Pfizer PGS Kalamazoo
Critical Lift and Crane Use Permit
.
Use this document for All Crane Lifts (sections A & B). Crane lifts determined to be Critical Lifts as defined
below, complete the Critical Lift Plan Permit (sections C through H). Keep the permit at the lift site for the
duration of the lift activity. Re-assess the permit when conditions (equipment, weather, and/or ground) or scope
of work has changes.
Critical Crane Lift: Check all that apply
Lifting loads over building, processes, trestle, etc.
Crane will "Walk" with Load
Load will be upended and weighs >10,000 lbs.
Two or more cranes are used to lift
Lifts =/> 24,000 pounds
Crane will Lift Personnel
Loads =/> 75% of Rated Load Capacity
A. GENERAL INFORMATION
Pfizer Contact: (CM, CMS):
Phone:
Crane Operator Company:
Pfizer Project Manager:
Start Date:
Est. Finish Date:
Crane Lift Location (Area/Building):
Verify the following individuals have been
notified prior to all crane lifts:
Crane Manufacturer:
CM / CMS: Review Site / Utility Drawings
Complete
n/a
Location:
Crane Size:
Pfizer Contractor Safety Representative:
Anita Pelak (DP) (269)217-0454
Joe Urnowey (API) (269)720-9666
Crane Model No:
Annual Inspection Date:
Describe Scope of Work:
Jack Routley (alternate) (269)217-9865
Pfizer Construction Management:
Jim Ledden (site) (269)377-5354
B. CRANE PRE-LIFT SAFETY CHECKLIST
COMPLETE CHECKLIST BELOW TO ENSURE A SAFE LIFT IS PLANNED
Yes N/A
 Verify crane location has been located on site FAA permit map (see appendix A & B)
 The load weight is confirmed: ____________ Lbs.
 The load hook is directly over the load center of gravity
 Outrigger pads are fully extended and matts are sufficient for the load / soil conditions
 Tires are clear of the ground and the crane is level
 Ensure all obstacles and obstructions have been identified and are in the lift plan
 Lifts where crane boom is within 20’ of power transmission lines meet MIOSHA R 408.11936
 A signal method has been determined between the crane operator and the signalperson
 An individual has been designated to observe for obstructions and unauthorized personnel
 Crane boom is equipped with airport safety flag and/or beacon light
 Counterweight swing radius has been barricaded and access is limited to authorized personnel
 Traffic and pedestrian controls are in place

The Operator has accredited crane operator certification
 
The Operator has performed a before use inspection
 A Qualified Rigger has inspected all slings, fastenings, and attachments for damage or defects

