed & ground conditions.

voice radio signals will be relayed

Print and Sign

Operator____________________________________________________________

Rigger in Charge_____________________________________Date_____________

Signalman___________________________________________________________

Lift Supervisor________________________________________________________

Other_______________________________________________________________

Other_______________________________________________________________

Other_______________________________________________________________

Other_______________________________________________________________

Other_______________________________________________________________

Other_______________________________________________________________

What type of communication will be used? hand Fill this in prior to a critical lift

Encl (1) - C410 KTR Crane Operations Requirement

Line

Enclosure (6)

RIGGING DIAGRAM/SKETCH (Draw or Attach)

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

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

Encl (1) - C410 KTR Crane Operations Requirement wes.naganuma Pencil

Pencil

Enclosure (7)

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:

WLL 4,000lbs Telescoping

Spreader Bar 12'/20' min/max

WLL 4,900lbs 9/32" X 20' Chain

Sling @ 600

40'-0"Beam Line Width WT 2TN

WLL 4,900lbs 9/32" X 20'

Chain Sling @

WLL 4,000lbs Telescoping

Spreader Bar 12'/20' min/max

12'/20' Spreader Bar 2TN Capacity

12'/20' Spreader Bar 2TN Capacity

12'/20' Spreader Bar 2TN Capacity

20'-10" Minimum

DE-BUILDING 2 REROOF JBPHH HI

RIGGING/DIAGRAM SKETCH

Encl (1) - C410 KTR Crane Operations Requirement robk Dimension 16" X 80'-0" Maximum Length Alum Roof Panels

Enclosure (8)

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.)

Kiln

Housings #5 #12

Encl (1) - C410 KTR Crane Operations Requirement patrick Arrow patrick Arrow patrick Arrow

Enclosure (9)

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

EXAMPLE BELOW

Activity Hazard Analysis (AHA ) Activity/Work Task: Overall Risk Assessment Code (RAC) (Use highest code)

RAC Code L

Project Location: Risk Assessment Code (RAC) Matrix

Contract Number:

Severity

Probability

Date Prepared: Frequent Likely Occasional Seldom Unlikely

Prepared by (Name/Title): Catastrophic E E H H M

Critical E H H M L

Reviewed by (Name/Title):

Marginal H M M L L

Negligible M L L L L

Notes: (Field Notes, Review Comments, etc.) Step 1: Review each “Hazard” with identified safety “Controls” and determine RAC (See above)

“Probability” is the likelihood to cause an incident, near miss, or accident and identified as: Frequent, Likely, Occasional, Seldom or Unlikely. RAC Chart “Severity” is the outcome/degree if an incident, near miss, or accident did occur and identified as: Catastrophic, Critical, Marginal, or Negligible

E = Extremely High Risk

H = High Risk

Step 2: Identify the RAC (Probability/Severity) as E, H, M, or L for each “Hazard” on AHA. Annotate the overall highest RAC at the top of AHA.

M = Moderate Risk

L = Low Risk

Job Steps

Hazards Controls RAC

1. Driving to Site.

2. Load Handling Equipment Set-up

Vehicular & pedestrian accidents

Equipment & pedestrian accidents

Prevent unintended LHE rolling.

Personnel protection from rotating structures of the LHE and fixed objects.

Damaging underground utilities.

Crane & Forklift driver will use defensive driving techniques;

move only with proper escorts and permits. Proper PPE shall be worn at all times to include: Hard Hats, construction gloves, hard toe safety shoes, bright colored clothing/safety vest, and personnel flotation device if working at edge of piers or at edge of afloat units.

Establish crane zone that will keep non-essential personnel from WHE area. Move equipment only when directed and with line of sight between operator and RIC/TC man. Speeds on piers are no more than 5 MPH. Do not drive wheels over manholes.

Parking brake shall be set whenever WHE is parked. The wheels shall be chocked if parked on an incline.

The swing radius of the cranes superstructure & counterweights shall be barricaded to prevent personnel from being struck or crushed. Utilize cones and caution tape to keep personnel out of crane zone.

If required, verify from NAVFAC FEAD to ensure no underground voids, pipes, boxes, etc. prior to the operation. Cranes must use 6’ x 4’ steel dunnage under each outrigger. 6’ x 4’ rigid steel dunnage is required on JBPHH/PHNSY piers.

