"ETD, ASHOKA HOUSE, ASHOKA MARG, ASHOKA NAGAR, NASHIK — 422 ] ASHOKA iO = _ + Environment Work Instructions | = T +/CO/DO/PR/HSE/PTW/O8 | REF: QMS:7.5.2 /EMS:7.5.2 / OH&SMS:7.5.2 | Page 1 of 8 1 No: 01 Issue Date:03 July 2019 | Rev. No.: 00 Revision Date: 03 July 2019 Title: Lifting Permit LIFTING PERMIT Objectives:- Permits must be posted at the lift site until lift is complete. Permits must be reissued if conditions (equipment, weather, and/or ground) or scope of work has changed. A Critical Lift Plan & Crane Permit including all supporting documents must be submitted and approved prior to any of the following types of lifts. Responsibility:- Project Manager, EQA- Road & Structure Incharge, Plant and Machinery Incharge, HSE officer (Two or more cranes are used to lift © Crane will "Walk" with Load Lifts =/> 100 kg Load will be upended and weighs >5 Tons Crane will Lift Personnel Loads =! 75% of Rated Load Capacity ‘Originator: Project Manager: ‘Start Date/Time: ‘Crane Owner: Emergency Phone Number: Crane Lift Location (AreaiBuilding): Competent Person (Crane Op- | Competent Person (Rigging): Contractor Safety Representati erator): Phone: Phone: Phone: Ta. Describe Load and Enter Total Weight Estimated Weight: Tons ‘Actual Weight: Tons 4. Load Weight: | 1b. Total load weight as a percentage of total iting capacity of crane: TotalLoadiVeight on eee ACORN 4100 =% Example Calculation (CraneCapacity | 2a. Main Hoist Black, Auxiliary Boom Head/ | Third Party Inspection: Ves] No Headache Ball: | Certificate No. Total Block Weight: Tons Separate Certificate attached to this permit 26. Slings, Shackles, Third Parly Inspection: Yes/ No Hardware (list all used) Certificate No. Total Rigging Weight: Tons ‘Separate Certificate attached to this permit 2c, Jib Weight Allowance: Tons | Check One: Erected (not used): O] Erected (in use): O] Jib Stowed (on boom): Management Representative L Issued By‘ASHOKA BUILDCON LTD, ASHOKA HOUSE, ASHOKA MARG, ASHOKA NAGAR, NASHIK — 422 | ASH OKA oun Fealth, Safety and Environment Work Instructions 5.2 | Page 20fe Doc. No.: WI/CO/DO/PR/HSE/PTW/08 | REF: QMS:7.5.2 /EMS:7.5.2 / OH&SM! 10 Issue No: 01 Issue Date:03" July 2019 | Rev. N Tile: Lifting Permit 3a, On Sling: 1+ 2b= Tons 3b. On Crane: 1 + 2a + 2b +2c= Tons Height of Load to be net greater than Feet [Elevation drawing showing load height relation to crane and any obstructions is attached (1s maximum heigh: of Crane Boom tip witin Permit Limits Granted? C} Yes [] No Current Permit Height: Maximum Radius of Load to be not greater than Feet S Operating Ra- | 7 pian view of load location and crane orientation attached _| As per Load Chart CRANE DATA [Link] Manufacturer: | Crane Manufaciurer: Model Number: Verify manufacturer's load chart indicates lifting capacity at stipulated load radius and boom lengths. Note: If boom length ardior radius is between the stipulated or posted value on the load chart select the next lesser rating capacity. The next lesser rating capacity may be the next longer or shorter boom length. [Link]: | [] Confirm Grane has an Anti Two Blocking Device Installed and is operational 4Counterwelght! 11 Yes Total Weight Tons [Link] Length: | Not ateater than [tren Height of Crene BoonvExtens on: 6. ub Extension: Jip Length (as extensior): sib Offset: [Link] Load Block: | Capacity Size Ton # Sheaves 8. Auxiliary Boom Head/Ball: Capacity Size: ‘Ton # Sheaves: Soil Type is Determined to be Acceptable for Imposed Load [Link], 11 _engncaing has reviewed and determined underground ies and stuchres are nota * . risk for damage. (Outriggers Fully Extended and Set Check One: Track Tires RIGGING DATA Diameter. Length: Capacity (per leg) 4. Sling(s) and/or _| Indicate how slings are to be used: Basket Hook Straight Pick Shackles: Size: ‘Management Representative Issued By‘ASHOKA BUILDCON LTD, ASHOKA HOUSE, ASHOKA MARG, ASHOKA NAGAR, NASHIK — 422 | ASHOKA ot I Health, Safety and Environment Work Instructions Doc. No.: WI/CO/DO/PR/HSE/PTW/O8 | REF: QMS:7.5.2 /EMS:7.5.2 / OHBSMS:7.5.2 | Page 308 Issue No: OL Issue Date:03" July 2019 | Rev. No.:00 | Revision Date: 03" July 2019 Title: Lifting Permit 2. Provide brief description and sketch of load rigging: LIFT COMPUTATION Maximum Boom Angle: Maximum Boom Length: Note: Cranes equipped with computers indicating boom length, angle, and radius are safety devices only and should not be used in place of the operator's responsibility to actually determine the measurements req to calculate a safe lift, Note: Accessories, Crane Capacity, Parts of Line and Rope Capacity, and the working quadrant of the crane should be considered when calculating Net Crane Capacities. 