Crane Safety Assessment
Verification of safety-critical items for crane work being conducted by a contractor on a Validus Energy Location.
Your Name
*
Date
*
-
Month
-
Day
Year
Date
Location of Job
*
Crane Owner
*
Activity
*
Please Select
Drilling
Completions
Production
Construction
Midstream
Other
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Personnel Verification
Crane Operator Name
*
Photo of Operator's Certification
*
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Operator's Certification Expiration Date
*
Rigger Name
*
Rigger Qualifications
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Signal Person Name
*
Signal Person Qualifications
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Additional Personnel Information
Crane Information
Crane Picture
*
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Manufacturer
*
Load Rating
*
Load chart is present
*
Yes
No
STOP THE JOB UNTIL COMPLETE
Annual inspection documentation onsite
*
Yes
No
Annual Inspection Photo
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STOP THE JOB UNTIL COMPLETE
Daily visual inspection has been completed.
*
Yes
No
Completed By:
*
STOP THE JOB UNTIL COMPLETE
Powerline assessment has been done, and crane is clear of overhead hazards.
*
Yes
No
STOP THE JOB UNTIL COMPLETE
Is the lift being done a critical lift?
*
Yes
No
Has a critical lift plan been developed?
Yes
No
Completed By:
STOP THE JOB UNTIL COMPLETE
A pre-lift safety meeting was held.
*
Yes
No
Led By:
STOP THE JOB UNTIL COMPLETE
Crane alarms and auto stops are functional.
*
Yes
No
STOP THE JOB UNTIL COMPLETE
Drop zone has been marked and barricaded.
*
Yes
No
STOP THE JOB UNTIL COMPLETE
The rigger has verified that all chains and slings meet the requirements to be in service.
*
Yes
No
STOP THE JOB UNTIL COMPLETE
Emergency procedures and fire extinguisher locations have been reviewed.
*
Yes
No
STOP THE JOB UNTIL COMPLETE
Additional Comments/Notes
Signature
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Should be Empty: