Crane Lift Permit Permit No.

SECTION - 1: WORK REQUEST

EXACT LOCATION NO. OF CREW
DESCRIPTION OF WORK:

SUBCONTRACTOR / DIVISION REQUESTED PERMIT: DATE APPLIED:

P.Receiver Contact NO Supervisor Contact No

Description of Load Crane Model/ Capacity

Weight of Load A Boom Length

Weight of Rigging and Crane Block B Jib Length

Total Erection Load (A+B） Maximum Radius of Lift

Percent Crane Capacity at Maximum

Crane Capacity at Maximum Radius
Lift Radius
of Lift radius C
（A+B）/ C
Attach supporting Rigging Study, Drawings and Lift Plan for
Non-Engineered Lift Engineered Lift
all Type ‘B’ and Type ‘C’ Engineered Lifts.

RIGGING GEAR REQUIRED – SIZE AND CAPACITY

Shackles Spreader
Slings Tailing Hook-Up
SECTION 2 SAFETY CHECK LOAD AND LIFTING LUG

1. Has the weight of the load been documented or accurately calculated? 2. Are all items that will be lifted with the equipment included in the weight?

3. Have the lifting lugs that will be used to lift the load been designed for that
4. Will the lifting lugs be used with the correct shackle?
purpose?

5. Will the lifting lugs be loaded only in the strong direction(s) of the lug? 6. Are the lifting lugs visibly free of defects or damage?

7. Has the load been checked for loose or unsecured items, which might fall off 8. For a one-crane lift will the crane hook be over the center of gravity at the initial
during the lift? pick?

RIGGING GEAR
9. 9. Have the capacities of the slings and shackles been checked for the 10. Have the slings and shackles been visually inspected for defects or damage?
load?
11. Have the sling angles been considered when checking the capacity of the slings 12. Has the center of gravity been considered when checking the capacities of the
and shackles? sling and shackles?

CRANE
13. For a crane that has a load-indicating device with overload cut-off, is the total 14. For a crane that does NOT have a load indicating device with overload cut-off,
load less than 90% of the allowable crane capacity? is the total load less than 80% of the allowable crane capacity?

15. Has the crane received a daily inspection and operational check by the operator? 16. Is the crane set up according to the manufacturer’s specifications?

17. Is the crane supported by approved crane mats? 18. If the lift involves more than one crane, can it be made without any possibility
of one of the cranes being overloaded?
19. Has the soil been inspected and determined to be adequate?

LIFT
20. Has the radius of the lift been checked by a tape measure? 21. Is the lift area free of operating process equipment, piping, or live electrical
lines?
22. Has the area under the lift been barricaded or everyone warned to stay away? 23. Is the wind less than 20 miles per hour?

24. If there is a possibility for boom or equipment interference, has a rigging layout
or clearance study been made? 25. Has one person been designated “Signalman-in-Charge” for the lift?

NOTE! All questions should be answered yes, no, or N/A (not applicable). The Rigging Superintendent must approve any checklist item answered by “no”.
SECTION 3. AUTHORIZATION
Position Name Signature Date
Requested By
Permit Receiver
Cons. In-charge
Reviewed By
HSE In-charge
☐PDC ☐(O&M)
Issued by PDC Discipline Engineer
SECTION 4. WORK COMPLETION
I confirm that the work has been properly performed and completed.
Equipment and area affected by the work has been left in a safety / tidy condition.
Name Date Time Sig
Permit receiver

Permit Issuer