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Life Plan Form
Westmont Engineering Lift Plan
Date
(Required)
Month
Day
Year
Job #:
(Required)
Job Site:
(Required)
Time
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Completed By (Competent Person)
(Required)
Project Manager
(Required)
Please Select
Charles
Dan
John
Mike G
Tim
Mike R
Note:
Applies to Cranes, Hoists ,Power-Operated equipment , Forklifts , Telehandlers , etc. that can be used to hoist, lower and/or horizontally move a suspended load.
General Considerations / Area Preparation: 1926.1402
1. Is the lift(s) within the rated capacities? (based on boom height, radius)
(Required)
Yes
No
N/A
2. Boom deflections considered?
(Required)
Yes
No
N/A
3. Have all potential obstructions been identified?
(Required)
Yes
No
N/A
4. Have environmental considerations been addressed? (wind, weather, lightning)
(Required)
Yes
No
N/A
5. Have electrical hazards been addressed (overhead /underground)
- Minimum Approach Distances established?
(Required)
Yes
No
N/A
- Spotter required?
(Required)
Yes
No
N/A
- Utilities located?
(Required)
Yes
No
N/A
6. Swing radius properly barricaded and personnel advised of hazards? 1926.1424
(Required)
Yes
No
N/A
7. Consideration given for no-load travel near energized equipment? 1926.1411
(Required)
Yes
No
N/A
8. The locations for the load landings has been selected and prepared?
(Required)
Yes
No
N/A
9. Blocking and/or cribbing available to set the loads on?
(Required)
Yes
No
N/A
10. Travel paths have been determined and cordoned off?
(Required)
Yes
No
N/A
11. Have ground bearing support questions been addressed?
(Required)
Yes
No
N/A
12. Other personnel in the area have been notified of the lifts?
(Required)
Yes
No
N/A
Considerations:
1. Weights and Centers of Gravity (COG) have been determined?
(Required)
Yes
No
N/A
2. Anything inside/outside the loads that could shift during the lift?
(Required)
Yes
No
N/A
3. Does rigging need protection from the loads?
(Required)
Yes
No
N/A
4. All anchor bolts, hold-downs, or fasteners have been removed?
(Required)
Yes
No
N/A
5. Potential for binding: are load cells required to verify the loads are free?
(Required)
Yes
No
N/A
6. Attachment points rated to take load weight?
(Required)
Yes
No
N/A
7. Are the loads structurally capable of being lifted? (bending/twisting issues)
(Required)
Yes
No
N/A
8. Crane assembly in accordance with the Manufacturer's requirements. 1926.1403
(Required)
Yes
No
N/A
9. Post assembly and Shift Inspection completed? 1926.1412
(Required)
Yes
No
N/A
10. Safety Devices and Operational Aids are present and functioning? 1926.1415 / 1926.1416
(Required)
Yes
No
N/A
11. Is a Critical Lift Plan required?
(Required)
Yes
No
N/A
Comments:
Rigging:
1. All rigging has been inspected by a Qualified Rigger? 1926.1413 / 1926.1414
(Required)
Yes
No
N/A
2. Have sling angles been calculated?
(Required)
Yes
No
N/A
3. Are shackles correctly sized for the sling eyes?
(Required)
Yes
No
N/A
4. Are softeners needed?
(Required)
Yes
No
N/A
Comments:
Personnel:
1. The roles, responsibilities and qualifications for personnel have been defined?
- (Operator, Lift Supervisor, Rigger, Signal Person)
(Required)
Yes
No
N/A
3. Personnel trained per the EM?
(Required)
Yes
No
N/A
2. A Pre-Lift meeting has been conducted?
(Required)
Yes
No
N/A
Comments:
Additional Information:
Operator:
Date
MM slash DD slash YYYY
Rigger(s):
Date
MM slash DD slash YYYY
Signal Person:
Date
MM slash DD slash YYYY
Other:
Date
MM slash DD slash YYYY
Send Form to Client?
(Required)
Yes
No
Client Name
First
Last
Client Email
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