This lifting work permit document outlines the necessary information and safety checks for a lifting operation. It requires details of the project, lifting equipment, riggers and operators. A checklist is provided to verify prerequisites like risk assessments, ground preparation, communication equipment and certifications are in place. Both the initiator and evaluator must sign to acknowledge the safety measures before authorization is given. Upon completion, their signatures confirm the area has been left in a safe condition.
This lifting work permit document outlines the necessary information and safety checks for a lifting operation. It requires details of the project, lifting equipment, riggers and operators. A checklist is provided to verify prerequisites like risk assessments, ground preparation, communication equipment and certifications are in place. Both the initiator and evaluator must sign to acknowledge the safety measures before authorization is given. Upon completion, their signatures confirm the area has been left in a safe condition.
This lifting work permit document outlines the necessary information and safety checks for a lifting operation. It requires details of the project, lifting equipment, riggers and operators. A checklist is provided to verify prerequisites like risk assessments, ground preparation, communication equipment and certifications are in place. Both the initiator and evaluator must sign to acknowledge the safety measures before authorization is given. Upon completion, their signatures confirm the area has been left in a safe condition.
This lifting work permit document outlines the necessary information and safety checks for a lifting operation. It requires details of the project, lifting equipment, riggers and operators. A checklist is provided to verify prerequisites like risk assessments, ground preparation, communication equipment and certifications are in place. Both the initiator and evaluator must sign to acknowledge the safety measures before authorization is given. Upon completion, their signatures confirm the area has been left in a safe condition.
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LIFTING WORK PERMIT
1. Project Information: (To be filled by initiator/originator)
Project Name: Permit No.:
Project Location: Requesting Contractor/Company
2. Permit Issuance Details: (To be filled by initiator/originator)
THIS PERMIT IS ONLY FOR ONE SHIFT AND NOT EXTENDABLE Description of Task:
Detail of Surroundings:
Permit Validity: Time (from): Hrs. Time (To): Hrs. Date:
Weight of Load : Max Height of Lift: Max. Radius of Lift: Lifting Equipment ID/Registration No.: Lifting Point Defined: ☐ Yes ☐ No Road Closure/ Isolation required: ☐ Yes ☐ No Underground services identified (if applicable): Load Centre of Gravity Calculated: ☐ Yes ☐ No ☐ Yes ☐ No
3. Lifting Operation Details: (To be filled by initiator/originator)
Crane Operator Contact: Rigger-1 Contact: Rigger-2 Contact: Type of Lifting Crane: ☐ Mobile Crane ☐ Elevated working Platform ☐ Wheel crane ☐ Crawler Crane ☐ Mobile Concrete Pump ☐ All Terrain ☐ All Winch ☐ Loader/Hiab Crane ☐ Other : ☐ Excavator Lifting Crane Specification: ☐ Year of make (<25 years): ☐ SWL: ☐ Lifting Capacity: ☐ Boom Reach: ☐ Fly Jib Reach: ☐ No. of rope fall wraps: ☐ Other(s): Type of lifting Gear(s): ☐ Chain Sling, ☐ Lifting Beam, SWL: No. Of Legs: ☐ Shackle, SWL: Each Leg Capacity: ☐ Chain Blocks, SWL: SWL: ☐ Hook with latch, SWL: ☐ Webbing Sling, SWL: ☐ Eye Bolt/Nut, SWL: ☐ Wire Rope, SWL: ☐ Other(s):
Page 1 of 2 ) 4. Prerequisites: (To be filled by initiator/originator and verified by Evaluator) Checks Yes-No-NA Checks Yes-No-NA Risk assessment/ method statement and Lifting Crane outriggers fully extended and ☐ ☐ ☐ ☐ ☐ ☐ Plan developed, approved and communicated? spreading pads in place Operatives are consulted and trained? ☐ ☐ ☐ All wheels are off the ground. ☐ ☐ ☐ SWL and radius indicators in working order Provision of vigilance supervision? ☐ ☐ ☐ ☐ ☐ ☐ with visual and audible warning Has the crane valid certification ☐ ☐ ☐ Wind indicator is fitted & in working order ☐ ☐ ☐ load(s) slung correctly by a competent Has the lifting gears valid certification ☐ ☐ ☐ ☐ ☐ ☐ rigger Riggers/slinger competent and certified ☐ ☐ ☐ Tag-line(s) are connected with the load ☐ ☐ ☐ Suspended Load slewing path is cleared Correct crane selected for the load(s) and radius ☐ ☐ ☐ ☐ ☐ ☐ from people and barricaded Destination of load(s) is cleared and Ground suitable, even, firm and prepared ☐ ☐ ☐ ☐ ☐ ☐ prepared sufficiently Safe means of access/egress provided? ☐ ☐ ☐ Load rating chart for the crane is available ☐ ☐ ☐ Crane is set-up away from excavation ☐ ☐ ☐ Communication aid available (radio device) ☐ ☐ ☐ rd Crane swing radius area is free from overhead Has the operator have a valid 3 party ☐ ☐ ☐ ☐ ☐ ☐ cable/ structure or other cranes certificate and license? Proper barricade and signage are posted? ☐ ☐ ☐ Others (specify): ☐ ☐ ☐
5. Acknowledgement by Initiator and Evaluator:
Acknowledge that all above precautions have been taken. These have also been fully explained to the operatives, and I consider the Initiator/Originator Designation: Name: Signature: Date /Time:
Evaluator (HSEthat Acknowledge Team): I have checked above control measures and considerDesignation: the work area safe to carry out the activity Signature: Date /Time Comments (if any):
6.Name: Authorization (PM/CM): Designation:
Signature: Date /Time:
7. Completion/Cancelation of Permit: Initiator: Designation: Acknowledge that the area have been restored to a safe and orderly condition. Signature: Date /Time
Evaluator: Acknowledge that I have checked the area and been restored to a safeDesignation: and orderly condition. Signature: Date /Time
