Project Name
Project Location / Area
General Contractor / Employer
Lifting Subcontractor
Permit Date
Permit Valid Time Period
Start
End
Specific Location of Lift
Description of Load / Work
Select all conditions that trigger this critical lift permit
Load exceeds 75% of crane rated capacity at maximum radius.
Multi-crane / Tandem lift (2 or more cranes lifting a single load).
Lifting personnel in a hoist platform / basket.
Operation within minimum approach distance of energized power lines.
Lifting over occupied buildings, active roadways, or critical processing units.
Non-standard or custom rigging arrangement / complex balance points.
Subsurface / Ground condition concerns (e.g., underground vaults, poor soil capacity).
High-value, unique, or long-lead time equipment item.
Role | Name | Phone Number | Certification # | Certification Exp | |
|---|---|---|---|---|---|
Lift Director | |||||
Crane Operator | |||||
Primary Signal Person | |||||
Lead Rigger | |||||
Site Safety Manager |
Crane Make & Model
Crane Type
Mobile Hydraulic (Rough Terrain / All Terrain)
Lattice Boom Crawler
Tower Crane
Crane Serial / Equipment ID
Third-Party Annual Inspection Date
Counterweight Installed (tons)
Main Boom Length (m)
Jib Length (m)
Jib Angle (°)
Outrigger Extension
100% Fully Extended
50% Intermediate
On Rubber (N/A)
Weight of Load / Object (kg)
Source of weight
Scale Ticket
Manufacturer Drawing
Calculated
Weight of Main Hook Block & Ball (kg)
Weight of Rigging Hardware (slings, shackles, spreader bars) (kg)
Weight of Jib / Boom Attachments (effective weight) (kg)
Weight of Hoist Cable below Boom Tip (kg)
Total Gross Load Weight (kg)
Maximum Planned Operating Radius (m)
Crane Rated Capacity at Max Radius (from Chart) (kg)
Percentage of Rated Capacity
Critical Threshold Policy: Lifts exceeding 85% capacity require written concurrence from a certified Professional Engineer (PE). Lifts exceeding 100% capacity are strictly prohibited.
Check Pass, Fail, or N/A for each requirement:
Safety Requirement | Pass | Fail | N/A | ||
|---|---|---|---|---|---|
1 | Ground & Soil Conditions: Ground compaction tested or matting installed per engineered bearing capacity calculations. | ||||
2 | Outrigger Cribbing/Pads: Steel plates or engineered timber mats properly sized and placed under outrigger floats. | ||||
3 | Underground Hazards: Location of underground utilities, vaults, pipes, or voids verified and clear of outriggers. | ||||
4 | Power Line Distances: Minimum approach distance maintained per OSHA Table T-1 (e.g., 20 ft for up to 350 kV). | ||||
5 | Weather & Wind Limits: Sustained wind speed is below maximum manufacturer limit | ||||
6 | Rigging Inspection: All slings, shackles, spreader beams, and eye bolts inspected and tagged with safe working load (SWL). | ||||
7 | Tag Lines: Minimum of two tag lines available and assigned to control load rotation. | ||||
8 | Exclusion Zone: Drop zone barricaded with warning tape; unauthorized personnel cleared from area. | ||||
9 | Communications: Two-way radios tested on dedicated channel, or visual signals agreed upon by Operator and Signal Person. | ||||
10 | Safety Devices: Anti-Two Block (A2B) device, boom angle indicator, and LMI (Load Moment Indicator) operational and calibrated. |
Before lifting, the Lift Director must conduct a mandatory toolbox talk with all involved personnel.
Reviewed sequence of operation and load path.
Clarified line-of-sight limits and designated signal personnel.
Emergency stop command reviewed (Anyone on site can call STOP if a safety issue arises).
Emergency action plan and evacuation routes confirmed.
PPE inspected (hard hats, high-vis vests, steel-toe boots, fall protection if applicable).
By signing below, all parties confirm that the pre-lift checks are complete, calculations are verified, and conditions are safe to perform the critical lift.
I certify that I have inspected the lift site, reviewed the critical lift plan, verified all load calculations, and conducted the pre-lift briefing.
Lift Director Signature
I confirm that I have reviewed the crane capacity chart, inspected the crane safety devices, and agree that the lift can be performed safely under current site conditions.
Crane Operator Signature
This Critical Crane Lift Permit is approved based on the verified safety measures and conditions noted above.
Site Safety Manager / Authority Having Jurisdiction Signature
To be completed immediately following the conclusion of the lifting operation.
Lift completed safely with no incidents or near-misses.
Equipment lowered and secured.
Exclusion zones and barricades removed.
Incident / Near-Miss occurred (If checked, attach Incident Investigation Report).
Lift Director Post-Lift Signature