Fillable Lift Plan Package As per CNRMA INSTRU.pdf

CNRMAINST 11262.lB

2 7 MAR 2020

CONTRACTOR CRANE/ LHE PRE-ENTRY CHECKLIST

Contracting

Office:

Contractor's

Package Rec'd:

Proposed Date of Prime Contractor: Prime Contractor POC: POCPhone:

Entry:

Contracting Officer: Phone: Contract Number:

Equipment Supplier / Phone ( If different from prime) Serial number Approved/Qualified Operator(s) and Rigger-in-Charge:

Equipment Manufacturer

Manufacturers Maximum Rated Capacity:

Cert. Type

Quadrennial:

Annual:

Exp. Date

Heavies Lift

Crane Setup Site:

Equipment Model Equipment Number

1.

2.

3.

Lift Type:

0 Critical

0 Routine

C r a n e Type at Check in Point Equipment Type

0 MobileRT

0 Mobile Truck

D Floater D Crawler Rough Terrain, Telehandler / Forklift

Front Loader

D D D Mobile on barge D Boom Truck

Excavator

D Telescopic Boom D Lattice Boom Equipment with Anti Two-Blocking device: Y / N / NA

Mode Code

Equipment at Check in Point Same as identified in submitted crane/LHE package?

Configured same as identified in submitted crane package?

All Hoist Block Hooks equipped with positive latching device?

Hoist wire rope free of obvious defects?

Hoist wire rope dead ended with:

Poured Socket? Y / N

Wedge Socket? Y / N

If wedge type socket, is pig tail clamped correctly? Y / N

Operator at Check in Point in Possession of:

Comp leted Certificate of Compliance? Y / N

Copy of Required Crane Certifications? Y / N

Current Crane Operator Qualifications? Y / N

Copy of Approved Lift Plan? Y / N

Backhoe D Other: ------------

YIN List/ trim angle indicator visible to operator while at controls? Y / N / NA

YIN Calibrated Load Moment/ Load Indicator present in operator's cab? Y / N / NA

YIN Equipment equipped with appropriately rated fire extinguisher? Y / N / NA

Y IN I NI A Equipment equipped with spill containment kit? Y / N /NA

Copy of approved ground loading restrictions for all set up/work locations? Y / N / NA

Approved cribbing plan and cribbing at pass office prior to entry? YIN/NA

YIN

YIN

YIN

Load Rating Charts visible to operator while at controls?

Boom angle indicator visible to operator while at controls?

Rigging gear free of obvious defects?

General Notes:

Reviewing Surveillance Team Member I Phone Date of Entry I Expiration of Permit I Time of Entry

Enclosure (3)

Check in time:

Max Outrigger load:

Description of Work:

CNRMAINST 11262.IB

2 7 MAR 2020

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 riaainQ operations) brouQht onto Navy property.

CONTRACTING OFFICER'S POINT OF CONTACT PHONE

( Government Representative)

PRIME CONTRACTOR/PHONE CONTRACT NUMBER

CRANE OR ALTERNATE MACHINE SUPPLIER/PHONE CRANE OR

(if different from prime contractor} AL TERNA TE 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 830 or other standards. The following OSHA regulations and ASME or other standards apply:

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 with 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 USAGE 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 riooing operations)

Enclosure (1) l l

CNRMAINST 11262.lB

2 7 MAR 2020

CONTRACTOR CRANE I LHE ENTRY PACKAGE CHECKLIST

Company

Equipment Manufacturer/ Equipment Model/ Equipment Number

Name ofCrane / LHE Company &Eq u i p m e n t Number

Date of Annual Inspection Expiration

Date of Quadrennial Inspection E xpiration Contracting Official

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

Does the package include a routine or critical lift plan? YES

Location of lift site I Duration crane will be continuously on the iob site (hrs, days, weeks ... ) I

YES

Does plan include certification from the contractor that the crane complies with ASME B30 standard [B30.5 (mobile cranes), B30.8 (floating cranes), B30.22 (articulating boom cranes), or B30.3 (construction tower cranes)l as applicable?

Does plan include a certificate of compliance per CNRMAINST l l 262.1B [enclosure (!)]? YES

Which OSHA regulations does the certificate of compliance indicate? (For cranes used in cargo transfer, 29 CFR 1917 applies; for cranes used in construction, demolition, or maintenance, 29 CFR 1926 applies;

for cranes used in shipbuilding, ship repair, or shipbreaking, 29 CFR 1915 applies).

Does t h e plan include valid medical certificate and proof of operator qualification from a source that qualifies crane operators (union, governmental agency, or an organization that tests and qualifies crane operators)? Verify qualification for each back-up operator (if provided) on the certificate of compliance. YES NO

Does the plan include designate a Rigger-in-Charge? YES

What is the weight of the heaviest load to be lifted?

What is the weight of the rigging gear?

Main Block

What are the crane /LHE components ( and their weights) that add to the weight of the load

(hook, jib, etc.)?

Aux. Block

Jib (Stowed)

Jib (Erected)

Other

What is the maximum total crane /LHE lift (sum of 13, 14 & 15 above)? TOTAL

What is the capacity of the crane/ LHE as configured?

