Jefferson Lab Lift Plan Form

(See ES&H Manual Chapter 6141 Appendix T4

Hoisting and Rigging Operations) for Instructions

 

 

Instructions:

This form must be completed for each lift using a mobile crane, or a critical lift, with an overhead crane and/or forklift.

This form should be used for a non-routine lift with overhead cranes or incorporated into a Temporary Operational Safety Procedure.

STEP 1 – Planning the Lift

Lift Title

 

 

Location:

 

 

Lift Date:

 

 

 

 

 

 

Lift Plan Prepared by:

 

 

 

 

 

 

Print

 

Date

Lift Plan Approved by:

 

 

 

 

Print

Signature

Date

JLab Work Coordinator:

 

 

 

 

 

Date

 

DOE Lift Classification:

 

CRITICAL

 

PREENGINEERED PRODUCTION

 

ORDINARY

 

Load Weight #

Weight Determined By:

 

   Equipment Manufacturers Data Plate

   Rigger Estimate

   Labeled Shipping Weight

   Dyno Measured

 

Describe the Load:

 

 

Rigging Hardware Required*: List all items (size & load rating) to be used under the hook to accomplish the planned lift.

 

 


 

 

PLAN VIEW

 


STEP 1 – Planning the Lift

Show the Following:

 

·     Load with CG labeled

·     Mobile Crane, Pivot and Outriggers

·     Distance from load CG to Crane Pivot

·     Underground Utilities, manholes and valve boxes

·     Overhead Obstructions

·     Lift Perimeter Demarcation

 

 


 

STEP 1 – Planning the Lift

ELEVATION

Show the Following:

 

  • Load with CG labeled
  • BTHLD’s
  • Sling Horizontal Angels
  • Sling Tensions
  • Label Rigging Gear, size & WLL
  • Label D/d ratios

 

 

 


 


STEP 2 – Setup for Lift[i]

Crane Make:

 

Model:

 

Type:

 

 

Crane Owner

 

 

·  Annually Inspection By:

 

Date:

 

 

·  Daily Inspection Documented:

Yes     No

·   Monthly Wire Rope Inspection Documented:

 

·   Quadrenial Proof Load Test Documented:

By:______________________________________

Date:_____________

 

Crane Operator[ii]

 

 

·  Certification/Qualification:

 

 

·  CCO No:

 

Expiration Date:

 

 

·  Employer:

 

 

 

Lead Rigger:

 

 

·  Certification/Qualification:

 

 

 

 

 

Lift Director (ASME) or PIC (DOE)[iii]:

 

 

Site Supervisor[iv]:

 

·   Establishes a perimeter that clearly identifies the area of the lift. 

·   Ensures all personnel within the perimeter:

·   Wear hard hat, safety shoes, safety glasses and any additional PPE required for the area.

·   Attend the Pre-Lift Meeting.

·   Conducts a Pre-Lift Meeting where the sequence of actions that will occur to accomplish the lift are presented.

Signal Person: __________________________________________________________________________

 

PPE Requirements:

·   Hard Hat

·   Safety Shoes

·  Safety Glasses

·   List Additional Requirements:

 

Watch Personnel:

(Maintains lift Perimeters)

 

 

Identify a Muster Point:

 

 

 


 

STEP 2 – Setup for Lift[v]

Emergency Procedure (In case of injury)

 

  1. Stop Lift
  2. Lower Load to a safe position
  3.  

 

 

 

 

 

 

Limits of Safe Operation (Example: Wind, Rain, Lighting, Traffic)

 

 

 

 

 

Step 3 - Lift

Accomplish the lift according to the Lift Plan.

Document minor adjustments required to accomplish the lift.

Step 4 – Post-Lift Actions

 

 

Post Lift De-Brief

 

 

What went well:

 

 

Suggested Improvements:

 

 

 

 

 

 

 

 

Documentation - Send a Copy of this Completed Lift Plan to:

Name:

 

 

 

 

 

Print

E-Mail

 

Mail Stop

 

 


 



* Rigging Hardware must be inspected and marked in accordance with the criteria contained in the following documents:

            ASME B30.9 Slings

            ASME B30.20 Below the Hook Lifting Devices

            ASME B30.26 Rigging Hardware

            29 CFR 1926.251 Rigging Equipment for Material Handling

 

[i] Excerpts from ASME B30.5-2007

5-3.1.3 Responsibilities

While the organizational structure of various projects may differ, the following roles are described here for purposes of delineating responsibilities.  All responsibilities listed below shall be assigned in the work site organization. (A single individual may perform one or more of these roles.

[ii] Crane Operator:  directly controls the crane’s functions.

[iii] Lift Director: directly oversees the work being performed by a crane and the associated rigging crew.  This position equates to the Person-In-Charge (PIC) identified in the DOE Hoisting & Rigging Standard.

[iv] Site Supervisor: exercises supervisory control over the work site on which a crane is being used and over the work that is being performed on that site.

 

Form Revision Summary

Revision 1.1 – 03/22/12 – Update to format only.

Revision 1 – 04/12/10 – Updated to reflect current laboratory operations

 

ISSUING AUTHORITY

FORM TECHNICAL

POINT-OF-CONTACT

APPROVAL DATE

EXPIRATION DATE

REV.

 

 

ESH&Q Division

Dave Kausch

04/12/10

04/12/13

1.1

 

This document is controlled as an on line file.  It may be printed but the print copy is not a controlled document.  It is the user’s responsibility to ensure that the document is the same revision as the current on line file.  This copy was printed on 3/22/2012.