Suspended Personnel Workbasket/Platform Checklist and Authorization

/ Form 000.653.F0118
Suspended Personnel Workbasket/Platform Checklist
and Authorization
CHECKLIST
A. / Description and Type of Work To Be Performed
(Provide details concerning duties, location, surrounding obstructions, and potential hazards.)
B. / Less Hazardous Alternatives
Note1:Answers to be based on hazardous exposure to employees performing the work. (Time and cost of operation must not be a determining factor in the method used.)
Note2:After each of the following, state reason(s) as to why this method may not be used to perform the work operation.
1. / Ladder and/or stairways (step, extension, A-Frame)
2. / Scaffolds (buck, tubular, two-point suspended)
3. / Aerial lifts (power platform, vehicle-mounted elevating and rotating work platforms – scissors lifts, JLGs, high-lift boom truck)
4. / Personnel hoist (elevators, spider lift)
5. / Other mechanical method (clam-shell, magnet, drag)
Note 3:If one of the above methods is feasible, that method must be used to perform the work. If not, continue completing this checklist.
C. / Crane Requirements
1. / Boom angle indicator / Yes / No
2. / Boom extension indicator / Yes / No
3. / Anti-two block device or damage prevention features / Yes / No
4. / Line speed governed (100 ft/min) / Yes / No
5. / Wire rope, lifting bridle, and associated hardware;
safety factor of 5 / Yes / No
6. / Brakes, pawls, or dogs in good condition / Yes / No
7. / Controlled (power) load lowering (no free fall) / Yes / No
8. / Controlled (power) boom (not live) / Yes / No
9. / Uniformly level (1 percent of level grade) / Yes / No
10. / Firm footing/support (mats needed) / Yes / No
11. / Outriggers extended and set / Yes / No
12. / Automatic safe working load indicator / Yes / No
13. / (a) / Crane gross capacity
(b) / Net capacity (after all deductions)
(c) / 50 percent of net capacity
14 / Inspected (crane and support) per manufacturer’s requirements / Yes / No
D. / Basket Requirements
1. / Designed by a qualified engineer / Yes / No
2. / Welded by a qualified welder / Yes / No
3. / Suspension system to minimize tipping / Yes / No
4. / Safety factor of 5 for basket design / Yes / No
5. / Perimeter guarding / Yes / No
6. / Inward swinging gate / Yes / No
7. / Grab rails entire perimeter / Yes / No
8. / Overhead protection / Yes / No
9. / Smooth interior surfaces / Yes / No
10. / Capacity and weight indicators / Yes / No
11. / Platform identification markings / Yes / No
12. / Radios needed for lift
13. / Number of workers permitted for work: 4 maximum (250 lb per person or equivalent national standard)
14. / Total weight of basket, rigging, workers, and materials
WARNING: If Item D-14 is greater than C-13(c), DO NOT MAKE LIFT!
E. / Testing and Inspections
1. / Workbasket / Yes / No
2. / Per work shift / Yes / No
3. / Trial run at all work locations / Yes / No
4. / Test lift (125 percent of basket capacity) at each crane setup / Yes / No
5. / Structural condition (welds, supports, etc.) / Yes / No
6. / Crane level after test lift / Yes / No
7. / Crane supports after test lift / Yes / No
F. / Pre-Lift Meeting
1. / Operator’s responsibility and duties reviewed / Yes / No
2. / Signal person’s responsibilities and duties reviewed / Yes / No
3. / Person(s) to be lifted responsibilities and duties reviewed / Yes / No
4. / Supervision aware of responsibilities and duties reviewed / Yes / No
5. / Review job safety analysis with all participants / Yes / No
AUTHORIZATION
We the undersigned, as Project/Site Management of (project name) at (project location) approve the use of a suspended workbasket at(site location where workbasket will be used) on (date).
The use of the workbasket will be in accordance with 29CFR1926.550 or equivalent incountry requirements concerning hoisting personnel baskets/platforms from cranes and derricks, other applicable regulatory standards, and P2S policies and procedures.
APPROVAL SIGNATURES
Position/Title / Signature / Date
Foreman
Equipment Superintendent
Construction Manager
Site/Project Manager
HSE Representative
Suspended Personnel Workbasket Authorized Person
Copyright © 2010, P2SAll Rights Reserved.
Form Date: 01Feb2010 / Page 1 of 3 / Health, Safety, and Environmental
/ Form 000.653.F0118
Suspended Personnel Workbasket/Platform Checklist
and Authorization

Note:This form is referenced in Practice000.502.1000.