SOW Attach 5__Contractor Lift Plan Form.pdf

CONTRACTOR LIFT PLAN

(SUSPENDED LOADS)

ENTRY PACKAGE

Today's Date

Tracking Number

Gov. Contracting Office NSWC Philadelphia Division

Gov. Contracting Officer (name)

Gov. Contracting Officer phone

Job will start on date: Time Location

For Government Use Only Below

1. Lift plan received: Date: Time:

2. Was the entry package complete? _____ Yes _____ No

3. Person who reviewed / completed packet

Return the submittal or memo with tracking number to the Gov’t Contracting Officer.

Reply sent: Date__________________ Time __________________

Comments:

Corrective Items Comments:

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SOW ATTACHMENT 5

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COMNAVREGMIDLANTINST 11262.1A

06 FEB 2013

CONTRACTOR LIFT PLAN (SUSPENDED LOADS) ENTRY PACKAGE CHECKLIST

Enclosure (2)

Company / Equipment Information

Company Name

Equipment Manufacture / Equipment Model / Equipment Number

2 Date of Annual Inspection Expiration

CONTRACT NUMBER

3 Date of Quadrennial Inspection Expiration

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

Contracting Official

Phone Number

5 Does the package include a routine or critical lift plan? YES NO

6 Has the contract been verified to contain all the requirements of NAVFAC P-307 Paragraphs 1.7.2 a.-j. as applicable? YES NO

7 Location of lift site

8 Duration equipment will be continuously on the job site (hrs, days, weeks...)

Does plan include certification from contractor that the equipment complies with applicab le ASME s tandards IAW Ref. (c)? YES NO

10 Does plan include a completed Certificate of Compliance [Enclosure (1)]? YES NO

11 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 subpart CC applies; for cranes used in shipbuilding, ship repair, or ship breaking, 29 CFR 1915 applies).

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

13 Does the plan designate a qualified Rigger-in-Charge? YES NO

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

15 What is the weight of the rigging gear? lbs.

What are the crane / equipment components (and their weights) that add to the weight of the load (hook, jib, etc.)?

Main Block lbs.

Aux. Block lbs.

Jib (Stowed) lbs.

Jib (Erected) lbs.

Other lbs.

TOTAL lbs.

lbs.

17 What is the total weight to be lifted

18 What is the capacity of the equipment as configured?

19 What percentage of the equipment capacity does this lift represent?

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

Main Jib Offset

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

22 Does the plan include the manufacturer's load chart for entire range of lift(s)? YES NO

Does plan include ground loading and outrigger reaction data to determine cribbing requirements, or a Waterfront Operational Permit? YES NO N/A jane.albright Text Box (sum of 14, 15 & 16 above)?

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2 Enclosure (2)

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

YES NO N/A

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

For mobile crane mounted on barge, does plan include revised load chart?

YES NO N/A

What are the environmental condi t ions under which crane / equipment operations are to be stopped?

Will the crane / equipment perform critical/complex lifts? (If NO, skip items 30 - 50.)

YES NO

What circumstances require this lift to be classified as a critical lift? (Blind lift, 75% of load chart non-routine rigging, etc.)

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

Does the lift plan indicate the crane position? (Overhead view)

YES NO

What is the maximum lift height of the lift?

What is the minimum boom angle?

What is the maximum boom angle?

What is the name of the operator?

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

Does the plan show lift points?

YES NO

Does the lift plan describe the rigging procedures?

YES NO

Does the lift plan indicate rigging hardware requirements?

YES NO

For personnel lifts, does the plan demonstrate compliance with 29 CFR 1926.1431?

YES NO N/A

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/equipment, the line, boom, and swing speeds, and the requirement for an equalizer beam? YES NO N/A

For floating cranes, refer to questions 20-22?

What is the name of the lift supervisor?

Does the plan indicate the qualifications of the lift supervisor?

YES NO

What are the names of the riggers?

Does the lift plan indicate the qualifications of the riggers?

YES NO

Did all involved personnel (Operator, Riggers, Lift Supervisor, etc.) sign the critical lift plan?

