Académique Documents
Professionnel Documents
Culture Documents
SAFETY FORM
Date: Time: AM PM
Project Number: Project Name:
Location of Critical Lift:
Name Competent Person:
Contractor Name: Tel:
The use of this checklist is mandatory if any of the following are answered Yes
Yes No Load exceeds 80% of load chart for crane or lifting device
Yes No Load exceed 50 % of load chart and failure endangers existing facilities
Yes No Two (2) booms are required for lift
Yes No Poles or derricks have been erected for this lift
Attach schedule of operations including time for rigging and equipment inspection
An Equal Opportunity-Affirmative
375334278.doc Rev Date 9/97 1 of 2 Action Employer
CRANE CRITICAL LIFT CHECKLIST
SAFETY FORM
Operator Experience
List experience on this type of equipment and type of lift (use separate sheet when
required)
1.
2.
3.
4.
Remarks
An Equal Opportunity-Affirmative
375334278.doc Rev Date 9/97 2 of 2 Action Employer