L

L

L

L

L

W.N Crane AHA Example Encl (1) - C410 KTR Crane Operations Requirement

Activity Hazard Analysis (AHA) Job

Steps Hazards Controls RAC

1. Rigging gear installation

2. Install / Remove Counterweights

IF Applicable

Qualified Riggers shall be used.

Load falling, damaged rigging gear.

Qualified Riggers shall rig and derig counterweights.

Personnel injuries and equipment damage

Qualified Riggers inspect rigging gear for any damage, ensure rigging gear has enough capacity to lift load, and ensure rigging gear is properly marked. Ref: ASME B30 and NAVFAC P-307 section 14.

Counterweight Installation / removal to be performed in accordance with OEM. All personnel associated with installation of counterweights shall be knowledgeable in manufacturer’s procedures and requirements. All personnel shall take special precautions to avoid pinch points and warn others of same. Operator shall only move crane and load when line of site with riggers and / or signalman is maintained. All personnel involved with installing / removing counterweights on the crane deck shall be trained in use of & shall use Fall Protection per 1926.1423(f) to prevent falls, including use of manufacturer’s access ladders, walkways & handrails.

L

L

Job Steps

H a z a r d s

Controls RAC

3. Lifting loads Qualified Riggers

Qualified Crane Signalers shall Install Rigging and Perform Signaling.

Crane winch or brake fails to lift or hold load.

Operator shall engage hoist or activate hoist only when directed by rigger or signalman. Signalman shall maintain clear view of all riggers / installers.

Hoisting to be performed within Safe Work Zone.

No personnel under load while being lifting or suspended.

CRANES: Minimum part hoist line as required by Manufacturer.

Operator shall engage hoist only when directed by rigger / signalman. Operator and /or signalmen shall maintain clear view of all riggers / installers.

After initial lift the operator shall immediately stop the lift to insure that rigging is set and hoist winch & brake can hold the Load, i. e.

Test Lift – stop the hoist on every lift after the load is off the surface!

L

Job Steps Hazard s Controls RAC

4. Lifting loads Alert site personnel of lift.

Operator unable to see loads & or Riggers /Installers for duration of lifts.

Sound Horn or whistle to notify personnel in area prior to lift. Prohibit access to only essential personnel.

Signalman shall direct load in conjunction with riggers / installers and maintaining constant contact with operator with use of hand signals or radios equipped with unique channel, throughout operations.

Operator or signalman shall maintain clear view of all riggers / installers.

Only standard hand and voice signals shall be used.

Operator shall stop all operations should communication with signal persons fail.

Anybody can call safety time out.

L

L

Job Steps Hazard s

Controls RAC

5. Lifting loads Sling or Rigging Failure

Two-Blocking of Hook block or Ball & Boom top.

IF Applicable to Equipment

Operator & Rigger shall ensure proper Sling / rigging selection and condition.

Daily Inspections or more frequent if indicated. Only rigging equipment that has affixed legible identification markings that indicates the safe working load will be used. Use sling softeners for areas that can damage slings.

Use of anti-two block device: Operator shall not over-ride nor disable. Operator shall stop lift if device is activated. If not available, operator & signalman shall maintain line of sight with each other and the two-block area.

L

Job Steps Hazards Controls RAC

6. Lifting loads Overhead power lines:

Wind Considerations:

Site Inspection revealed no OH power lines within a boom length of this operation. Controlling Entity shall alert all personnel of the position of the OH Lines. See 29 CFR 1926.1408, EM 385-1-1-1 sec 16-1, NAFVAC P-307 sec 10.

Operator shall remain vigilant to riggers’ loss of control of load.

At wind speeds measured by a wind indicating device of 20 mph or greater all hoisting operations shall cease. Operator, Rigger & Lift Supervisor shall consult & determine if operations can safely proceed.

If winds are at or predicted to exceed 30 MPH: all operations shall cease & the crane shall be secured from operations. Boom mounted Anemometer shall be used to determine wind speeds.

L

L

Job Steps Hazards Controls RAC

7. Lifting loads Spinning or load control

Lightning

Crushing fingers, hands during assembly

Use Tagline(s) when needed to help control loads.

