ALC-HSEF-012 Date: 05/01/2023 REV NO: 00 Page 1 of 3

Allied Contracting L.L.C

PERMIT FOR LIFTING OPERATION

PROJECT - G+6+Roof Residential Building, ARJAN-PLOT NO: 673-1307 Dubai.

Client - sky Capital Group.
Consultant – Model Engineering Consultants
Company - Allied Contracting LLC.

Company details
Company conducting Company managing the lifting
the lift operation

Crane owner Other companies involved

People Involved (Names & Numbers)

Appointed Crane
Supervisor (Foreman/
Engineer)
3rd party
Crane Operator competency and
expiry date _____/_____/20_____
rd
3 party
Rigger competency and
expiry date _____/_____/20_____
3 party
rd

Rigger competency and

expiry date _____/_____/20_____

Crane Involved
Maximum lift
capable in Tones
Make / Model
supplied
configuration (consult Load Chart)
Registration / Plant Boom length to be
Metres
number used

Yes Yes No
Is the Load chart Is SWL indicator
available in the crane calibrated
No
____/____/20____
3rd party Certification- Certification due
last inspection date _____/_____/20_____ date ____/____/20____

Certificate Number Last major service

____/____/20____
Monthly crane Known defects
inspection Yes / No with crane, if any

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 ALC-HSEF-012 Date: 05/01/2023 REV NO: 00 Page 2 of 3
Complete a separate form if more than one hook or configuration is used.

Lifting gear
Item ID Number SWLL Date thoroughly examined

_____/_____/20_____

_____/_____/20____

_____/_____/20____

_____/_____/20____

_____/_____/20____

_____/_____/20____
Visual check made
by (Rigger)

The Lift
What is to be lifted?
Place more detail on back
of form if required.
What is the weight of
lifting equipment used? Kgs
(Hook, spreader bar etc.)
What is the weight of the
items to be lifted? include Are other cranes Yes / No
more info on back of involved?
form if required

Site Conditions
What is the ground
Obstructions in lifting
angle at the lifting
location __________degrees
location?
0 degrees if level ground
Are the area concealing
Check ground
underground hazards?
conditions for
i.e. Pipes, recently back-
outriggers
filled etc.
Wind _______m/s
Could weather condition
Yes / No Rain light/heavy
affect this operation? If yes, give details of
the point where the
Area barricaded off to Other __________
operation will cease
prevent unauthorised Yes / No
access

Information
Name of
Pre-start toolbox talk
_____/_____/20____ supervisor
conducted
conducting
toolbox
Underground services
talk
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 ALC-HSEF-012 Date: 05/01/2023 REV NO: 00 Page 3 of 3
documentation held Yes / No
Approvals
I have checked the above information as indicated and confirm that to the best of my knowledge, the
information is accurate and therefore this form is valid until the prescribed date, providing that conditions and
provided information has not changed.

Work can be stopped and Permit to work can be withdrawn by the safety officer if adequate safety requirements
are not Complied with.

Desc Name Signature

Lifting Supervisor Phone No.

Site Engineer Phone No.

HSE Phone No.

Prescribed
Prescribed start ____________AM/PM ____________AM/PM
date/Time
date/Time
Valid until
_____/_____/20____ _____/_____/20____

7. Permit close out request (By the permit applicant)

I have inspected the work site and I certify that there is no suspended load on lifting equipment and all lifting
equipment brought to safe position.

Name: Signature

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