10. lifting-plan-checklist-and-method-statement-2

©-Peninsula v1 Form LPC – Lifting Plan Checklist Page 1 of 5
Lifting Plan Checklist and Method Statement (Mobile Cranes)
Site or Contract: ………………………………….Managed or Contract lift; ………………….…
Task description: ………………………………….….
Date planned for lift: ………………………………….
Use this checklist before carrying out a lifting operation. It is based on requirements set out in
British Standard 7121-1:2016 Code of practice for safe use of cranes. If you are using a contractor
expect them to ask for the information set out in Section A. Require the contractor to supply you
with the information as in Sections Band C before the lifting operation takes place.
Section A: PRE-PLANNING
For completion before a lifting operation under your control and supply to the crane operating
company before a crane is ordered.
1. The load to be lifted;
Size
Shape
Lifting eyes, lifting points
Centre of gravity and stability
Location
2. Access route for crane and space
available at planned operating position.
3. Crane position before, during and after
the lift.
(see sketch plan overleaf)
4. Maximum load to be lifted in tonnes.
5. Lifting accessories and attachments.
Specify their weight if not included
above.
6. Expected operating radius in meters.
7. Lift height required, in meters.
8. Presence of overhead cables and other
hazards that could affect the lifting
operation.
9. Ground conditions - foundations,
made-up ground, impact loading, etc.
10. Crane configuration and arrangements
for erection and dismantling
11. Crane to be used and configuration
12. Maximum permissible motion speeds,
acceleration and deceleration

13. Other factors taken into account.
Sketch plan.
Site access for crane and position of crane before, during and after the lifting operation. Show crane safety
working zone and any exclusion zones.
Completed by: on date

Section B: CRANE ON SITE
To be completed by the appointed person in control of the lifting operation before the lift begins.
Crane Details
Type of Crane Size of Crane
Identification No
Hire Company if applicable
Thorough Examination of Lifting Accessories?
Valid only if completed within the last 6 months.
Thorough Examination of Lifting Equipment?
Valid only if completed within the last 12 months.
SWL Indicator Functional?
Weekly Inspection Book in Cab?
Is the crane of the correct size and type?
Driver, Operator Details
Driver, Operator name
CPCS Card No
Or other qualification
Crane Position
Adequate and suitable base? All outriggers fully extended?
Adequate packing under outriggers? Position of outriggers satisfactory?
Lifting Gear
Type Identification No
SWL Test Certificate in place No
Visual Check
(i.e. general condition)
Can the lift proceed in safety?
Comments;
Completed by on-

Section C: METHOD STATEMENT & AUTHORISATION OF LIFTING
OPERATION
Task to be carried out.
Where the work is expected to take
more than a day specify the
configuration of the crane at the end
of each day’s work.
Explain the control measures required
to eliminate or minimise risk to those
involved.
Explain the steps required to eliminate
risk to other people e.g. road closures
and segregation zones.
Pre work checks of crane, site, and
load.
Task allocation to named people;
 Appointed person in control of
lifting operation.
 Crane supervisor.
 Crane operator.
 Slingers – signalers.
 Others
Confirmation of load details; weight,
dimensions, CoG.
Lifting points and lifting method
including accessories to be used and
their configuration.
Pickup and landing points
Height and radius of lift
Model and configuration of crane.
Configuration of outriggers and
ground supports
Overhead and underground hazards

Sequence of lifting operations
Control measures to eliminate or
minimise risk.
Environmental limitations – wind
speed, sea state etc.
Access to attach and remove slings and
lifting accessories.
Measures to ensure that the load
remains stable once slings and
attachments have been removed.
Arrangements for working at height
and rescue plans – if applicable.
Method of communication e.g. hand
signals, radio, etc.
PROVISION OF AUTHORITY -
Authorisation commences (date and time)
Authorisation issued by
Name
Signature
The person givingthis authorisationconfirms thatthe operator, slingers, signalers, supervisorsand others
involved in this lifting operation have taken part in a team briefing at which this method statement was
explained and they were given all necessary information and made aware of specific hazards i.e. position
of load, loads to be lifted, any excavation, soft ground, overhead cables, etc.
Accepted by Crane Driver
Name
Signature
THIS AUTHORISATION IS VALID UNTIL -

10. lifting-plan-checklist-and-method-statement-2

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