Title:    Project:	Date:    Job Number:
Description:    Jobsite Address:
Customer:	P.O./ Contract#:
Lift Plan Drawing and Load Placement Drawing attached?    Notes:

Crane Information

Manufacturer:

Model:

Serial #:

Crane Rating:

Crane Inspection Date:

Notes:

Lift Information

Crane Radius:

Crane Capacty at Radius:

Capacity at Pick Point:

Capacity at Set Point:

Notes:

Crane Configuration

Crane Carrier:

Counterweight:

Chart Capacity:

Main Boom Length:

Boom Sections:

Parts of Line:

Line Size:

Capacity of Line @ Parts:

Radius:

Boom Angle:

Tip Height:

Jib Used?

Jib:

Jib Offset:

Jib Angle from Ground:

Ground Bearing Pressure (Worst Case):

Setup Information

Crane Setup:

Setup Distance:

Mat Used?

Mat Dimensions:

Ground Bearing Pressure below Mat:

Notes:

Load Configuration

Gross Load Weight:

Description:

Dimensions:

Load Weight:

Rigging Weight:

Hook Weight:

Block Weight:

Load Line Weight:

Hook Height:

Sling Length:

Sling Angle:

Sling Equipment #:

Sling Type:

Sling Capacity:

Spreader Bar #:

Spreader Bar Capacity:

Hook Block:

Shackle Type:

Shackle Qty:

Shackle Capacity:

Additional Rigging:

Additional Rigging Capacity:

% of Chart Capacity:

Chart Capacity Deduction:

Deduct Capacity:

Notes:

Title:    Project:

Date:    Job Number:

Notes:

Notes:

Pre-Lift Checklist

Crane Operator:	Name:
Signalperson Assigned:	Name:
Communication Method:
Crane Inspected by Operator?
Rigging Inspected?
All Permits Obtained?
Are weather conditions OK?
Wind OK?
Are there Power Lines?
Is Operators Certification Card current?
Is area OK for entry and exit of jobsite?
Has a pre-lift meeting between operator, signalperson, supervisor, and any and all other persons occured?
Other Considerations:

Signatures

Engineer:	Name:	Signature:	Date:
Supervisor:	Name:	Signature:	Date:
Operator:	Name:	Signature:	Date:
Client:	Name:	Signature:	Date: