<p> AAMHERST CCOLLEGE Lifting Plan Cranes and Other Lifting Equipment - > 2,000 lbs</p><p>Building/Site: ______Address: ______Date: ____/____/______</p><p>Lift Description: ______</p><p>Date of Lift: ____/____/______to ____/____/______Time of Lift: _____:_____ to _____:_____</p><p>Competent Person: ______Lift Supervisor: ______</p><p>Crane Information</p><p>Manufacturer: ______Owner: ______</p><p>Model Number: ______Crane Operator: ______</p><p>Crane Description/Type: ______Hoisting License #: ______</p><p>Rated Capacity: ______lbs/tons Last Annual Inspection: ____/____/______</p><p>Gross Weight: ______lbs/tons Inspection Company: ______</p><p>Area of Operation: ______</p><p>Insurance Coverage for Equipment, Liability and Negligence: ______Company and Representative Lifting Plan to the following - Crane Operator: ______- Riggers: ______Company and Representative Signature Company and Representative Signature </p><p>- Engineers: ______- General Contractor: ______Company and Representative Signature Company and Representative Signature</p><p>Lifting Sketch to the following </p><p>Lift Supervisor: ______Crane Operator: ______Company and Representative Signature Company and Representative Signature </p><p>General Contractor: ______Company and Representative Signature</p><p>Maximum Operating Radius to be used during Lift: ______(ft)</p><p>Crane Configuration Main Boom Jib(s) to be used? ____Yes ____ No</p><p># Of Sections: ______# Of Sections: ______Boom Size: ______Jib Size: ______</p><p>Boom Length: ______Jib Length: ______</p><p>Boom Type: ______Jib Type: ______</p><p>Hoisting (Main Boom): ______Job Offset Angle: ______</p><p>Main Boom (Line size/dia): ______Jib Load Radius (max): ______</p><p>Load Radius (max): ______</p><p>Capacity at Lift Point (max): ______Jib Capacity @ Lift Point (max): ______</p><p>Main Boom (Length): ______Jib Boom (Length): ______</p><p>Main Boom @ Pick Angle (Deg): ______Jib Boom @ Pick Angle (Deg): ______</p><p>Main Boom @ Set Angle (Deg): ______Jib Boom @ Set Angle (Deg): ______Lift-Weight Data and Calculations</p><p>Load weight (max): ______lbs Rigging – Lifting Beams (#): ______</p><p>Load Line weight (max): _____lbs/ft @100’ ______lbs Rigging Slings (#): ______</p><p>Load Block (weight): ______lbs Type: ______Capacity: ______</p><p>Crane Components (weight): ______lbs Rigging Shackles (#): ______</p><p>Crane Components Lift Load (weight): ______lbs Type: ______Capacity: ______1.10 Total weight plus factor of % ______lbs Capacity of the Lift ______%</p><p>Pre Lift Checklist</p><p>Crane Inspection Performed by: ______</p><p>Site Inspection Performed by: ______- Safe Entry and Exit - Underground Pits, Tunnels and Utilities - Electricity (underground or overhead) - Obstacles - Overhead Hazards, Barriers and Signage - Swing Clearance - Grade/Slope - Caution Tape/Guards for Crane Swing</p><p>Weather Conditions - Detailed Description: ______Wind Speed: ______mph Wind Gusts: ______mph</p><p>Crane Operator Name: ______Hoisting License#: ______</p><p>Qualified Signal Person(s) is: ______</p><p>Rigging Inspection by Qualified Rigger: ______</p><p>Tag lines to be used?  _____ Yes _____ No _____ N/A o (1 side) (2 side) Length of Line: ______(ft) Line Diameter: ______(in) Description of use: ______</p><p>Pre Lift Meeting (all Contractors/Subcontractors) - Post Pre Lift meeting modifications (detailed): </p><p>______</p><p>______</p><p>Additional graph paper should be used for more detail</p>