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LIST
PROJECT NUMBER
WORKS MANAGER
DOCUMENT NUMBER
Page 1 of
7
PROJECT TITLE
SITE MANAGER
DATE
OF
MANDATORY REQUIREMENTS
HAZARD
Unidentified Job
Specific
Hazards
CONTROL MEASURE
JHA to be carried out by staff detailing on the day
hazards that could not be practically assessed prior to
attending site in addition to this CHECK LIST. All staff
to sign on to JHA accepting this form and the on the day
hazards and controls. JHA has been completed and
approved by the relevant personnel in accordance with
the JHA Procedure
Hydro HazardsLack of
awareness of
local asset and
other
simultaneous
operations
Unlisted
Specific Lift
Hazards
CHECKED
No crane works are to take place until the lift study has
been completed in full
Riding load or hook is prohibited
Load never lifted over workers or plant
Unknown Crane
Type
Unknown Crane
Owner
Unknown
Capacity
Unknown Crane
Driver /
Operator
Unknown
Rigger(s)
Ticket No
Ticket No(s)
DOCUMENT REFERENCE: CL
07 02
REVISION: 4
HYDRO-285-68
DATE: 19/06/2012
Page 2 of
7
PROJECT TITLE
SITE MANAGER
DATE
GENERAL REQUIREMENTS
HAZARD
Unacceptable
lifting
Equipment
and
arrangement
Incorrect
operation of
Crane
Unsuitable
Crane Position
Unsuitable
Crane
Condition
Unsuitable
Landing Area
Soft or
Unsuitable
Ground
Overhead
Hazards
Faulty
Communicatio
ns
CONTROL MEASURE
Weight of Load to be lifted
(see page
4)
Weight of Lifting Equipment
(see page
4)
Total Weight
(see page
4)
Load Slinging Arrangement Agreed
Slinging Points Assessed as Suitable
The Need for Load Control Assessed
Review daily crane operational check list
Control and slinging / rigging by certified
rigger / dogman
Radius from Centre of Crane to Centre of
Load
From Crane Chart - Capacity of Crane as per
Radius
Location of crane confirmed
N/A
CHECKED
DOCUMENT REFERENCE: CL
07 02
REVISION: 4
HYDRO-285-68
DATE: 19/06/2012
Page 3 of
7
PROJECT TITLE
SITE MANAGER
DATE
GENERAL REQUIREMENTS
HAZARD
Fences or
Buildings in
Close
Proximity
High Winds,
Snow,
Electrical
Storms Etc
Unsuitable
Lifting Gear
Selection
Unauthorised
Access
CONTROL MEASURE
N/A
CHECKED
Falls From
Heights
Lack of Coordination
SLING
PLANT ID
NUMBER
S.W.L
DOCUMENT REFERENCE: CL
07 02
WITHIN
CURRENT
CERTIFICATIO
VISUALLY
INSPECTED
N/A
CHECKED
REVISION: 4
HYDRO-285-68
DATE: 19/06/2012
Page 4 of
7
PROJECT TITLE
SITE MANAGER
DATE
DESCRIPTION
Does the task require the use of multiple cranes
NO
YES
AND
PERSONNEL DETAILS
CRANE 1
Crane Type
Crane Owner
Capacity(SWL)
Crane Driver
Rigger(s)
Ticket No(s)
Ticket No(s)
CRANE 2
Crane Type
Crane Owner
Capacity(SWL)
Crane Driver
Rigger(s)
Ticket No(s)
Ticket No(s)
CRANE 3
Crane Type
DOCUMENT REFERENCE: CL
07 02
REVISION: 4
HYDRO-285-68
DATE: 19/06/2012
PROJECT TITLE
SITE MANAGER
DATE
Crane Owner
Capacity(SWL)
Crane Driver
Rigger(s)
CRANE
NUMBER
CRANE 1
CRANE 2
CRANE 3
ESTIMATED
SHARE OF
LOAD
(%)
Page 5 of
7
Ticket No(s)
Ticket No(s)
RADIUS FROM
CRANE TO
LOAD
(M)
CAPACITY OF
CRANE FROM
CHARTS
(T)
ADJUSTED
CAPACITY
(SEE NOTE)
(T)
ESTIMATE
LOAD FOR
EACH CRANE
(T )
TOTAL
CAPACITY
NOTE: For Multiple crane lifts, it is a statutory requirement that the capacity
of each crane at the require boom or jib length be as follows.
OF
LIFT
DOCUMENT REFERENCE: CL
07 02
REVISION: 4
HYDRO-285-68
DATE: 19/06/2012
Page 6 of
7
PROJECT TITLE
SITE MANAGER
DATE
SITE REGISTRATION (Note: Applies to all Work Parties and personnel working
on site)
REQUIREMENT
CHECKED
Permit To Work issued
Visitors register sheet or emergency board being used. Site Map
issued (showing emergency assembly areas and fire equipment)
Hydro Tasmania Level 2 O H & S Induction complete
Hydro Tasmania Level 3 Site induction complete
S
CERTIFICATION
I have personally checked and verified all items on all pages of this check list
Works Manager Name
Signature
Date
I acknowledge and agree that all items are detailed on all pages of this check list. I
agree to ensure that all employees and sub-contractors engaged in this work will
fully comply with all control measures indicated
DOCUMENT REFERENCE: CL
07 02
REVISION: 4
HYDRO-285-68
DATE: 19/06/2012
DAILY REVIEW
IF THERE IS A SIGNFICANT
REQUIRED
DATE AND TIME
DOCUMENT REFERENCE: CL
07 02
Page 7 of
7
PROJECT TITLE
SITE MANAGER
DATE
Signature
CHANGE IN
WORK
Date
AND OR
REVIEWED / COMMENT
REVISION: 4
CONDITIONS
A NEW
CHECK LIST
IS
HYDRO-285-68
DATE: 19/06/2012