Prelift Check List

Section 1 - Review for all lifts:

All Lifts
Rigging - Technical:
Weight and Center of Gravity d Yes No
Cable Size(s) adequate for the w Yes No
Eye bolts, turnbuckle, chain fall Yes No
Rigging equipment inspected priYes No
Cable “softeners” available and Yes No
Tag line available and used if re Yes No

Site Preparation:
Final location for lifted compon Yes No
Blocking to set component upon Yes
i No
Notify other contractors/customeYes No
Rope off required areas w/ red taYes No
FME devices ready for use (if re Yes No

Pre lift discussion with cre

Roles & responsibilities been d Yes No
personnel involved in the lift
EHS Manual Section 13 definitions - Lifts using more than
Section
one crane.2 Lifts
- Major
greater&than
Critical
75% ofLifts
the crane’s
(also capacity.
complete Section 1):
Outdoor lifts performed during wind speed between 20 and
30 mph., if wind speed exceeds 30 mph, do not attempt
lift. Lifting of critical equipment, over critical equipment.
At the discretion of the GE site lead and/or EHS manager.
Owner may impose more stringent requirements.

EHS Reference:
http://ehsweb.sch.ge.com/ehs/gs/webdata/ifs/document/01_gi&fs_ehs_manual_&_forms/EHS_13H_IFS_Mobile_and_Overhead_Cranes.doc

Component Being Lifted:

Date and Time of Lift:

Major/Critical Lift Rigging pla Yes No

Major/Critical Lift Plan is attac Yes No
JSA/Risk Assessment form com Yes No
Pre lift discussion with crew – d Yes No
Field Engineer assigned to supervYes No

Verification that the above Major

___________ ___________ ________
Field Enginee Field Enginee Owner (If

For Major/Critical lifts file a completed copy of this form in the Site Safety Folder Rev 30 May 2007
Date: ____________

For Major/Critical lifts file a completed copy of this form in the Site Safety Folder Rev 30 May 2007
 Major & Critical Lift Permit Issue Date:

Mobile Crane
Section A - Load & Capacity Data
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 @ 9. Parts of Load
time of Lift: cable on Block:
10. Max radius during lift (pick, 11. Swing Dir. And Degrees of 12. Lift Elevation (ft.) 13. Boom Angle
swing, and set) swing
________ Max. ________ Min ________ Pick ________ Set
14. Is a Jib / Boom Ext. installed? Yes ____ No ___ 15. Who determined weight of load and Lift?
If Yes: Length (feet / meters) Name: ______________________________________________________
Erected Y / N Stowed Y / N How: ______________________________________________________
16. Component Weights 17. Load Description: 18. Mfg. (100%chart) rated capacity from 0
chart as outlined in Blocks 5 - 14
Jib / Boom extension:

Headache Ball Size: 19. Weight of Load: 0

Load Block Size: 20. Total Lift Load - (Block 16+19) 0

21. Load % of Crane Capacity, (Divide Block
Auxiliary Boom Head: 20 by 18)

Weight of Cable (Load Fall): If load is 75% or below proceed with lift
If load is between 76 and 85% proceed w/ caution
Slings, Rigging, Shackles, Etc. : If load is above 85% DO NOT proceed w/ lift

Lifting Booms or Bars: 22. Inspection/Testing:

Allowance for Unaccounted 23. Crane Level Yes___ No ___ Date of Last Certification/inspection: __________

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

Other: Calculations? -- Required _______ Not Required _______

Total Component Weights: 0

____________________ Crane Mats? -- Required _______ Not Required _______
25. Tagline Required? 26. Hazards - attach additional sheets as required:
Yes ________ No ________ Electrical? Yes ________ No ________ If Yes, explain: ______________
Overhead? Yes ________ No ________ If Yes, explain: ______________
27. Communications: Underground? Yes ________ No ________ If Yes, explain: ______________
Hand ( ) or Radio ( ) Others? _____________ Yes ________ No ________ If Yes, explain: ______________
28. Sketch of Crane relative to lift and rigging to component attach additional sheets if required: 29. Rigging Component List

Section B - Signatures:

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 Folde r Rev 30 May 2007