Crane Plan Review Request Form

This form must be completed by a project manager and submitted 14 business days prior to any mobile crane use on campus. Please allow EHS up to 3 business days for review and refer to the following EHS reference guide for more information prior to submitting your request.


Mobile Crane Use on Campus


The following documents will be required to complete your submission:



  • Crane Plan Review (make and model of crane, lift capacity, boom angles musts be listed, annual and quad testing certification dates)
  • Job Hazard Analysis (hazards identified + mitigating activities)
  • Crane Operator / Rigger / Signalman Certification Cards (Type of crane and expiry date musts be clearly listed)
  • Current Medical Examiner’s Certification for Crane Operator
  • Traffic Control Plan (Map of crane transport route)
 
 
mm/dd/yyyy
 
 
 
 
Phone
 
 
 
 
mm/dd/yyyy
 

[hh:mm (am/pm)]

 

[hh:mm (am/pm)]

 
 

Only if qualified, one person may share both the role of Site Supervisor and Lift Director. All remaining roles must be separate individuals.


Enter First and Last Name

 

Enter First and Last Name

 

Enter First and Last Name

 

Enter First and Last Name

 

 

Documents Required for Review

Upload the documents listed below at the bottom of the form (scroll down).


  1. Crane Plan Review (make and model of crane, lift capacity, boom angles must be listed, annual and quad testing certification dates)
  2. Job Hazard Analysis (hazards identified + mitigating activities)
  3. Crane Operator / Rigger / Signalman Certification Cards (Type of crane and expiry date musts be clearly listed)
  4. Current Medical Examiner’s Certification for Crane Operator
  5. Traffic Control Plan (Map of crane transport route)
 

 

Traffic Control Plan Requirements

The following departments must be notified:


  • Transportation Services
  • Police Department
  • Campus Fire Marshal
 

 

Additional Information

 
 
Drop your files here