Format No: ZCI /Safety /37
Rev No: 00
Date: 10/7/2017
Lifting Plan
A Lifting Machine: Model/Make Capacity :
B Lifting Gear: Size Capacity
Wire Rope/Nylon sling Remark
D shackles
Spreader Beam
Hook Block
No: of Falls
C Lift Details
Boom Length
Working Radius
Counter weight:
Corresponding SWL
D Load Details(Attach Sketch)
Description
Lifting Points
Dimension
Centre of Gravity
E Load Calculation
Weight of Load
Lifting gear weight
Hook block weight
Total weight
Crane Capacity Usage
F Safety Checklist
Crane Level Yes No Remark
Outrigger properly placed Yes No
Overhead clearance Yes No
Swing radius clear and barricaded Yes No
Limit Switch working Yes No
Audible warning Devices Yes No
Crane equipped with load indicator Yes No
Operator Qualification checked Yes No
Crane Documents (RC, PUC, etc.) Yes No
Crane inspection certificate reviewed Yes No
Signal Person Identified Yes No
Taglines/guide rope available Yes No
G Sign Off
Lift Supervisor Name: Sign:
Crane Operator Name: Sign:
Safety Supervisor Name: Sign:
Permit Issuer Name: Sign: