Crane Operation Work Permit Request
Permit No.
Date
Work Location
Requested By
Department
Contact No.
Crane & Operation Details
Crane Type
Crane Capacity
Crane Operator
Operation Date
Operation Time
Object to be Lifted
Weight of Load
Lift Radius (m)
Lifting Plan Available?
Yes
No
Safety Precautions
Risk Assessment Conducted?
Yes
No
All Required Permits Checked?
Yes
No
Spotter Assigned?
Yes
No
Remarks / Special Instructions
Approvals
Requested By (Signature/Name)
Supervisor (Signature/Name)
Safety Officer (Signature/Name)