Form-034 Crane Work Permit

Form-034 Crane Work Permit

This form must be submitted at least 24 hours before work commences.
Permit Receiver Name
Permit Receiver Phone No
Permit Receiver Company/Boat Name
Permit Receiver Email
example@example.com
Job Location
Crane Company Name
Crane Operator Name
Are they SML Approved Contractor?
Has operator completed SML Health & Safety Induction?
Work/Task/Project Description
List operator competency certificates
Please upload operator competency certificate

Cancelof
Task Analysis
When setting up and using equipment at Seaview Marina we will make every effort to;
- Operator & Rigger hold a current licence & competency.
- Crew established a clear method of comms.
- Crew discussed the task and reviewed the lift plan/Task analysis.
- The area of the lifting operation been protected using barricades and/or spotters.
- If the lift involves lifting personnel, is the an anti-block device installed and has it been tested immediately prior to the lift.
- Pre/post start operational checks been completed.
- Have the ground/structure conditions been assessed for bearing capacity and determined to be adequate.
- The lift within the specific limits of the specific load charts for the configuration and radius.
- Has all the lifting equipment been quarterly tested and tagged, are the tags all in date.
- The load free of loose unsecured items.
- The wind speed, weather (including lighting) and sufficient light been assessed and deemed within safe limits.
- Consultation been undertaken with all affected parties.
I confirm I have read and understood the above instructions.
I confirm that the information on this form is correct and all necessary precautions have been taken to complete the work being carried out at Seaview Marina. I accept responsibility for the safety of the site while I am carrying out crane/lift operations as a contractor at Seaview Marina
Permit Required From

DayMonthYear
Date
Hour MinutesAM/PM Option
Permit Required To

DayMonthYear
Date
Hour MinutesAM/PM Option
Permit Receiver Signature
Seaview Marina Ltd, Doc #: Form-034 Crane Work Permit, Version #: 1.1, Revised on #: 04/06/2026
Should be Empty: