EM_385-1-1_Form_16-3_ Critical_Lift_Plan .pdf

EM 385-1-1

30 Nov 14

16-77

Date:

Location:

A. TOTAL LOAD

lbs lbs lbs lbs lbs lbs lbs lbs lbs.

ft.

ft.

ft. G. PRE-LIFT CHECKLIST (YES) N/A ft.

lbs.

lbs.

deg.

deg.

lbs.

12. Lift is % of the Crane's rated capacity

13. If Jib/Ext. is to be used:

Length ft.

Offset ft.

14. Rated Capacity of Jib/Ext. lbs C. HOIST ROPE Main Aux 1

Size:

lbs.

lbs.

6. Shackle Rated Capacity(s) _________________

Aux 2

1. # of Parts

2. Rope Diamter

3. Capacity

5. Shackle Size(s):

8. Signal Person Qualifications

2. Rigging Inspected

3. Crane Set-up

4. Overhead Hazard Check

5. Swing Check

6. Counterweight Check

7. Operator Qualifications

15. Site Control

16. Signatures

14. Traffic Hazard Check

11. Load Test

12. Tag Lines

13. Wind Conditions

(NO)

1. Crane Inspected

YES / NO

1. Certified Operator?

2. Option?

3. Certified for Type, Class & Capacity?

4. Designated in writing by emp

YES / NO

YES / NO

B. CRANE F. OPERATOR QUALIFICATIONS

YES / NO

Note: Bearing Pressure Calculations must be attached on Page 3.

Note: If Obstructions are present they must be shown on Page 4.

E. CRANE PLACEMENT (Mobile Cranes Only)

YES / NO

YES / NO

1. Load Weight

3. Wt. of Main Block

Note: Source of load weight (Drawings, Calcs, etc.) must be attached on Page 2.

Note: If Elelctrical Hazards are present they must be shown on Page 4.

Note: Ground Condition Calculations must be attached on Page 3.

1. Hitch Type(s)

2. No. of Slings:

3. Sling Type:

4. Sling Assembly Capacity:

D. RIGGING

9. Rigger Qualifications

10. Load Chart in Crane

6. Wt. of Jib/Ext. (erected/stowed)

7. Wt. of Hoist Rope

8. Other:

1. Type of Crane

3. Radius (Maximum)

4. Radius (Minimum)

5. Boom Length (Maximum)

6. Boom Length (Minimum)

8. Crane Capacity (Min Radius)

9. Boom Angle (Maximum)

USACE District:

Prepared By:

CRITICAL LIFT PLAN

U.S. Army Corps of Engineers

For use of this form, see EM 385-1-1, Section 16. Proponent agency is Crane HHWG.

6. Other?

Apr-13 Page 1 of 6

PSF

H. SIGNATURES

2. Rigger

1. Crane Operator

3. Signal Person

4. Lift Supervisor

5. Other

6. Other

7. Crane Capacity (Max Radius)

5. Travel with Load Required?

4. Obstructions to Lift or Swing?

3. High Voltage or Electrical Hazards?

2. Ground Conditions Suitable for Load?

1. Maximum Bearing Pressure

11. Gross Load of Crane

4. Wt. of Lifiting Beam

5. Wt. of Sling/Shackles

TOTAL WEIGHT

Mobile Hydraulic Truck

10. Boom Angle (Minimum)

2. Wt. of Aux. Block

2. Maximum Crane Capacity

A "critical lift" can be defined as any non-routine crane lift requiring detailed planning and additional or unusual safety precautions.

Critical lifts include lifts made where the load weight is greater than 75% of the rated capacity of the crane; lifts which require the load to be lifted, swung or placed out of the operator's view (except Change 6 exemption) ; lifts made with more than one crane; lifts involving non-routine or technically difficult rigging arrangement; hoisting personnel with a

FORM 16-3

Critical Lift Plan

16-78

Show here or attach calculations, drawings, etc.

CRITICAL LIFT PLAN

U.S. Army Corps of Engineers

Page 2 of 6Apr-13

LOAD CALCULATIONS

For use of this form, see EM 385-1-1, Section 16. Proponent agency is Crane HHWG.

16-79

Show here or attach calculations, drawings, etc.

U.S. Army Corps of Engineers

CRITICAL LIFT PLAN

For use of this form, see EM 385-1-1, Section 16. Proponent agency is Crane HHWG.

BEARING PRESSURES & GROUND CONDITIONS

Apr-13 Page 3 of 6

16-80

Show here or attach load chart

U.S. Army Corps of Engineers

CRITICAL LIFT PLAN

For use of this form, see EM 385-1-1, Section 16. Proponent agency is Crane HHWG.

LOAD CHART

Apr-13 Page 4 of 6

16-81

Show here or attatch operator qualifications

U.S. Army Corps of Engineers

CRITICAL LIFT PLAN

For use of this form, see EM 385-1-1, Section 16. Proponent agency is Crane HHWG.

OPERATOR, RIGGER, SINGAL PERSON QUALIFICATIONS

Apr-13 Page 5 of 6

16-82

Show here or attach site plan and sequencing

U.S. Army Corps of Engineers

CRITICAL LIFT PLAN

For use of this form, see EM 385-1-1, Section 16. Proponent agency is Crane HHWG.

SITE PLAN

Apr-13 Page 6 of 6