Contractor Safety
Number: CSM - 019
Title:
Critical Lift Template
Revised: 08/21/2013
1. Applicability
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CO2
KMC
Natural Gas
Products Pipeline
Terminals
All Projects & Contractors
2. Scope
The Crane Critical Lift Template provides an in-depth evaluation and plan for all heavy and/or
complicated crane lifts and should be completed before attempting the lift.
3. Definitions
1. Competent Person – OSHA defines a competent person as "one who is capable of
identifying existing and predictable hazards in the surroundings or working
conditions which are unsanitary, hazardous, or dangerous to employees, and who
has authorization to take prompt corrective measures to eliminate them".
2. Qualified Person – OSHA defines a qualified person as “one who, by possession of
a recognized degree, certificate, or professional standing, or who by extensive
knowledge, training and experience, has successfully demonstrated his ability to
solve or resolve problems relating to the subject matter, the work, or the project.
3. Critical Lift: A critical lift has one or more of the following conditions:
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Load is over 75% of the crane’s rated capacity for current configuration.
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Load is more than 20 tons.
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Lift is over operating systems (charged electrical equipment, pipelines, etc.)
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Lift requires the use of two (2) or more cranes.
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Hoisting of contractor employees on a suspended work-platform or man
basket.
4. Contractor’s Construction Supervisor: The contractor’s supervisor is responsible for
the completion of the critical lift.
Page 1 of 7
Contractor Safety
Number: CSM - 019
Title:
Critical Lift Template
Revised: 08/21/2013
5. Crane Operator: The operator who will be operating the crane and making the lift.
6. Rigging Supervisor: The contractor’s supervisor responsible for planning and
executing the rigging being used for the critical lift.
7. Contractor’s Safety Manager: The contractor’s site safety manager.
8. Contractor’s Construction Manager: The contractor’s construction manager
responsible for the contractor’s daily construction activities at the site.
4.
Requirements
Review the “Critical Lift Plan” at the lift site just prior to making the lift.
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Critical Lift Plan documentation
The lift plan must include:
o Current certification of the crane operator
o Type of crane(s; rubber tire, track stationary, does the crane require on site
assembly, including a copy of the most current certification
o Is a load test required?
o Type rigging that will be used, including rated capacity
o Most recent annual inspection records, which must include the name of the
person conducting the inspection and qualifications
o Conditions that may delay the lift
o Overhead hazards power lines, guidelines etc.
o Soil/ground conditions [are the any subsurface vaults USTs, duct-banks storm
water sewers, etc.
o A Communication Plan – will radio or hand signals be used, how will other
affected stakeholders in the area notified
o Load details
o Will tag lines be used? If yes: how will they be used, is there sufficient room,
what are the hazards etc.
o Contingency plan what if something goes wrong? Mechanical failure, incorrect
load calculation resulting in exceeding 90% of crane capacity
o Written calculations of the lift, including the configuration of the rigging and load.
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Safety precautions necessary for all employees in the area, including personnel
employed by other contractors.
All lifts out of water require additional calculations.
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Review of crane inspection and maintenance documentation to ensure they are current.
Page 2 of 7
Contractor Safety
Number: CSM - 019
Title:
Critical Lift Template
Revised: 08/21/2013
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A Pre-job briefing including all employees involved in making the lift.
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The briefing of all other contractor’s superintendents who have employees working
within the area, if any.
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Review and update of all associated JHA’s/JSA’s.
The contractor shall comply with all Federal, State, and Local laws and regulation regarding the
inspections, maintenance, and operation of the cranes within their fleet.
The OSHA rule prohibits hoisting personnel by crane or derrick except when no safe alternative
is possible. Based on the review of the record, OSHA determined that hoisting with crane- or
derrick-suspended personnel platforms constitutes a significant hazard to hoisted employees
and must not be permitted unless conventional means of transporting employees are not
feasible or unless they present greater hazards.
Page 3 of 7
Number: CSM - 019
Title:
Critical Lift Template
Revised: 08/21/2013
Contractor Safety
CRITICAL LIFT PLAN
Project Name:
Location:
Date:
Company:
Submitted By:
Approved By:
Crane Manufacturer:
Model Number:
Crane Inspection Date:
Weather Condition:
Description of Load:
Boom Length:
Boom Angle:
Degree of Swing:
Jib Length:
Offset/Type:
Max Operating Radius:
Crane Rated Cap:
Total Weight:
Percent of Chart:
Classification (check all that apply)
Load is over 75% of crane’s capacity for current configuration
Lift is more than 20 tons
Lift is over operating systems(charged electrical equipment, pipelines, etc)
Lift uses two (2) or more cranes
Hoisting of Contractor employees on a suspended work-platform/man-basket
Signatures
Construction Supervisor:
Construction Manager:
Safety Manager:
Crane Operator:
Rigging Supervisor:
Page 4 of 7
Number: CSM - 019
Title:
Critical Lift Template
Revised: 08/21/2013
Contractor Safety
Pre-Lift Meeting Attendees
Printed Name
Signature
Page 5 of 7
Number: CSM - 019
Title:
Critical Lift Template
Revised: 08/21/2013
Contractor Safety
LIFT DETAIL SHEET 1
Weight
Jib
Weight of Equipment
Weight of Headache Ball
Weight of Load Block
Weight of Lifting Bar
Lbs.
Lbs.
Lbs.
Lbs.
Weight of Slings & Shackles
Weight of Jib
Weight of Cable (Load Fall)
Allowance for Unaccounted Material
in Equip. (10% of Equip Weight)
Other (Water):
Total Weight
Source of Load Weight
Lbs.
Lbs.
Lbs.
Lbs.
Lbs.
Lbs.
(Name Plate, Drawings, Calculated):
Weight Verified By:
Crane
Type of Crane:
Crane Capacity
Lifting Arrangement:
 Max Distance Center
Load to Center Pin
Lbs.
Stowed:
Length of Jib
Angle of Jib
Rated Cap of Jib (from Chart)
Sizing of Slings/Shackles
Sling Selection
Ft.
Deg.
Lbs.
Type of Arrangement
Number of slings in hookup
Cert. Attached or Number
Sling Length
Slings
Rated Capacity of Slings
Shackle Selection
Lbs.
Ft.
Capacity
Shackles attached to load by
Number of Shackles
Tons
Cert Attached or Number
Ft.
 Length of Boom
Ft.
 Angle of Boom @Pickup
Deg.
 Angle of Boom @Set
Deg.
Rated Capacity of crane under most severe lifting
conditions:
 Over Rear
Lbs.
 Over Front
Lbs.
 Over Side
Lbs.
Rate Capacity of Crane for Lift
Lbs.
Maximum Load on Crane
Lift is
% of Crane’s Rated Capacity
Erected:
Crane Placement
Yes
No
Smooth Solid Foundation in area?
Electrical Hazards in area?
If “Yes” Explain:
Obstructions/Obstacles to Lift/
Swing?
If “Yes” Explain:
Lbs.
Underground piping/Cables?
If “Yes” Explain:
Page 6 of 7
Number: CSM - 019
Title:
Critical Lift Template
Revised: 08/21/2013
Contractor Safety
LIFT DETAIL SHEET 2
Pre-Lift Check List
Questions
Yes
No
Questions
Yes
Matting Acceptable?
Outriggers Fully Extended?
Crane in Good Condition?
Adequate Awing Room?
Tag line Used?
Experienced Operator?
Experienced Flagman Designated?
Experienced Rigger?
Head Room Checked?
Maximum Counterweight Used?
Load Chart in Crane?
Wind Conditions?
Crane Inspected by:
Date:
Functional Test of Crane By:
Date:
Diagram Crane & Load Placement
(Draw in Space Below or attach copy)
No
Diagram Rigging Configuration
(Draw in Space below or attach copy)
Special Instructions or Restrictions for Crane, Rigging, Lift, Etc.
(a) MULTIPLE CRANE LIFTS REQUIRE A SEPARATE LIFT PLAN FOR EACH CRANE.
(b) ANY CHANGES IN THE CONFIGURATION OF THE CRANE, PLACEMENT, RIGGING,
LIFTING SCHEME, ETC. OR CHANGES IN ANY CALCULATIONS REQUIRE THAT A LIFT PLAN
BE DEVELOPED.
Page 7 of 7