ComplexLiftPlanForm:008Rev:00Date:Page1of2Health,Safety&EnvironmentalNameofProjectLocationCompanyNameRMEDateDescriptionoftheLiftLoadDetailsTypeofLift:SingleLiftTandem(Double)LiftDetailsofCraneCraneOneCraneTwoTypeofCrane/CapacityMaximumBoomLengthCounterweightBoomLength–Luffer/FlyMaximumRadiusofLiftOutriggerCentresLoadCalculationCraneOneCraneTwoMaximumWeightoftheLoad(A)WeightofRigging/LiftingEquipment&HookBlock(B)TotalWeightofLoadtobeLifted(C)=(A+B)CraneCapacityatMaximumRadiusofLift(SWL)(D)PercentCraneCapacityatMaximumLiftRadius(C/D)%No.ofLiftingPoints(incaseofTandemLift)TypesofLiftingGearstobeused:(SpreaderBar,Shackles&Slings)LimitSwitches,SLI,Brakes,AngleIndicatorisWorking?YesNoFlagMan,BanksMan,Barricades,SafetySignsinPlace?YesNoEnergizedPowerLinesWithinBoomRadius?YesNoInCaseofNightShift,DoYouhaveApprovalandallSafetyArrangements?YesNoTagLinesRequiredWindSpeed9.8m/sAnyElectricalHazardsTypeYesNoTypeYesNoTypeYesNoStructuralHazardsLoad85%ofRatedLoadCapacity(BS7121)CraneandallLiftingGearsCertifiedby3RDParty?TypeYesNoTypeYesNoTypeYesNoGroundFirm&LevelAnyUndergroundHazardsCraneandLiftingGearsInspectionStickernotExpired?TypeYesNoTypeYesTypeYesNoNoRiskAssessmentandMarkedPlotPlanattached(required)YesNoComplexLiftPlanForm:008Rev:00Date:Page2of2Health,Safety&EnvironmentalResponsibilities1.ALLCRANESMUSTHAVEAVALIDINDATETESTCERTIFICATEBEFOREOPERATIONSBEGIN.2.CRANEINSPECTIONCHECKLISTMUSTBECOMPLETEDBEFORELIFTINGCOMMENCES.3.LIFTINGEQUIPMENTMUSTBECHECKED,CERTIFIEDANDCOLOURCODEDBEFOREUSE.4.LIFTSPECIFICTOOLBOXTALKTOBECONDUCTEDBYALLINVOLVEDINTHELIFTAPPOINTEDPERSON/RIGGER1-preparesliftplan.LIFTSUPERVISOR-receivesliftplanandchecksthecrane(s)areconfiguredaspertheliftingplan.SITEMANAGERORHISCOMPETENTDESIGNATEDPERSON-areinvolvedintheplanningprocessi.e.identificationofloadweights,liftingpointsetc.APorRigger1,LiftSupervisor,SlingerSignaler/RiggerandCraneOperatorsignontotheliftplanA/PORRIGGER1NameSignedLIFTSUPERVISORNameSignedCRANEOPERATORSignedRIGGER(S)SignedSiteManagerorCompetentDesignatedPersonName:Signature:Date:AnyquestionsorqueriesfortheaboveLiftingschedule,pleaseconsulttheLiftingOperationsManager