7/28/2019 Critical Lifting Mobile Crane

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GE ENERGY MAJOR CRITICAL LIFT PERMIT MOBILE CRANE Tab VIssue Date:

1. Project Name 2. Contractor 3. Lift Date 4.Lift Location

5. Crane Manufacturer 6. Model # 7.Serial # 8. Total Boom/Boom Ext.&/or Jib Length @

time of Lift:

10. Max radius during lift (pick,swing, and set)

11. Swing Dir. And Degrees of swing

12. Lift Elevation (ft.) Max. Min. 13. Boom Angle: Pick Set

If Yes: Length (ft)Name:

Erected ( ) Stowed ( )

How:

16. Component Weights 17. Load Description: 15

Jib / Boom extension: 1

Headache Ball Size: 119. Weight of Load: 3

Load Block Size: 1 20. Total Lift Load - (Block 16+19) 12

Auxiliary Boom Head:1

21. Load % of Crane Capacity, (Divide Block

20 by 18) 80.00%

Weight of Cable (Load Fall): 1

Slings, Rigging, Shackles, E 1

Lifting Booms or Bars: 1 22. Inspection/Testing:

Allowance for Unaccounted 1 23. Crane Level Yes No Date of Last Certification/inspection:

Material in Equipment: 1 24. Soil Conditions? Poor Good

Other: Calculations? Required Not Required

Total Component Weights:  9 Crane Mats? Required Not Required

25. Tagline Required? 26. Hazards - attach additional sheets as required:

Yes Electrical? Yes No If Yes, exp

No Overhead? Yes No If Yes, exp

27. Communications by: Underground? Yes No If Yes, exp

HAND OR RADIO Others? Yes No If Yes, exp

28. Sketch of Crane relative to lift and rigging to component attach additional sheets if required: 29. Rigging Component List

 

Pre-Lift Meeting Date:

1. Operator Date: 4. Project Construction Manager Date:

2. Rigger Date: 5. Safety Manager Date:

3. Designated Signal Person Date: 6. Supervisor Date:

7. Client (Enter NA if not required ) Date:

File a completed copy of this form in the Site Safety Folder 

9. Parts of Load

cable on Block:

Major & Critical Lift Permit ~ Mobile Crane

If load is 75% or below proceed with lift

If load is between 76 and 85% proceed w/ caution

If load is above 85% DO NOT proceed w/ lift

15. Who determined weight of load and Lift?14. Will Jib &/or Boom Ext be used? Yes No

18. Mfg. (100%chart) rated capacity from

chart as outlined in Blocks 5 - 14

Section B - Signatures:

Section A - Load & Capacity Data

 

May, 2008 1 of 1 Rev 1