Non-Critical Daily Lift Plan
Project name:
Job No.
Site and Area:
Completion Date:
Part A: Schedule of "Routine" Lifts
Part A: Schedule of "Routine" Lifts
Rows
Description of load
Approx. weight (lbs)
Approx. reach (ft)
Approx. height (ft)
Method
Total Weight: ((Weight / Lifting Capacity) * 100%)
1
2
3
*** All lifts shall have a lift plan completed prior to performing any lifts. A new plan should be completed every day to assess current conditions and inspection of all rigging hardware and attachments. If a tandem lift (two or more pieces of equipment) is to be performed or the lift is over 75% of the equipment's rated capacity, contact the Safety Department for completion of a Critical Lift Plan. ***
Part B: Type of Equipment
Type of Equipment
Telehandler
Forklift
Hoist
Excavator
Make:
Model:
Serial Number
Attachments (bucket, jib, etc.):
Date of Last Inspection:
Lifting Capacity
Maximum Safe Working Loads (lbs):
Max Radius (ft) (Measured from Out Riggers):
Lifting Capacity:
Maximum Height (ft):
Maximum Reach (ft):
Part C: Rigging Configuration
Type of Rigging to be Used:
Rigging Safe Working Load (SWL):
SWL Tags Attached & Legible:
Rigging Length (ft):
Shackles (size/rating):
Rigging Horizontal Angle < 45°:
Yes
No
Part D: Pre Lift-Checklist
Part D: Pre Lift-Checklist
Rows
Present?
Is the lift within the rated capacity?
Yes
No
Unstable or soft ground identified? Matts or plates needed?
Yes
No
Rigging components compatible? Are there visual signs of side loading?
Yes
No
Are softeners and/or edge protectors used to protect from sharp edges?
Yes
No
Have wind speeds been accounted for?
Yes
No
Any overhead lines or obstructions within the equipment's swing radius?
Yes
No
Exclusion zone and travel path have been identified and delineated?
Yes
No
Rigging and lifting attachments inspected and within the rated capacity for the load?
Yes
No
Pre-Lift meeting has been conducted and roles/responsiblityies for all personnel defined?
Yes
No
Part E: Plan Review
Part E: Plan Review
Rows
Name
Signed
Date
Designated Signal Person
Equipment Operator
Supervisor or Designated Lead
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