When conditions are such that lightning is observed: all crane & hoisting operations shall cease. A period of 30 minutes between subsequent observations shall be observed prior to resuming work.

Signal person shall take added precaution to insure all riggers and / or installers are clear of any potential load drop. Blocking & shims should be used to prevent crushing.

L

L

8. Lifting and slewing loads near personnel.

Head, Hand, Foot and Eye Injury’s

Under the fall zone / getting under the load

Personnel Protection Equipment (PPE)

All personnel must stay clear of the fall zone unless directed by the rigger in charge. Stop load movement first.

Personnel are never allowed under the load handle loads at chest height not above the head .

Personnel Are Never Allowed Under The Load: Ref NAVFAC P-307, EM 3851-1, 29

CFR.

Establish crane zone (barricade) by using cones, caution or danger tape, designate safety personnel if required to keep personnel away of crane operations.

PPE must be worn at all times including:

Bright vest, gloves, hard toed shoes, safety glasses, hard helmet.

L

Crane / Equipment MHE Accident Dropping of load, banging load against object, damaged rigging gear, Vehicle/ Machine Accident/ Damage Personnel injury.

Stop evolution, make operation safe, call 911 if necessary, notify Contracting Officer and Contractor Crane Oversight (CCO) personnel. Wait for further direction by Contracting Officer and CCO. Keep the situation in lock down for photos. Submit crane accident or near miss report

LHE Operational Requirements ï Fueling (NA for PRL-PND-611)

• Fire from static Discharge or ignition of vapors

• LHE shall be shut down before and during fueling operations. Closed systems, with an automatic shut-off that will prevent spillage if connections are broken, may be used to fuel diesel powered equipment left running.

• One (minimum) dry chemical or CO2 fire extinguisher with a minimum rating of 10- B:C installed in the cab or at the machinery housing

L

(Space for field personnel to write-in additional site-specific steps, hazards, and controls)

Equipment PPE Competent or Qualified Personnel Name(s) Inspection Training

• Personal Vehicles

• Fire Extinguishers

• First Aid Kits

• Power Tools

• Small hand tools

• Heavy Trucks

• LHE

• Rigging

• Cribbing

• Engine Hoist

• Hard hats

• Safety toed boots with ankle supports

• Safety glasses

• Safety vests (Class 2

Reflective Safety Vest)

• Gloves (as needed)

• Insulated gloves (as needed)

• Hearing protection (as needed)

• Competent Person:

• Qualified Person: D

• Initial inspection of all equipment and tools to be used.

• Daily inspection of equipment and tools.

• Daily EHS documented inspections.

• PPE inspections.

• NAVFAC P-307

• First aid/CPR/BBP

• Initial site safety briefing

• Daily tailgate safety briefings

• Vehicle training

• Proper license to operate heavy equipment

• Fall Protection (potential for assembly of LHE)

• Medical Clearance (if required)

AHA Signature Page

In accordance with NAVFAC Supervision “Work will not begin until the AHA for the work activity has been completed. The AHA shall be reviewed and modified as necessary to address changing site conditions, operations or change of competent/qualified persons.

By signing below I understand, agree to, and will conform to the site rules set forth in this AHA, my respective company’s Planning Documents (including amendments and attachments), and those controls agreed upon during any site-specific health and safety briefing(s).

Name Signature Date Briefing By

Equipment to be Used Training Requirements/Competent or

Qualified Personnel name(s) Inspection Requirements

Load Handling Equipment: Crane

Multipurpose Machine Forklift Hoists &

Rigging

NCCCO or Equivalent Certification for

Operator provided under separate cover for:

or alternate.

NCCCO or Equivalent Certified Rigger /

Crane signaler Signal:

Operator & Crane Certification CDL License Medical

Certification Operators Daily Crane Inspection

Document

Rigger / Crane Signaler Qualifications

Prepared by (Print Name, Sign and Date):

Crew Supervisor Review (Print Name, Sign and Date):

AHA Discussed with Crew at Preparatory Meeting Held On: __________

Sign: Sign:

Print: Print:

Sign: Sign:

Print: Print:

Sign: Sign:

Print: Print:

Sign:

Print:

Sign:

Print:

Sign:

Print:

Add additional pages as needed for additional signatures.

