Petron

CRITICAL LIFT CHECKLIST

SAFE WORK PERMIT NO.:

JOB DESCRIPTION:
LOCATION
NOTES:

1.
2.

3.
1.

!!! A SAFE WORK PERMIT IS REQUIRED FOR A CRITICAL LIFT !!!

All items on this checklist form an integral part of this standard. Each item MUST be acknowledged by
circling Y (yes), N (no) or N/A (not applicable). Items on the checklist with only a Y (yes) answer
opposite them are mandatory.
A pre-job planning meeting is required to ensure complete job preparation and understanding.

General
Planning Information:
Total load weight below hook

Max. Boom length

Lowest Boom angle

Max. Operating radius

Allowable load at max. radius

% of allowable load

Method(s) used to determine load weight:

Name of person responsible for load weight determination:

Site/unit safety standards and procedures specific to this job have been reviewed

N/A

All workers clearly understand their role and responsibilities

Weather conditions are favourable for this lift

Wind speed judged acceptable for this lift

Emergency plan discussed for worst case scenario

Loads centre of gravity is prevented from shifting during lift

Any underground installations within lift area needing special treatment?

N/A

(If yes, what?)

Best and most practical method of communication (between signal person and
equipment operator to be used:
[ ] Radio

[ ] Hand Signals

Other

A designated channel/frequency is available for radio communication

(CHANNEL # )

2.

Workers Responsibilities

PAGE 1 OF 5

Petron
CRITICAL LIFT CHECKLIST
a)

b)

c)

3.

Signal Person

Name

Person is a competent worker in his role

Understands lift procedure/plan

Familiar with method of communication

Will be wearing a signal vest

Has plan for controlling lift zone

Has experience with this type of lift

Will ensure receiving area is properly prepared for load

Head Rigger

Name

Person is a competent worker in his role

Has experience with this type of lift

Familiar with method of communication

Will ensure adequate condition and rating of rigging equipment before lift

Will inspect for proper rigging before lift

Will inspect for proper rigging practices before lift

Knows determined load weight

N/A

Hoisting Operator

Name

Certified to operate the equipment

Has experience operating this type of equipment

Has inspected the equipment and found it in acceptable condition for this lift

Understands lift procedure/plan

Has experience with this type of lift

Familiar with method of communication

Has verified allowable load calculations

Max. Operating radius measured with proper/legal measuring device

Has pre-lift check of crane been completed i.e. water/fuel/oil levels

If communication fails the operator will cease lifting operation immediately

Hoisting Equipment:
Major hoisting equipment to be used:

Soil bearing allowable load checked

PAGE 2 OF 5

Petron
CRITICAL LIFT CHECKLIST

Outrigger beams will be fully extended

N/A

Outrigger float pads are being used and good condition

N/A

Proper mats are being used and in good condition

N/A

Machine will be level during lift operation

Structural worthiness certificate up to date

Load cable visually inspected

Lift lugs are properly designed, used and inspected

N/A

N/A

Y
Y
Y

N
N/A
N/A

Lift is within 4.5 meters of or above high voltage conductors

or
Uninsulated high voltage lines within the 360 degree swing arc of the boom
(If yes, complete this section)

N/A

4.

Conditions

a)

Load exceeds 85% of max. Allowable load

(If yes, complete this section)
Weight of load (empty)
Weight of load internals
Weight of hooks
Weight of load block
Weight of headache ball
Weight of cable
Weight of spreader bar
Weight of rigging
- Total Weight
- Percentage total load weight of max. Allowable load

lbs/kg
lbs/kg
lbs/kg
lbs/kg
lbs/kg
lbs/kg
lbs/kg
lbs/kg
lbs/kg
=

%
b)

Load exceeds 50% of max. allowable load and failure would endanger existing facilities
(If yes, complete this section and section 4a)

c)

Existing facilities
=
Facilities can be protected
Plan in place can be place for isolating facilities in case of failure
Occupied facilities beneath lift zone will be vacated

Lift has been approved

(If yes, approved by)
Alternate lift/swing positions have been examined
De-energizing lines/conductors is not considered feasible
All workers are aware of electrical hazard
There is a separate signal person designated to watch line/conductor clearance only
Name
``
Crane is properly grounded

PAGE 3 OF 5

Y
Y
Y
Y

N/A

Petron
CRITICAL LIFT CHECKLIST

d)

e)

More than one crane required to make the lift and the verified lift exceed 50% of the max.
allowable load for any of the cranes
(If yes, complete this section)

A plan detailing the sequence of steps for the entire lift has been reviewed
All applicable conditions have been considered for each boom
Is the lift planned so that at no time any of the booms will have more than 80% of
their load capacity
A competent person has been selected to co-ordinate this lift
Name

Y
Y
Y

Lift will require use of man-basket

(If yes, complete this section)

Y
Y
Y
Y
Y
Y
Y

f)

Alternate means of access have been considered

Man-basket has been inspected (and documented) in the last 12 months
Man-basket will be visually inspected before lift
Wind speed judged acceptable for this lift
At least one attended tag line to be used
Fall protection to be used
Weather changes during lift have been considered
Crane will not be used for any other purpose during lift
Crane will not be travelled with personnel elevated
Operator will not leave with personnel elevated
Emergency rescue plan discussed and understood by all
Escape type breathing apparatus available in crane cab and in basket if in areas of
potential hazardous gas release
Communication system for elevated personnel established
Only personnel and small tools will be carried in the man-basket

Y
Y
Y
Y
Y
Y

Lift requires hydraulic crane with 2 lines reeved

(If yes, complete this section)

Y
Y
Y
Y
Y

N/A

Anti-two-blocking devices are operational

Additional weight of hooks and rigging have been considered
Is the whip line capable of handling the entire load?
A plan detailing the sequence of steps for the entire lift has been reviewed
Is the lift planned so that at no time either of the lines will have more than 80% of
their load capacity

A competent person has been selected to co-ordinate the lift

Name

Additional Comments:

PAGE 4 OF 5

Petron
CRITICAL LIFT CHECKLIST

Safety plan/lift procedure reviewed by the following involved parties (Name in BLOCK letters, followed by signature):
Client Representative:

SNC-Lavalin:

Contractor:

All workers involved with lift:

PAGE 5 OF 5