PDFWAC 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.