Copyright © 2019 The Crosby Group LLC All Rights Reserved Copyright © 2019 The Crosby Group LLC All Rights Reserved 473

R ig g in g

In fo473

Rigging Information

OPERATING PRACTICES - ASME B30.9 LOAD CONTROL 15

WHENEVER ANY SLING IS USED, THE FOLLOWING PRACTICES SHALL BE

OBSERVED.

1. SLINGS THAT ARE DAMAGED OR DEFECTIVE SHALL NOT BE USED.

2. SLINGS SHALL NOT BE SHORTENED OR LENGTHENED BY KNOTTING

OR TWISTING.

3. SLING LEGS SHALL NOT BE KINKED.

4. THE RATED LOAD OF THE SLING SHALL NOT BE EXCEEDED.

5. SLINGS USED IN A BASKET HITCH SHALL HAVE THE LOADS

BALANCED TO PREVENT SLIPPAGE.

6. SLINGS SHALL BE SECURELY ATTACHED TO THEIR LOAD.

7. SLINGS SHALL BE PROTECTED FROM EDGES, CORNERS,

PROTRUSIONS AND ABRASIVE SURFACES TO PREVENT SLING

DAMAGE.

8. DURING LIFTING, WITH OR WITHOUT LOAD, PERSONNEL SHALL BE

ALERT FOR POSSIBLE SNAGGING.

9. ALL EMPLOYEES SHALL BE KEPT CLEAR OF LOADS ABOUT TO BE

LIFTED AND OR SUSPENDED LOADS.

10. HANDS OR FINGERS SHALL NOT BE PLACED BETWEEN THE SLING

AND ITS LOAD WHILE THE SLING IS BEING TIGHTENED AROUND THE

LOAD.

11. SHOCK LOADING SHOULD BE AVOIDED.

12. A SLING SHALL NOT BE PULLED FROM UNDER A LOAD WHEN THE

LOAD IS RESTING ON THE SLING.

INSPECTION: EACH DAY BEFORE BEING USED, THE SLING AND ALL

FASTENINGS AND ATTACHMENTS SHALL BE INSPECTED FOR DAMAGE

OR DEFECTS BY A COMPETENT PERSON DESIGNATED BY THE EMPLOYER.

ADDITIONAL INSPECTIONS SHALL BE PERFORMED DURING SLING USE

WHERE SERVICE CONDITIONS WARRANT. DAMAGED OR DEFECTIVE

SLINGS SHALL BE IMMEDIATELY REMOVED FROM SERVICE.

POSITIVE LOAD

CONTROL

REEVING THROUGH CONNECTIONS TO LOAD

INCREASES LOAD ON CONNECTION FITTINGS BY AS

MUCH AS TWICE.

DO NOT REEVE!

SLING ANGLES

TWO LEGGED SLING - WIRE ROPE, CHAIN, SYNTHETICS

VERTICAL SHARE OF

LOAD ON SLINGS ARE

EQUAL IF CENTER OF

GRAVITY IS IN THE MIDDLE

BETWEEN PICK POINTS

ANGLE OF

LOADING L

ANGLE OF LOAD ANGLE

LOADING (A) DEGREE FACTOR = L/H

90 1.000 60 1.155 50 1.305 45 1.414 30 2.000

LOAD ON EACH LEG OF SLING =

VERTICAL SHARE OF LOAD X LOAD ANGLE FACTOR

LOAD ON SLING CALCULATED

TENSION 1 = LOAD X D2 X S1/(H(D1+D2))

TENSION 2 = LOAD X D1 X S2/(H(D1+D2))

ANGLE OF LOADING

OF LESS THAN 30

DEGREES ARE NOT

RECOMMENDED REFER

TO ASME B30.9 FOR FULL

INFORMATION

LOAD ON SLING CALCULATED

TENSION 1 = LOAD X D2 X S1/(H(D1+D2))

TENSION 2 = LOAD X D1 X S2/(H(D1+D2))

D1 D2

H

CG

H

D1 D2

S1 S2

H

Tuflex Roundslings

T u fl ex

Tuflex Endless (EN) The Most Versatile Tuflex Roundsling

Features, Advantages and Benefits

Maintains all the basic Tuflex features plus...