Tag Lines are in place to control load
Wind / Weather Conditions:
Wind Speed: Crane is equipped with anemometer:
Yes
No
Lightning: Cranes are not to be operated when Lightning is within 10 miles
Lifts are not allowed when wind speeds exceed the Manufacturer’s Limit
Manufacturer’s Maximum Operating Wind Speed Limit:
MPH / Knots / MPS
Wind Speed at time of lift:
MPH / Knots / MPS
Lifts during wind speeds in excess of 20 MPH / 17 Knots must have the approval of Pfizer EHS
Kalamazoo Airport Automated Weather Information: (269) 384-5729
Changes in vehicular traffic and/or road closings require a site notification. Contact the following:
Fire Station: (269) 833-5122
Transportation: (269) 833-3767
Security: (269) 833-3636
The Contractor, Rigger, and Crane Operator are responsible for safe execution of the lift. Execution of the lift shall be
in accordance with Pfizer and MIOSHA policies and regulations.
Certified Crane Operator:
Name: ______________________
Signature: _______________________________
Date: ________
Certified Signal Person:
Name: ______________________
Signature: _______________________________
Date: ________
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Pfizer PGS Kalamazoo
Critical Lift and Crane Use Permit
C. LIFT DATA
1a. Describe Load and Enter Total Load Weight:
1. Load Weight:
Estimated Weight:
Lbs.
Actual Weight:
Lbs.
1b. Total load weight as a percentage of rated load capacity of crane from load chart:
2a. Main Hoist Block, Auxiliary Boom Head / Headache Ball:
Total Block Weight:
%
Lbs.
2b. Slings, Shackles, Hardware (list all used):
2. Rigging weight:
Total Rigging Weight:
Lbs.
2c. Jib Weight Allowance:
Lbs.
Check One: Erected (not used):
Erected (in use):
3a. On Sling: 1a + 2b =
Lbs.
3b. On Crane: 1a + 2a + 2b + 2c =
Jib Stowed (on boom):
Lbs. Total Lift Weight:
Lbs
Example Calculation:
3. Total Lift
Weight:
TotalLoadWeight
 100  %
RatedLoadCapacity
Example Calculation:
50,000lbs
 100  20%
250,000lbs
*Note: Contingency = Total Lift Weight Must be =/< 90% of Load Chart Capacity
Height of Load to be not greater than
4. Lifting Height:
5. Operating
Radius:
Feet
Maximum Height of Crane Boom / Extension Tip
Feet
Elevation drawing showing load height relation to crane and any obstructions is attached
Is maximum height of Crane Boom tip within Permit Limits Granted by Airport / FAA
Yes
No
Additional FAA Approval Is Required For Any Work Outside Current Pfizer Lift Zones
(See Appendix A & B)
Current Permit Height:
Zone #
Maximum Radius of Load to be not greater than
Feet
Plan view of load location and crane orientation attached
D. CRANE DATA & LIFT SET UP
1. Crane
Manufacturer:
Crane Manufacturer:
Size:
Model Number:
Date of Last Annual Inspection:
2. 
Inspected by:
Verify manufacturer's load chart indicates lifting capacity at stipulated load radius and boom lengths.
Note: If boom length and/or radius is between the stipulated or posted value on the load chart select the next lesser rating
capacity. The next lesser rating capacity may be the next longer or shorter boom length.
3. Attachments:
Confirm Crane has an Anti Two Blocking Device Installed and is operational
4. Counterweight:
Yes
Total Weight
Lbs.
Total Crane Weight
5. Jib / Extension:
Jib Length (as extension):
Jib Offset:
6. Main Load
Block:
Capacity Size:
Ton
# Sheaves:
7. Auxiliary Boom
Head/Ball:
Capacity Size:
Ton
# Sheaves:
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Weight
Weight
Lbs.
Lbs.
Lbs.
Pfizer PGS Kalamazoo
Critical Lift and Crane Use Permit
An engineering review has determined underground utilities and structures are not at risk
Outriggers Fully Extended and Set
Check One: Track
Tires
Total Outrigger Bearing Pressure has been Calculated and Soil Type, Ground, and Pavement has
Capacity to Support the Total Imposed Load
Outrigger Mats are Sized to Reduce Soil Bearing Pressure to Safe PSI Levels
Construction Manager has provided site drawing with crane set up zone identified.
Pre-surveying meeting occurred with Surveyor, SME’s, CM, & Crane Firm (Operator attendance
preferred)
CM escorted utility surveyor and maintained accuracy and potential problematic areas on sketch &
provided/discussed with crane firm.
Post survey meeting occurred with Surveyor, SME’s, CM, & Crane Operator on
morning of work commencement
Ground Penetrating Radar (GPR) Conducted (recommend <2 weeks prior).
Radio Frequency Testing Conducted (recommend <2 weeks prior)
All utilities marked per APW uniform color codes.
8. Outriggers,
Pads, and Tires:
E. RIGGING DATA
Type of Sling:
Length:
Capacity (per leg):
Basket / Straight / Choker:
1. Sling(s)/
Shackles
Size:
Capacity (ea.)
Spreader Bar:
Feet
Lbs.
Verify MFG/Eng. Stamp:
F. LIFT COMPUTATION
Minimum Boom Angle:
Maximum Boom Length:
Maximum Lift Radius:
Note: Cranes equipped with computers indicating boom length, angle, and radius are safety devices only and should
not be used in place of the operator's responsibility to actually determine the measurements required to calculate a
safe lift.
Note: Accessories, Crane Capacity, Parts of Line and Rope Capacity, and the working quadrant of the crane should
be considered when calculating Net Crane Capacities.
1.
Crane Capacity: (Load Chart Capacity)
Lbs.
2.
Net Crane Capacity: (Load Chart Capacity - Block, Rigging, and Accessory Weights) =
3.
Load orientation prior to lift:
4.
Swing orientation relative to crane:
Front
Side
Front
Lbs.
Rear
Side
Rear
G. APPROVALS
The Contractor, Rigger, and Crane Operator are the competent persons responsible for the safe execution of the lift(s).
Execution of the lift shall be in accordance with MIOSHA regulations.
Construction Manager / CAS/PM:
Name: ______________________
Signature: _______________________________
Date: ________
Contractor Representative:
Name: ______________________
Signature: _______________________________
Date: _________
KCA Representative:
Name: ______________________
Signature: _______________________________
Date: ________
3/8/2016
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Pfizer PGS Kalamazoo
Critical Lift and Crane Use Permit
H. Provide Description & Sketch of Crane/Load Rigging
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Pfizer PGS Kalamazoo
Critical Lift and Crane Use Permit
Appendix A
Attach Map if Appliable
West Side Permit Map
Inside Perimeter Approved for Lifts =/< 130’ AGL
Appendix B
Attach Map if Appliable
East Side Permit Map
Inside Perimeter Approved for Lifts =/< 95’ AGL
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