What percentage of crane / LHE capacity does this lift represent?

Boom Mode Main Jib

What is the main boom length? If a jib will be utilized, indicate the length and offset. /Counterweight Used

For Multipurpose Eauipment : boom working height I

What are the minimum and maximum load radii? I Min Max

Does the plan include the manufacturer's load chart for the entire range of lift(s)? YES Does t h e plan include ground loading and outrigger reaction data to determine cribbing requirements or a Waterfront Operational Permit? YES NO

Enclosure (2)

NO

NO

NO

NIA

NO

lbs.

lbs.

lbs.

lbs.

lbs.

lbs.

lbs.

lbs.

lbs.

Offset

NO

NIA

CNRMAINST 11262.1B

CONTRACTOR CRANE / LHE ENTRY PACKAGE CHECKLIST (Cont.)

23 For crawler crane, does the plan indicate area restrictions for operation? YES NO N/A

24 For floating crane, does plan include maximum allowable list? YES NO N/A

For mobile crane mounted on barge, is crane equipped with load indicating device? wind indicating device? marine type list and trim indicator (readable in one-half degree increments)? YES NO N/A

26 For mobile crane mounted on barge, does plan include revised load chart? YES NO N/A

27 What are the environmental conditions under which crane operations are to be stopped?

28 Will the crane perform critical lifts per CNRMAINST 11262.1B? (If no, skip items 29 -49.) YES NO

What circumstances require this lift to be classified as a critical lift?

(Blind lift, 75% of load chart non-routine rigging, etc.)

30 What are the exact dimensions of the load? (L x W x H)

31 Does the plan indicate the crane position? (Overhead view) YES NO

32 What is the maximum lift height of the lift?

33 What is the minimum boom angle?

34 What is the maximum boom angle?

35 What is the name of the operator?

36 Indicate name(s) of backup operator (if required).

37 Does the plan show lift points? YES NO

38 Does the plan describe the rigging procedures? YES NO

39 Does the plan indicate rigging hardware requirements? YES NO

40 For personnel lifts, does the plan demonstrate compliance with 29 CFR 1926.550? YES NO N/A

41 Does EM 385-1-1 govern this lift? YES NO N/A

What are the coordination and communication requirements for the lift (e.g., radio and hand signals)?

For tandem or tailing crane lifts, does the plan indicate the make and model of the crane, the line, boom, and swing speeds, and the requirement for an equalizer beam? YES NO N/A

Has FAA Form 7460-1, Notice of Proposed Construction or Alteration, in accordance with CFR Title 14 Part 77 been submitted”

What is the name of the lift supervisor?

46 Does the plan indicate the qualifications of the lift supervisor? YES NO

47 What are the names of the riggers?

48 Does the plan indicate the qualifications of the riggers? YES NO

49 Did all involved personnel (Operator, Riggers, Lift Supervisor, etc.) sign the critical lift plan? YES NO

Signature below verifies LHE package complies with CNRMAINST 11262.1B

Contracting Official: Organization: Signature: Date: Phone:

27 MAR 2020

Ref: https://oeaaa.faa.gov/oeaaa/external/gisTools/ gisAction.jsp?action=showNoNoticeRequiredToolForm YES NO N/A

LIFT PLAN DETAIL SHEET

NON-Critical______ Critical________

Before making a critical or non-critical lift plan, qualified personnel shall prepare the lift plan, which can be, qualified members of the crane team, site supervisor/lift director or crane engineer. Key members, such as the lift supervisor, rigger and crane operator shall participate in the preparation.

The plan shall designate the crane operator, lift supervisor and rigger and state their qualifications For tandem or tailing crane lifts, the plan will specify the make and model of the cranes, the line, boom, and swing speeds, and requirement for an equalizer beam.

___ RIGGING PLAN DETAIL LIFT POINT

DESIGNATED AS (X)

ALSO, MANUFACTURE OR COMPANY’S

DETAIL DRAWING IS ACCEPTABLE

OPERATOR

QUALIFIED RIGGER IN CHARGE

___ QUALIFIED RIGGERS

Rigging Gear Used A _____________________________________________________________ Specifications

B _____________________________________________________________

C _____________________________________________________________

D______________________________________________________________

Crane Make & Model ______________________________________________________________

Personnel Basket Inspection Date ____________ Total weight of test weight _______________

Rigging Procedure _____________________________________________________________

COMMUNICATION:

A. Hand Signals ____ B. Two-way Radio ___ C. Others Specify____________________________

IN-PROCESSING SHEET

FOR

CONTRACTOR'S CRANE-ENTRY PACKAGE

Today's Date

Tracking number

Gov. Contracting office

Gov. Contractor's officer name

Gov. Contractor's phone #

Crane packet was received on- date ______time:......-_______ . ;, Job will start on - date'--____ time'--____ location~-----

1 Was the entry package complete? ·Yes or No

2. Person name that reviewed & completed the packet: ___- ________

Return the submittal or memo with tracking number to the Gov. Contraction officer.

Date __~, time ___ replywas sent.

Comments

Corrective items comments

SURVEILLANCE OFFICE USE ONLY