Petron

CRITICAL LIFT CHECKLIST

SAFE WORK PERMIT NO.:

JOB DESCRIPTION:

LOCATION

NOTES:1. !!! A SAFE WORK PERMIT IS REQUIRED FOR A CRITICAL LIFT !!!2. All items on this checklist form an integral part of this standard. Each item MUST be acknowledged by circling Y (yes), N (no) or N/A (not applicable). Items on the checklist with only a Y (yes) answer opposite them are mandatory.

3. A pre-job planning meeting is required to ensure complete job preparation and understanding.

1.General

Planning Information:

Total load weight below hook=

Max. Boom length=

Lowest Boom angle=

Max. Operating radius=

Allowable load at max. radius=

% of allowable load=

Method(s) used to determine load weight:

Name of person responsible for load weight determination:

Site/unit safety standards and procedures specific to this job have been reviewedYN/A

All workers clearly understand their role and responsibilitiesY

Weather conditions are favourable for this liftY

Wind speed judged acceptable for this liftY

Emergency plan discussed for worst case scenarioY

Loads centre of gravity is prevented from shifting during liftY

Any underground installations within lift area needing special treatment?YN

(If yes, what?)

Best and most practical method of communication (between signal person and equipment operator to be used:

[ ] Radio

[ ] Hand Signals

Other

A designated channel/frequency is available for radio communication

(CHANNEL # )YN/A

2.Workers Responsibilities

a)Signal Person

Name

Person is a competent worker in his roleY

Understands lift procedure/planY

Familiar with method of communicationY

Will be wearing a signal vestY

Has plan for controlling lift zoneY

Has experience with this type of liftY

Will ensure receiving area is properly prepared for loadY

b)Head Rigger

Name

Person is a competent worker in his roleY

Has experience with this type of liftY

Familiar with method of communicationY

Will ensure adequate condition and rating of rigging equipment before liftY

Will inspect for proper rigging before liftYN/A

Will inspect for proper rigging practices before liftY

Knows determined load weightY

c)Hoisting Operator

Name

Certified to operate the equipmentY

Has experience operating this type of equipmentY

Has inspected the equipment and found it in acceptable condition for this liftY

Understands lift procedure/planY

Has experience with this type of liftY

Familiar with method of communicationY

Has verified allowable load calculationsY

Max. Operating radius measured with proper/legal measuring deviceY

Has pre-lift check of crane been completed i.e. water/fuel/oil levelsY

If communication fails the operator will cease lifting operation immediatelyY

3.Hoisting Equipment:

Major hoisting equipment to be used:

Soil bearing allowable load checkedY

Outrigger beams will be fully extendedYN/A

Outrigger float pads are being used and good conditionYN/A

Proper mats are being used and in good conditionYN/A

Machine will be level during lift operationY

Structural worthiness certificate up to dateY

Load cable visually inspectedY

Lift lugs are properly designed, used and inspectedYN/A

4.Conditions

a)Load exceeds 85% of max. Allowable loadYN

(If yes, complete this section)

Weight of load (empty)

lbs/kg

Weight of load internals

lbs/kg

Weight of hooks

lbs/kg

Weight of load block

lbs/kg

Weight of headache ball

lbs/kg

Weight of cable

lbs/kg

Weight of spreader bar

lbs/kg

Weight of rigging

lbs/kg

- Total Weight

lbs/kg

- Percentage total load weight of max. Allowable load

= %

b)Load exceeds 50% of max. allowable load and failure would endanger existing facilitiesYN/A

(If yes, complete this section and section 4a)

Existing facilities=

Facilities can be protectedYN

Plan in place can be place for isolating facilities in case of failureYN/A

Occupied facilities beneath lift zone will be vacatedYN/A

c)Lift is within 4.5 meters of or above high voltage conductorsYN

or

Uninsulated high voltage lines within the 360 degree swing arc of the boomYN

(If yes, complete this section)

Lift has been approvedYN/A

(If yes, approved by)

Alternate lift/swing positions have been examinedY

De-energizing lines/conductors is not considered feasibleY

All workers are aware of electrical hazardY

There is a separate signal person designated to watch line/conductor clearance onlyY

Name

``

Crane is properly groundedYN/A

d)More than one crane required to make the lift and the verified lift exceed 50% of the max. allowable load for any of the cranesYN

(If yes, complete this section)

A plan detailing the sequence of steps for the entire lift has been reviewedY

All applicable conditions have been considered for each boomY

Is the lift planned so that at no time any of the booms will have more than 80% of their load capacityY

A competent person has been selected to co-ordinate this liftY

Name

e)Lift will require use of man-basketYN

(If yes, complete this section)

Alternate means of access have been consideredY

Man-basket has been inspected (and documented) in the last 12 monthsY

Man-basket will be visually inspected before liftY

Wind speed judged acceptable for this liftY

At least one attended tag line to be usedY

Fall protection to be usedY

Weather changes during lift have been consideredY

Crane will not be used for any other purpose during lift

Crane will not be travelled with personnel elevatedY

Operator will not leave with personnel elevatedY

Emergency rescue plan discussed and understood by allY

Escape type breathing apparatus available in crane cab and in basket if in areas of potential hazardous gas releaseY

Communication system for elevated personnel establishedY

Only personnel and small tools will be carried in the man-basketY

f)Lift requires hydraulic crane with 2 lines reevedYN

(If yes, complete this section)

Anti-two-blocking devices are operationalY

Additional weight of hooks and rigging have been consideredY

Is the whip line capable of handling the entire load?YN/A

A plan detailing the sequence of steps for the entire lift has been reviewedY

Is the lift planned so that at no time either of the lines will have more than 80% of their load capacityY

A competent person has been selected to co-ordinate the liftY

Name

Additional Comments:

Safety plan/lift procedure reviewed by the following involved parties (Name in BLOCK letters, followed by signature):

Client Representative:

SNC-Lavalin:

Contractor:

All workers involved with lift:

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