IssueDate: 19-04-2018
Page: 1of6
ECHO’s Health and Safety Requirements
SECTION 1: (Trade-Contractor carrying out the work to complete)
Contract No. & Site:
Contractor:
Brief description of work and loads to be lifted:
Crane Supplier:
CraneType:
Type of Lifting Equipment:
Name: / Signature:
Lift Plan Prepared By:
Lift Supervisor
Crane Driver
Slinger/Signaller
Slinger/Signaller
These signatures must be obtained prior to the lift commencing to confirm that they have been fully briefed on the lifting plan, their duties described within as well as the findings of the checklists.
Location:
SECTION 2: Attachments: (Principal Contractor Approved Person to complete)
Lift Plan or MS&RA[[1]] /
Y / N
/ Approved Lift Plan NoChecklists[[2]] /
Y/ N/A
/Permit will not be approved if checklists are not completed and attached[2]
SECTION 3: AUTHORISATION (Authorised person by Site Manager – Lifting Coordinator)Permit to Commence: / Date: / Time:
Permit to Expire: / Date: / Time:
Date: / Position: / Date:
Name: / Signature: / Name:
SECTION 4: ACCEPTANCE OF PERMIT (Trade Contractor’s Competent Person to complete)
I hereby confirm that all persons under the control of our Company will abide by the conditions of this permit.
Date: / Position:
Name: / Signature:
SECTION 5: Completion of work (Trade Contractor’s Competent Person to complete)
The work for which this permit was issued is complete (or stopped) and all persons, materials and equipment under my supervision have been withdrawn or left in a safe manner.
Date: / Time:
Name: / Signature:
SECTION 6: WORKS COMPLETE (Authorised person by Site Manager – Lifting Coordinator)
I certify that the work specified above has been satisfactorily completed.
Date: / Time:
Name: / Signature:
Comments:
THE PERMIT IS NOW CANCELLED - A NEW PERMIT WILL BE REQUIRED IF WORK IS TO CONTINUE
CHECKLISTFOR LIFTING OPERATION
A copy of the checklists must also be attached to the permit and their findings briefed to all operatives involved in the lift.
A1. Information of crane and operator
/ Mobile crane / / Crawlercrane / / Lift cranelorry / / Other types (telehandler, backhoe loaders)
Type of crane (incl. lifting gear) / Operator first and Last name / Contractor company name / Maximum capacity [kg, t]
…………………………………… / ………………………………………………………… / UDT cert: / ……………………………..
A2. Cranepositioning
Is the crane / device set in the indicated place, on the prepared ground / ground with adequate load capacity? / / Is crane is properly positioned with respect to the overhead powerlines, edge of the excavations, etc.? /
Are the supports properly spaced? / / Exclusion zones set (where appropriate)? /
Have the correct sleepers been used? / / The risk of works in collision with other devices on site (eg other cranes, concrete pumps, etc.)? /
Place of positioning will be changed? / / Other (specify): ………………………………………………………….. /
IN CASE OF CHANGE OF CRANE LOCATION ON SITE – THE OPERATOR AND DIRECT SUPERVISOR ARE OBILGED TO ENSURE SAFE POSITIONING CONDITION AT PLACE
A3. Control-list of crane and lifting equipment
Subject / YES / NO / N/A / Subject / YES / NO / N/A
The crane, lifting gear, control device, rigging are in good condition / / Do the lifting slings and accessories have certificates, periodic inspection logs and are clearly marked? /
Signaling and warning devices are in good technical condition / / Are the slings in good condition and have legible labels with WLL parameter? /
Sleepers are in good conditions / / Good technical condition of platforms and handrails, ladders on the device / / /
Is the marking visible: max. lifting capacity, etc? / / Appropriate means of communication provided (radio, gestures)? / /
Is the visible label with max. crane capacity? / / / / Anemometeravailable / / /
Operation & Maintenance Documentation in crane? / / / Tag linerequired? / /
Other: ………………………………………………… / / / / Other: / / /
A4. Information on loads and slings
Loads / Type/name of slings
Description of loads / Number of legs
Weight [kg, t] / Ends type (hooks, shackles, eyes)
Dimensions
Lenght width height [m] / LENGTH
[m]
Package type
np. pallet, basket, beam, etc. / SWL/WLL
[kg, t]
Method of slinging / Centre of gravity
[known/atypical]
A5.Operation planning[items checked and correct]
/ Crane apropriate to the weight of the load / / Selected slings are proper to size and weight of the load / / Slingmans/signallers are instructed regarding assistance of lifted load and communication / / Slingmans and signallersquallifiaction / / Prepared safe loading and storage point (ceiling, platforms, laydown areas).
A6. Applicant–Contractor Carrying out the work[statement of the safe operations posibility]
Name: / Contractorcompanyname: / Date: / Signature
Lifting CoordinatorNomination
I. Lifting CoordinatorCo-ordinator’s Duties to Include:
- The assessment of the lifting operation to provide such planning, selection of crane(s), lifting gear and equipment, instruction and supervision as is necessary for the task to be undertaken safely. This should include consultation with other responsible bodies if necessary and ensuring that where different organisations are involved they collaborate as necessary
- Ensuring that adequate inspection and maintenance of the equipment has been carried out
- Ensuring that there is an effective procedure for reporting defects and incidents and taking any necessary corrective action
- Responsibility for the organisation and control of the lifting operation
- Authority to stop the lift if he considers the conditions unsafe
Appointment of a Lifting Coordinator at the Construction Site: ……………………………………………………………..
Name: / Company name: / Job Position: / Date and signature:
Lifting Plan [exemplarytemplate]
- Information aboutloads
Types of loads
……………………………………... / ……………………………………... / ……………………………………...
Loadparameters / Weight
[kg, t]
Lenght, width, height
[m]
Otherdetails:
Type of package
[pallet, basket, etc.]
Slings
[type, WLL]
Method of slinging
Centre of gravity
Place of loading
[loading platform, ceiling, etc.]
Place of storage
[ceiling, platform, etc. kN/m2]
Load control
[tag line, eye contact]
- Craneparameters
Crane1 / Crane 2 / Crane 3 / Crane 4 / Crane 5 / Crane 6
Capacity [kg, t]
Boom length L [m]
Outreach R [m]
Height of lift H [m]
Loweringheight h [m]
Anemometer [Yes/No]
- Organization of operations
Subject / Details / comments / Crane No.
Means of communication (radio stations, whistles)
Coordination with othercontractors
Instructing the team performing the lifting operation
Silngmans and signallers function separation, ensuring a sufficient number of signallers
Work in the collision with other cranes
Work in collision with other devices (concrete pumps, mobile-person lifts)
Risk of collision with buildings
Tandem lift
Man-basket lift, concrete baskets with platform for operator
- Diagram of area and positions of crane
Lifting plan prepared by:
[1]Lifting Plan is required for non-regular operations (large loads, load weight > 5T, tandem lift). Method Statement & Risk Analysis is required for regular lifting operations (ie. re-bars, shuttering beams, etc.).
[2] Checklist – required only for mobile cranes,