Promotes Safety

• Load stability and balance can be achieved by spreading sling legs.

Saves Money

• Wear points can be shifted to extend sling life

• The most flexible style of sling

TUFLEX ENDLESS ROUNDSLINGS

WARNING*

How To Measure

Length

Do not exceed rated capacities. Sling capacity decreases as the angle from horizontal decreases.

Slings should not be used at angles of less than 30°.

Refer to Effect of Angle chart page 12.

** This is the smallest recommended connection hardware diameter to be used for a vertical hitch.

Part No. Color

Rated Capacity (lbs.)*

Minimum Length

(ft.)

Approximate Measurements

Vertical Choker Basket @ 90°

Basket @ 45°

Weight (lbs. / ft.)

Body Dia.

Relaxed

(in.)

Width at Load

(in.)

Minimum Hardware

Dia. ** (in.)

EN30 Purple 2,600 2,100 5,200 3,600 1 1/2 .2 5/8 1 7/16

EN60 Green 5,300 4,200 10,600 7,400 1 1/2 .3 7/8 1 3/8 5/8

EN90 Yellow 8,400 6,700 16,800 11,800 3 .5 1 1/8 1 3/4 3/4

EN120 Tan 10,600 8,500 21,200 14,000 3 .6 1 1/8 1 7/8 7/8

EN150 Red 13,200 10,600 26,400 18,000 3 .8 1 3/8 2 1

EN180 White 16,800 13,400 33,600 23,000 3 .9 1 3/8 2 1/8 1 1/8

EN240 Blue 21,200 17,000 42,400 29,000 3 1.3 1 3/4 2 5/8 1 3/16

EN360 Grey 31,000 24,800 62,000 43,000 3 1.7 2 1/4 3 1/4 1 1/2

EN600 Brown 53,000 42,400 106,000 74,000 8 2.8 2 3/4 4 2

EN800 Olive 66,000 52,800 132,000 93,000 8 3.4 3 1/8 4 5/8 2 1/8

EN1000 Black 90,000 72,000 180,000 127,000 8 4.3 3 5/8 5 1/4 2 1/2

W

(W)

Encl (1) - C410 KTR Crane Operations Requirement

Rectangle

CRANE AND RIGGING NEAR MISS REPORT

Near Miss Category: Crane Near Miss Rigging Near Miss

Name and UIC of Reporting Activity: Copy To: Navy Crane Center Bldg. 491 NNSY Portsmouth, VA 23709 Fax: 757-967-3808

Name and UIC of Activity Responsible for the Near Miss:

Activity Name and UIC of Event Location:

Report No:

Specific Location:

Date:

Time:

BOS Contractor: Yes No

Other Contractor Yes No If Yes, Contract #_________________________

Crane No:

Crane Type:

Category:

Crane OEM:

Crane Capacity:

Hoist Capacity:

Weight of Load on hook:

Weather:

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

Is this near miss indicative of a recurring problem? Yes No

In the space below, include a description of the event, root cause and corrective actions taken to prevent recurrence:

Brief description:

Root cause:

Corrective Actions:

INCLUDE: Printed Name, Code and Date unless otherwise specified.

Preparer:

Phone:

E-mail:

Code:

Approved by: Phone:

E-mail:

Code:

Figure 12-2 (1 of 2)

CRANE AND RIGGING NEAR MISS REPORT INSTRUCTIONS

1. Near Miss Category: Indicate crane or rigging near miss.

2. Reporting Activity/UIC: The activity and unit identification code responsible for reporting the near miss in accordance with the guidance of paragraph 12.6.2.

3. Activity Responsible for the Near Miss/UIC: Same as #2 above, or for NAVFACENGSYSCOMs, provide the FEC level UIC.

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

5. Location UIC: The activity and unit identification code where the event took place.

6. Specific Location: The detailed location where the near miss took place (e.g., building 213, drydock 5).

7. Near Miss Date: The date the near miss occurred.

8. Time: The time (24-hour clock) the near miss occurred (e.g., 1300).

9. Is the responsible party a BOS Contractor? Check yes or no.

10. Is the responsible party a contractor other than a BOS contractor? Check yes or no. If yes, enter contract number.

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

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

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

14. Crane OEM: The original equipment…

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