Crane Lift Worksheet Form CRANE LIFT WORKSHEETProject:(Required)Date:(Required) MM slash DD slash YYYY Description:(Required)Job #:(Required)Jobsite Address:(Required)CRANE INFORMATIONManufacturer:(Required)Model:(Required)Serial #:(Required)Crane Rating:(Required)Crane Inspection Date:(Required) MM slash DD slash YYYY SETUP INFORMATIONCrane Setup:(Required) Over Rear Over Front Over Side 360 Foundation/Ground Stability Accepted:(Required) YES No Underground Utilities in Crane Road:(Required) YES No Electrical Hazards in Lift Area:(Required) YES No Obstruction to the Load Movement:(Required) YES No Mat Used:(Required) YES No Mat Dimensions:(Required)CRANE CONFIGURATIONCrane Carrier Weight:(Required)The weight of the crane carrier. Specified in Crane Manual.Counterweight:(Required)The total weight of all counterweight being utilized on the crane.Main Boom Length:(Required)Length of boom in correlation with chart being utilized.Boom Sections:(Required)The number of sections that the boom will have. For a hydro crane this can be found on the chart that will be utilized for the specified setup.Parts of Line:(Required)The parts of crane cable that are visible from the tip of the crane down to the hook or block.Boom Angle:(Required)Angle that the boom will be at while picking the load.Tip Height:(Required)The height of the boom tip while picking the load.Boom Tip to Load Clearance:(Required)The distance from the tip of the boom to the load at the greatest point.Jib Used(Required)Will a jib be used? Yes/No. What size jib & at what angle?LIFT INFORMATIONCrane Radius:(Required)The radius that the crane will be setting at during the liftCrane Capacity at Radius:(Required)The capacity specified on the load chart that is being utilized at the specified radius while lifting.SUBMITTALS RECEIVEDAnnual Inspection:(Required) YES No Operator CCO:(Required) YES No Load Chart:(Required) YES No Panel Layout (Tilt Job):(Required) YES No 3D Lift Plan (Optional): YES No LOAD CONFIGURATIONDescription:(Required)Description of the load being lifted (Tilt Panel 31, RTU’s, Roof Insulation, etc.)Dimensions:(Required)Dimensions of the load being lifted.Load Weight:(Required)The weight of the material that will be hoisted (TPO, insulation, RTU, Tilt Panel, etc.). This number should be the total weight of the heaviest load that will be picked by the crane.Rigging Weight:(Required)The total weight of just the rigging that will be used. (shackles, slings, chokers, etc.).Hook Weight:(Required)The weight of the Hook & Ball of the crane if applicable.Block Weight:(Required)The weight of the Block of the crane if applicable.Load Line Weight:(Required)The weight of the crane cable from the tip of the boom to the load at the ground when picking up the heaviest load. Crane Cable weight per foot multiplied by the distance from the tip of the boom to the load will equal this number.Spreader Bar Weight:(Required)The weight of the spreader bar if applicable.Spreader Bar Capacity:(Required)The total weight capacity of the spreader bar if applicable.Gross Load Weight:(Required)The total of Load Weight, Rigging Weight, Hook or Block Weight, Load Line Weight, and Spreader Bar Weight, added all together.% of Chart Capacity:(Required)Gross Load Weight divided by the Load Chart Capacity at the specified crane setup and radius.Operator Sign Off:PhoneThis field is for validation purposes and should be left unchanged.
