Date:Location:

A. TOTAL LOADlbs.lbs.lbs.lbs.lbs.lbs.lbs.lbs.

lbs.ft.ft. YES / NOft. G. PRE-LIFT CHECKLIST YES No

ft.lbs.lbs.deg.deg.lbs.

12. Lift is % of the Crane's rated capacity13. If Jib/Ext. is to be used:

ft.ft.

Length Offset

14. Rated Capacity of Jib/Ext. lbsC. HOIST ROPE Main Aux 1

Size:

lbs.

lbs.______________________________

6. Shackle Rated Capacity(s) _________________

Aux 21. # of Parts

2. Rope Diameter3. Capacity

8. Signal Person Qualifications

2. Rigging Inspected3. Crane Set-up4. Overhead Hazard Check5. Swing Check6. Counterweight Check7. Operator Qualifications

15. Site Control16. Signatures

14. Traffic Hazard Check

11. Load Test12. Tag Lines13. Wind Conditions

NA

1. Crane Inspected

YES / NO

1. Certified Operator?2. Certificates Provided / Available3. Certified by Type, Class & Capacity?4. Designated in writing by employer:

YES / NO

YES / NO

B. CRANE F. OPERATOR QUALIFICATIONSYES / NO

E. CRANE PLACEMENT (Mobile Cranes Only)

YES / NO

YES / NO

Note: Source of load weight (Drawings, Calcs, etc.) must be attached on Page 2.

1. Hitch Type(s)2. No. of Slings:3. Sling Type:4. Sling Assembly Capacity:5. Shackle Size(s):

D. RIGGING

9. Rigger Qualifications10. Load Chart in Crane

Reviewed By:Prepared By:

CRITICAL LIFT PLANBONNEVILLE POWER ADMINISTRATION

PSF

H. SIGNATURES

1. Crane Operator2. Rigger3. Signal Person4. Lift Supervisor5. Other

______________________________5. Travel with Load Required?6. Other?

1. Maximum Bearing Pressure Note: Bearing Pressure Calculations will be attached on Page 3.

2. Ground Conditions Suitable for Load? Note: Ground Condition Calculations will be attached on Page 3.

3. High Voltage or Electrical Hazards? Note: If Electrical Hazards are present they must be shown on Page 4.

4. Obstructions to Lift or Swing? Note: If Obstructions are present they must be shown on Page 4.

TOTAL WEIGHT

1. Load Weight2. Wt. of Aux. Block3. Wt. of Main Block4. Wt. of Lifting Beam5. Wt. of Sling/Shackles6. Wt. of Jib/Ext.7. Wt. of Hoist Rope8. Other:

1. Type of Crane2. Maximum Crane Capacity3. Radius (Maximum)4. Radius (Minimum)5. Boom Length (Maximum)6. Boom Length (Minimum)7. Crane Capacity (Max Radius)8. Crane Capacity (Min Radius)9. Boom Angle (Maximum)

10. Boom Angle (Minimum)11. Gross Load of Crane

DEFINITION: A "critical lift" is defined as any non-routine crane lift requiring detailed planning and additional or unusual safety precautions. Critical lifts include: lifts made where the load weight is greater than 75% of the rated capacity of the crane; lifts which require load to be lifted, swung or placed out of the operator's view ; lifts made with more than one crane; lifts involving non-routine/technically difficult rigging arrangement; hoisting personnel with a crane ; or any lift which the crane operator believes should be critical.

lbs.

YES / NO

Contract No. Contractor:

Show here or attach calculations, drawings, etc.

Page 2 of 6Oct-20

LOAD CALCULATIONS

BPA - CRITICAL LIFT PLANNon-Mandatory Form

Show here or attach calculations, drawings, etc.

BPA - CRITICAL LIFT PLAN

BEARING PRESSURES & GROUND CONDITIONS

Oct-20 Page 3 of 6

Show here or attach load chart

BPA - CRITICAL LIFT PLAN

LOAD CHART

Oct-20 Page 4 of 6

Show here or attach operator qualifications

BPA - CRITICAL LIFT PLAN

OPERATOR, RIGGER, SIGNAL PERSON QUALIFICATIONS

Oct-20 Page 5 of 6

Show here or attach site plan and sequencing

BPA - CRITICAL LIFT PLAN

SITE PLAN

Oct-20 Page 6 of 6