YES NO

Signature below verifies crane package complies with CNRMA INST 11262.1A and NAVFAC P -307

Contracting Official: Organization: Signature: Date: Phone:

Reviewed By:

CONTRACTOR LIFT PLAN (SUSPENDED LOADS) ENTRY PACKAGE CHECKLIST

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NAVFAC

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CONTRACTOR LIFT PLAN (SUSPENDED LOADS) PRE-ENTRY FORM

Contracting Office:

Contractor’s Package Rec'd:

Proposed Date(s) of Entry:

Prime Contractor: Prime Contractor POC: POC Phone:

Contracting Officer: Phone: Contract Number:

Crane / Equipment Supplier / Phone (If different from prime contractor):

Serial number Approved/Qualified Operator(O) and Rigger-in- Charge (RIC):

O Equipment Manufacturer Equipment Model Equipment Number

O Manufacturer’s Maximum Rated Capacity: Heaviest Lift

RIC

Cert. Type Exp. Date

Quadrennial:

Annual:

Equipment Setup Site: Lift Type:

Critical

Routine For Government Use Only Below

Equipment Type at Check in Point

Mobile RT Floater Other (Specify):

Mobile Truck Mobile on barge

Crawler Boom truck

If Boom Truck, will boom be used for lift? Y N If yes, does Boom Truck have required papers? Y N

Boom Type

Telescopic manufactured after 02/28/92? Y N NA

Lattice manufactured after 02/28/92? Y N NA

Equipped with Anti Two-Blocking device? Y N NA

Boom free of obvious defects? Y N NA

(Circle answers below) Equipment at Check in Point Same as identified in submitted crane/WHE package? Y N List / trim angle indicator visible to operator while at controls? Y N NA Configured same as identified in submitted crane/WHE package? Y N Calibrated Load Moment / Load Indicator present in operator's cab? Y N NA All Hoist Block Hooks equipped with positive latching device? Y N Crane equipped with appropriately rated fire extinguisher? Y N NA Hoist wire rope free of obvious defects? NA Y N Crane equipped with spill containment kit? Y N NA

Hoist wire rope dead ended with:

Poured Socket? Y N Wedge Socket? Y N Swage Socket? Y N If wedge type socket, is pig tail clamped correctly? Y N

Operator at Check in Point in Possession of:

Completed Certificate of Compliance? Y N Copy of Required Crane/WHE Certifications? Y N NA Current Crane/WHE Operator Qualifications? Y N NA Copy of Approved Lift Plan? 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? Y N NA Load Rating Charts visible to operator while at controls? Y N NA Boom angle indicator visible to operator while at controls? Y N NA Rigging gear free of obvious defects? Y N

General Notes:

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

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NAVFAC

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Enclosure (4)

CONTRACTOR CRANE/WHE OPERATING PERMIT

NAVFAC MIDLANT CONTRACTOR CRANE/WHE

OPERATING PERMIT

DATE ISSUED

EXPIRATION DATE

CONTRACTING AGENT NAME & PHONE# ________________________

CONTRACT #

AUTHORIZED LOCATION

EQUIPMENT CONTRACTOR

EQUIPMENT NUMBER

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

SUSPENDED LOADS) AND RIGGING GEAR REQUIREMENTS

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:

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 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) Figure P-1

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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

Specifications of A _____________________________________________________________ Rigging to be Used

B _____________________________________________________________

C _____________________________________________________________

D______________________________________________________________

Crane Make & Model ______________________________________________________________

Personnel Basket Inspection Date ____________ Total weight of test weight _______________

Rigging Procedure to be Used:_______________________________________________________

COMMUNICATION:

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

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LIFT PLAN DETAIL SHEET

NON-Critical______ Critical________

Crane

Boom length _______

Lift radius

Designation point Building _____ _____ Ship Truck _____ _____ Pier Other _____

________Boom angle

__________Total weight of load

Center pin

GROUND CONDITIONS

Mat (cribbing) design is to be provided by the contractor, which will be used to achieve a level and stable foundation of sufficient bearing capacity for the lift.

Crane is to be positioned on: concrete____, asphalt_____, grassy area_____, solid____, sand____, Other (specify) _____________________________________________________________________

ENVIRONMENTAL CONDITIONS

Lift operations shall be immediately terminated if the following conditions arise:

a. Adverse operating condition: (climatic conditions (snow, ice, severe rain, wind, thunderstorms).

b. Winds in excess of _______ mph.

c. Other factors (specify)_____________________________________________________________

d. Comments:_____________________________________________________________________ jane.albright Text Box (Based on wind calculations per equipment manufacturer's recommendations.)

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