Attachment 3_StandardLiftPlanForm16-2Fillable.pdf

FORM 16-2

Standard Pre-Lift Plan (LHE)/Checklist

Date: Job #: Location: _______________________

Time: Completed By (Competent Person): _____________________________

Note: Applies to Cranes, Derricks, Hoists and Power-Operated equipment that can be used to hoist, lower and/or horizontally move a suspended load (includes excavators, forklifts, Rough Terrain equipment, etc., when used with rigging).

Crane Considerations Yes No

1 Are the lifts within the crane’s rated capacities? (based on boom height, radius)

2 Boom deflections considered?

3 Have all potential crane boom obstructions been identified?

4 Have environmental considerations been addressed? (wind, weather, lightning)

5 Have electrical hazards been addressed (overhead /underground)

- Clearance distances established?

- Is a spotter required?

- Public Utility contact required?

6 Crane swing radius properly barricaded and personnel advised of hazards?

Comments:

Crane Considerations Yes No

1 Weights and Centers of Gravity (COG) have been determined?

2 Anything inside/outside the loads that could shift during the lift?

3 Does rigging need protection from the loads?

4 All anchor bolts, hold-downs, or fasteners have been removed?

5 Potential for binding: are load cells required to verify the loads are free?

6 Attachment points rated to take load weight?

7 Are the loads structurally capable of being lifted? (bending/twisting issues)

8 Is a Critical Lift Plan required per EM 385-1-1, Section 16.H?

Rigging Yes No

1 All rigging has been inspected by a Qualified Rigger?

2 Have sling angles been calculated?

3 Are shackles correctly sized for the sling eyes?

4 Are softeners needed?

Comments:

Personnel Yes No

1 The roles, responsibilities and qualifications for personnel have been defined?

(Operator, Lift Supervisor, Rigger, Signal Person)

2 A Pre-Lift meeting has been conducted?

3 Personnel trained per the EM?

Comments:

Area Preparation Yes No

1 The locations for the load landings has been selected and prepared?

2 Blocking and/or cribbing available to set the loads on?

3 Travel paths have been determined and cordoned off?

4 Other personnel in the area have been notified of the lifts?

5 Have ground bearing support questions been addressed?

Crane Operator: ___________________________________ Date: __________

Rigger(s): _________________________________________ Date: __________

Signal Person: ___________________________________ Date: __________

Other: _________________________________________ Date: ________

Check Box11: Off