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WAC 296-155-56410

Personnel platform lift planning and authorization form.

Personnel Platform Lift Planning and Authorization Form
1.
Location:
Date:
2.
Purpose of the Lift:
 
3.
Hoisting Equip. Mfg:
Model #:
Serial:
4.
Expected Radius:
(maximum) (at work location)
5.
(a) Rated Load at Radius:
(b) Maximum Lift Load: [50% of 5(a)]
6.
Platform ID:
Platform Rating:
7.
Platform Weight:
Type: (Pin On)
(Suspended)
8.
(a) Number of Platform Occupants:
(b) Approx. Wt. (With Equip.)
9.
Total Lift Weight:
[7 + 8(b)] [No more than 5(b) above]
10.
Personnel Supervisor:
11.
What are the Alternatives to This Lift?
 
12.
Why are they not being used?
 
13.
Pre-Lift Briefing Held (Date & Time):
/ / AM/PM
 
Attendees:
 
 
14.
Anticipated Hazards (wind, weather, visibility, power lines):
 
15.
Lift Accomplished Date:
Time:
16.
Remarks:
 
 
 
 
 
 
 
 
 
Employer Signature
Date
 
[Statutory Authority: RCW 49.17.010, 49.17.040, 49.17.050, 49.17.440, 49.17.060, and 29 C.F.R. 1926, Subpart CC. WSR 12-01-086, § 296-155-56410, filed 12/20/11, effective 2/1/12.]
Reviser's note: The brackets and enclosed material in the text of the above section occurred in the copy filed by the agency.
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