QMS-TM-HSSE-CL/LP001 Rev 0

LIFTING PLAN
PERMIT No. MEINHARDT/LP/20…./00001

Date of Plan:__________________________ Date of Lift :________________

* This lifting plan must be displayed prominently at the work area

SECTION A - WORK REQUEST

Contractor: _____________________________________________________________________________________________
Location: _________________________________________________________________ Date: _____________ Time: ____________
Specific Work Area: __________________________________________________________________________________________________________
Equipment to be worked on: ________________________________________________________________________________________________
Description of work: _______________________________________________________________________________________________________
____________________________________________________________________________________________________________
Nearest Overhead Obstruction or Wires :___________________________________________
Max Weight of Pick :________________ Radius @ max Weight:______________ Height :_________# Picks:______________

SECTION B - CRANE INFORMATION

1 License/PMA number :_______________________ 7 Weight of rigging (include headache ball) :_____________________
2 Type of Crane :__________________________ 8 Capacity @ max Radius :__________________
3 Gross Tonnage :_________________________ 9 Size / Type of Cribbing Required:_________________
4 Total Boom Length (incl jib) :____________________ (Typically : gross tonnage / 5=Sq feet)
5 Boom Angel :_____________________ 10 Describe Rigging / Configuration :_________________
6 Max Height :_____________________ (Spreader bar , Slings , Choker, basket configuration etc)
11 Rigging Capacity (each point):_______ of Pick Points:___________

SECTION C - BEFORE CRANE MOBILIZATION ( Tick as appropriate )

12 Posted & readable crane load limit charts. 20 Determine operator's qualifications
13 Boom/Mast warning lights and flagging in place and operational 21 A copy of the manufacturers Operating Manual is on the crane.
14 Contractor perform site walk. Review, at minimum: 22 Verify anti-two-block (limit switch) system is operational
15 Contractor perform site walk. Review, at minimum: 23 A minimum of a ABC portable fire extinguisher is on the crane.
16 Location of overhead electrical lines. 24 Ensure all rigging has been inspected and is in good condition.
17 i) Distance of lift to lines : _________ft. 25 Daily / periodic inspections are completed for this crane : (initial)
ii) Lines Energized ? Yes No 26 Determine operator's qualifications
iii) Person designated to observe line clearance: Signal Man 27 A copy of the manufacturers Operating Manual is on the crane.
18 Any multi - loading activities must be approved by HSSE Department
19 Procedure for safe operations of multiple cranes.

SECTION D - CHECKLIST (Tick as appropriate ) Yes No N/A Yes No N/A

28 Has crane/lifting equipment been a certificate from the authority? 41 Oil Seal Check
29 Crane operator have valid license/competency from the authority 42 Hydraulic Pump Seal Check
30 Cranes must be equipped with sound or light signals 43 Have weather conditions been considered?
31 Have barriers been positioned with warning signs? 44 Awkward size / shape / sharp edges
32 Has a signalman been on duty at all times? 45 Have rigging/lifting points on load?
33 Has a crane hooks been with safety latch? 46 Safety fasten for a load
34 Has a load chart been available in the cab? 47 Tag lines, Tugger lines
35 All lifting tools must be inspected before use 48 Is the route & laydown area clear of obstructions?
36 Adequate area for crane set - up “outrigger fully extended 49 Is the landing area adequate size and load bearing ability?
37 Outrigger Condition 50 Quality of foundations (soil compaction etc)
38 Hoist Ropes Drums (Rope not crossed or bird cage) 51 Clear communications
39 Rope Greased 52 To determine accurate weight of load to be lifted
40 Loose Lifting Tackle

SECTION E - MANDATORY SAFETY & PRE - TASK PLAN BRIEFING (all personnel associated with lift)

53 Conduct a safety / briefing, converting at least :

a. Minimum and Maximum operating conditions ( wind , rain , etc ) identified f. "Free wheeling" of cable is prohibited.
b. Evacuation Plan g. Outriggers must be used at all times.
c. Rigging Procedures, including the reminder of the mandatory use of tag lines. h. PPE ( Hardhat, safety glasses, gloves, body harness, lanyards, etc. )
d. Coordination and verify hand signals i. Barricades around counterweight swing- path,and load swing -path
e. Verify & review means of communication and emergency signalling. j. Safety personnel must be standby when lifting operation on-going.

HSSE Manual 1 HSSE Lifting Permit

Rev_ 01(03092018)
54 SECTION F - SKETCH LAYOUT OF THE MOBILAZATION

ATTACH THE FOLLOWING :

a. Load chart of crane. Circle or highlight appropriate columns and rows.
b. Rough diagram depicting area layout : Include crane paths, load
positions and any over head wires or obstructions.
c. Test load certificate for all lifting and rigging equipment & gears

SECTION G: AUTHORIZATION
55 I have verified the PTW and document/ records relevant to this work and in my opinion the contractor's control measures and /or safety programs are able to mitigate
the risk of this project. I hereby authorized this work to be carried out on the above stated date.

Contractor Site Manager Name: Signature: Date:

SECTION H: DECLARATION

56 I have inspected the crane PMA No.(______________) I confirm that the crane is in good working condition and all its safety features function properly. I also accept
the responsibility for safe operation and use of this crane. I shall adhere to safe working load (SWL) as well as safe working practices when performing the lifting
activity and operating this crane

Machine Operator Name: Signature: Date:

SECTION I: DECLARATION & AUTHORIZATION

57 I confirm that all safety precautions stated in the Method Statement /JHA & Lift Plan have been implemented. I will supervise and coordinate the lifting operation in a
safe and effficient way based on lifting plan and comply with statutory requirements

Lifting Supervisor Name: Signature: Date:

SECTION J: AUTHORIZATION

58 I have verified all the documents/records relevant to this work and in my opinion the control measures and /or safety programs are able to mitigate the risk of this
work. I hereby authorised this work to be carried out on the stated date.

Contractor HSSE: Signature: Date:

SECTION K : FINAL ACCEPTANCE BY PROJECT MANAGEMENT TEAM

59 I hereby confirmed that I have informed the Contractor Site Manager on scope of work and Meinhardt HSSE requirements relevant to this work and reviewed the PTW
and its relevant documents. This permit may be revoked if contractor violates Meinhardt or legal HSSE requirements while working

Meinhardt Construction Management: Signature: Date:

SECTION L: EXTENSION & DAILY AUTHORIZATION

60 I hereby certify that I have re-examined the situation covered by this Permit and authorise its extension to the Time and Date noted below.The extension is permitted
with the condition that no changes in the work scope and level of risk

Date / Time Lifting Supervisor Name Signature Date / Time Contractor HSSE Personnel Signature

SECTION M: CLOSE OUT

61 This permit has been cancelled due to unsafe action and / or conditions observed during work site inspection
I confirm that the work has been completed. I have inspected the work area and found that it is in a safe. I hereby closed this permit

HSSE Manual 2 HSSE Lifting Permit

Rev_ 01(03092018)
Contr. HSSE /Supervisor Name: Signature: Date:

HSSE Manual 3 HSSE Lifting Permit

Rev_ 01(03092018)