Provide comprehensive identification and contact information for the project, equipment, and personnel. All certification documents must be current and uploaded.
Project Name
Project Number
Crane Manufacturer
Crane Model
Crane Serial Number
Crane Manufacturing Year
Maximum Rated Capacity (metric tons)
Maximum Boom Length (meters)
Total Counterweight Installed (tons)
Crane Certification Document
Certified Crane Operator Full Name
Operator Certification Number
Operator Certification Expiry Date
Years of Crane Operating Experience
Operator License/Certification Document
Planned Outrigger Setup Date & Time
Site Manager/Supervisor Name
Site Manager Contact Number
Emergency Contact Name
Emergency Contact Number
Current Insurance Certificate
Complete detailed geotechnical assessment and matting calculations. All values must be verified by a qualified geotechnical engineer. Provide calculations for both un-matted and matted conditions.
Primary Soil Classification
Clay (Cohesive)
Silt (Cohesive)
Sand (Granular)
Gravel (Granular)
Organic Soil
Bedrock
Fill Material
Unconfined Compressive Strength (kPa)
Measured Soil Bearing Capacity (kPa)
Has a geotechnical report been prepared for this site?
Bearing Pressure Calculation Matrix
Load Scenario | Crane Load (tons) | Outrigger Reaction Force (kN) | Outrigger Pad Area (m²) | Calculated Ground Pressure (kPa) | Soil Capacity (kPa) | Within Safe Limits? | |
|---|---|---|---|---|---|---|---|
Maximum Load - Unmatted | 90 | 850 | 1.5 | 567 | 45 | ||
Maximum Load - Matted | 90 | 850 | 9 | 94 | 45 | Yes | |
Steel Matting Material Specification
Grade 350 Steel Plate
Grade 400 Steel Plate
Aluminum Alloy 5083
Composite High-Density Polyethylene
Timber Laminated Mats
Matting Length (meters)
Matting Width (meters)
Matting Thickness (mm)
Required Matting Overlap (mm)
Total Matting Weight (kg)
Is ground improvement (e.g., soil stabilization, compaction) required?
Applied Safety Factor
Have independent engineering calculations been verified?
Comprehensive utility and cavity inspection is mandatory before outrigger placement. All detection methods must be documented with photographic evidence.
Underground Utility Detection Methods Used
Ground Penetrating Radar (GPR)
Electromagnetic Locator
Utility As-Built Drawings Review
Visual Pot-Holing/Excavation
Acoustic Pipe Locator
Vacuum Excavation
Are current utility maps available and accurate?
Utilities Identified Within 10m Radius of Outrigger Positions
Electrical Power Lines
Natural Gas Pipeline
Water Mains
Sewer/Storm Drain
Fiber Optic/Communication
Fuel Storage Tanks
Steam Pipes
No Utilities Detected
Minimum Clearance Distance to Nearest Utility (meters)
Depth of Nearest Utility Below Grade (meters)
Are any utilities located within the crane's operating radius?
Has Ground Penetrating Radar (GPR) been used to scan for sub-surface cavities?
Any voids, cavities, or undocumented excavations detected?
Utility Inspection Completion Date & Time
Qualified Utility Inspector Name & Credentials
Upload Utility Clearance Permit
Photo Documentation of Utility Markings at Site
Real-time weather monitoring and precise outrigger leveling are critical for safe crane operations. All measurements must be taken immediately before and during operations.
Current Wind Speed at Ground Level (m/s)
Wind Speed at Maximum Boom Height (m/s)
Wind Direction (cardinal direction)
Gust Factor (maximum recorded)
Is current wind speed within manufacturer's safe operating limits?
Ambient Temperature (°C)
Relative Humidity (%)
Precipitation occurring?
Visibility (meters)
Weather Data Source/Station ID
Outrigger Position & Leveling Verification
Outrigger Position | Distance from Crane Center (m) | Pad Elevation (m) | Level Reading (degrees from horizontal) | Within ±1° Tolerance? | Contact Pressure (kPa) | Photo of Pad Placement | |
|---|---|---|---|---|---|---|---|
Front Left | 6.5 | 102.3 | 0.5 | Yes | 95 | ||
Front Right | 6.5 | 102.3 | 0.3 | Yes | 98 | ||
Rear Left | 6.5 | 102.3 | 0.4 | Yes | 96 | ||
Rear Right | 6.5 | 102.3 | 0.6 | Yes | 94 | ||
Leveling Verification Method
Digital Inclinometer
Spirit Level/Bubble Level
Laser Level
Total Station Survey
Crane's On-board Leveling System
Are all outrigger pads fully bearing on stable ground/matting?
Describe any weather-related restrictions or operational limitations
Final verification and joint authorization by qualified personnel. All preceding sections must be completed satisfactorily before sign-off.
Pre-Operational Safety Checklist Verification
Not Verified | Verified - Satisfactory | Verified - Requires Attention | N/A | |
|---|---|---|---|---|
All outriggers properly extended and positioned | ||||
Matting correctly sized and positioned under all outriggers | ||||
Swing radius barricaded and controlled | ||||
Load chart available and appropriate for configuration | ||||
Anti-two block system functional | ||||
Load moment indicator (LMI) calibrated and functional | ||||
Ground conditions stable and verified | ||||
All personnel briefed on lift plan | ||||
Emergency procedures communicated | ||||
Communication devices tested and functional |
Has a comprehensive lift plan been developed and reviewed?
Planned Maximum Load for This Setup (tons)
Maximum Load Radius (meters)
Are there any overhead hazards within the work zone?
Designated Emergency Assembly Point
Designated Radio Communication Channel
Have all ground personnel and spotters been briefed?
Special Precautions or Operational Restrictions
Photo Evidence of Completed Outrigger Setup
Photo of Overall Site Configuration
Certified Crane Operator Digital Signature
Operator Sign-Off Timestamp
Site Safety Director Digital Signature
Safety Director Sign-Off Timestamp
I confirm that all information provided is accurate and complete to the best of my knowledge, and that crane operations may proceed safely under the conditions specified.