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Critical Lift Plan Form - Sa 9644 Rev.01

This critical lift plan outlines the details of an upcoming lift, including: 1) A description of the load and its weight, the crane and rigging equipment to be used including their weights, configurations, and capacities. 2) Requirements for the lift location including ground conditions, clearances, and environmental factors. 3) Roles and approvals of personnel involved in the lift.

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2K views1 page

Critical Lift Plan Form - Sa 9644 Rev.01

This critical lift plan outlines the details of an upcoming lift, including: 1) A description of the load and its weight, the crane and rigging equipment to be used including their weights, configurations, and capacities. 2) Requirements for the lift location including ground conditions, clearances, and environmental factors. 3) Roles and approvals of personnel involved in the lift.

Uploaded by

Anuraj
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PTW#________________________________ Rev -01

Critical Lift Plan*


(*Each Piece Of Participating Lifting Equipment Shall Have A Separate Critical Lift Plan)
Organization Name: _______________________ Date of Lift: _______________________
Work Permit Required? YES NO
Facility Name: ___________________________ Specific Work Location: ____________________ Contract #: _______________
A) Load Description & Weight (From USER): B) Load Handling Devices (See “Notes” Below):
_____________________ ________ lbs/kgs Load Handling/Boom Stowed Erected N/A Weight:
Attachments lbs/kgs
C) Crane Information (See “Notes” Below): Swing-Away Jib: ______
1. SA Inspection Sticker YES NO Other Jibs: ______
2. Inspection Sticker Expiry Date: __________ Hook Block (Main): ______
3. Equipment ID #: ____________________ Auxiliary Boom Head: ______
4. Crane Model: ______________________ Headache Ball: ______
5. Crane Type: _______________________ Lifting/Spreader Beam Needed? YES NO ______
Does Beam Have Current Inspection Sticker? YES NO
6. Crane Rated Capacity: ___________ lbs/kgs Slings, Shackles, etc.: ______
7. Hoisting rope Diameter: _________ in/cm Other: ________________________________ ______
8. Single Line Pull Capacity: ________ lbs/kgs Weight of Load Handling Devices (Section B Above) ____________ lbs/kgs
9. # of Parts of Line: ______________
+ Weight of Load to be Lifted (Section A) ____________ lbs/kgs
10. Total Gross Capacity Hook Block as Reeved:
_____________________ lbs/kgs
= Total Gross Weight (Sections A + B) ____________ lbs/kgs
D) Crane Configuration (See “Notes” Below): E) Rigging (See “Notes” Below):
1. Required Boom Length: __________ ft/m 1. Hitch Arrangement: _______________________________________
2. Boom Angle: ________________ degrees 2. Sling Type(s): ___________________________________________

3. Required Counterweight: _________ lbs/kgs 3. Sling Size(s): _____________________________________ in/cm


4. Sling Length(s): ___________________________________ ft/m
4. Operating Radius: _______________ ft/m 5. Shackle Size: __________ in/cm & Capacity: __________________ lbs/kgs
5. Lift Quadrant (Front, Rear, 360°): ________ 6. Capacity of Above Configuration: ___________________ lbs/kgs
F) Maximum Crane Capacity in This Load Chart Configuration: lbs/kgs Total Load ÷ Load Chart Capacity = _____ %
G) Surface Requirements Needed (Other Than Mandatory Outrigger Pads): Mats? YES NO Is the Ground Level? YES NO
Proper Ground Compaction? YES NO Excavation Hazards Controlled? YES NO Use of man basket (to be separate
lift plan) ? YES NO
H) Wind Speed Shall Not Exceed 10M/sec Limits for any Lift .
I) Energized Power-Lines Within Boom Radius? YES NO Explosion/Fire Hazards Within Boom Radius? YES NO
***Attention: A Pre-Lift Safety Meeting is Mandatory CAN CRANE MAKE LIFT? YES NO
Positions: Name (Signature) Badge # Certificate # Approved by: TechnipFMC Rigging Supervisor.
or Job Incharge
Originator: __________________ ___________ ______________
Name (Print):
Rigger: __________________ ___________ ______________
Crane Operator: __________________ ___________ ______________
Lifting __________________ ___________ ______________
Signature:
Supervisor:
Notes: 1. Attach sketch(es) of lift site, noting obstacles to movement of load, boom, or tail swing.
2. All units of weight shall be listed in the same units of measure as Crane Load Chart.
3. All units of measure shall be listed in the same units of measure as Crane Range Diagram.
4. Attach copy of Crane Load Chart, Range Diagram, and Safety Notes.
Certain weights may be deducted from Crane Load Chart capacities based on manufacturer’s specifications.
5. Use of two cranes or for tandem lift additional lift plan generated for the second crane*(1st Crane and 2nd Crane).

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