4, Net Crane Capacity: (Rated Lift Capacity - Block, Rigging, and Accessory Weights)= Tons 2. Load orientation prior tolift: [] Front [J Side C)Rear 3. Swing orientation relative to crane: [Front [1] Side) Rear 4, Total Lift Weight: Item 3b of LIFT DATA: Tons Management Representative Xe Issued ByZASHOKA BUILDCON LTD, ASHOKA HOUSE, ASHOKA MARG, ASHOKA NAGAR, NASHIK= 422] Oi 7 * | ASHOKA || Health, Safety and Environment Work Instructions | } Doc. NNo.: WI/CO/DO/PR/HSE/PTW/O8 | REF.: QMS:7.5.2 /EMS:7.5.2 / OH&SMS:7.5.2 | Page 4 of 8 13" July 2019 Tue Wo Ot [sie onoa7 ay 2019 [ev no 00 | Revlon bal ifting Permit 5, Total weight on slings and shackles: Item 3a of LIFT DATA: 6. Wind Speed: Lifts are not allowed with wind speed in excess of, 15 (miles per hour) MPH or 7 (meters per second )M/s : Wind Speed at time of lft: MPH or Mis 7. Comments, Notes, and Sketches: if required separate sheet attached APPROVALS The Contractor, Rigger, and Crane Operator are the competent persons solely responsible for the safe execu- tion of the lift(s). Execution of the lift will be in complete accordance with regulations. EQA Structure incharge: Name: Signature: Date: EQA Structure Incharge: Name: Signature: Date: Plant and Machinery Incharge: Name’ Signature: Date: HSE Officer: Name: Signature: Date: Contractor Representative Name’ Signature: Date: Crane Operator: Name: Signature: Date: Crane Load Rigger: Name: Signature: Date: Customer Representative: Name: Signature Date: Project Manager: Name’ Signature Date Management Representative Issued ByASHOKA BUILDCON LTD, ASHOKA HOUSE, ASHOKA MARG, ASHOKA NAGAR, NASHIK - 422 ase ASHOKA Health, Safety and Environment Work Instructions Doc. No.: WI/CO/DO/PR/HSE/PTW/O8 | REF: QMS:7.5,2 /EMS:7.5.2 / OH&SMS:7.5.2 | Page 5 of 8 Issue No: 01 Issue Date:03" July 2019 | Rev. No.: 00 _| Revision Date: 03" July 2019 Title: Lifting Permit COMPLETE CHECKLIST BELOW TO ENSURE A SAFE LIFT IS PLANNED Checklist | ‘CRAWLER CRANE ~ LIFT PLAN ‘To be used for all lift up to 10t, complete each time crane is set-up at new location Calculation based on minimurn planned lift weight and radius at current set-up i SET-UP CHEKLIST (To be completed by crane operator) 1. Crane set on level ground? YES No 2, Pick up and drop paths identified? ves. No 43. Rigging Equipment inspected and correctly color coded? ves No 4, 1s the lift area around the crane controlled? YES. No 5. Daily crane checklist complete and safe to commence work? YES No CALCULATIONS A= ssssre m m D=0-2t 24t 6-8t 8-10t 10-12 Total Weight (C+D) = t MAXIMUM WEIGHT CAPACITY (at crane set-up) t ‘CURRENT % CRANE CAPACITY % SIGH-OFF SECTION Crane Operator Competent Rigger 1D Number ID Number Time & Date Time & Date Crane Type vn Capacity License Plate Management Representative z wx Tssued By| 011 ‘ASHOKA BUILDCON LTD, ASHOKA HOUSE, ASHOKA MARG, ASHOKA NAGAR, NASHIK - 422 ASHOKA Health, Safety and Environment Work Instructions Doc. No.: WI/CO/DO/PR/HSE/PTW/08 | REF: QMS:7.5.2 /EMS: 5.2 / OHBSMS:7.5.2 Page 6 of 8 Issue No: 01 Issue Date:03" July 2019 | Rev. No.: 00 13 July 2019 Title: Lifting Permit Checklist Il: CHECKLIST FOR LIFTING PLAN SIN [items an I [Remarks Lifting team and lifting machine 7 | Has a competent Lifting Team been identified? (Certfica fions andlor train- ane ing records) bien 2 eon ‘exact weight of the load (including rigging and all components) speci- co [Link]| 3 _| isthe crane suitable for the identified lif(s) in terms of correct rated capacity | voc n No Ie and Safe Working Load (SWL)? 4 _ | Has the maximum load limits for the lift(s) been specified according to man- oan ufacturer's recommendation? aes 8 Has the k 5 [fast a Lad char been provided to verify boom angle, load radius and lift eee 6 Is the Lifting Machine (LM) certificate for the crane valid? a Yes 5 No Drawings / Sketches 7 | Are drawings / sketches with standard unit of measurement provided for the following? (a) Crane position in relation to any nearby streets or structures 13 Yes 0 No| (b) Location of all nearby utiles both underground and overhead a Yes o No (c) Height of the lift to be accomplished z a Yes o No (d) Load radius from center pin of crane to center of the hook at load pick up a Yes o No (start) point (e) Load radius from center pin of crane to center of the hook at load set (end) | a Yes a No point (f) Boom length and angle for the lif(s) 3 Yes o No jing 8_| Are the full sling details (include SWL and Factor of Safety) checked? 5 Yes 5 No 9 _| Is lifting gear certificate for selected rigging valid? a Yes o No Is spreader type, length and SWL suitable for the lift? cea “aYesaNo | Are shackles size, type and SWL suitable for the lift? a Yes No sketch of rigging method provided? 0 Yes o No 43. | Are working and collapse zones of the crane within the site boundaries? Yes o No 15_| Has the limiting wind speeds for operation been considered? 0 Yes o No 16_| Has the proximity to overhead structure(s) been considered? 0 Yes o No 17_| Has the access to lifting location been verified to be suitable? Yes No 18 _| Are excavations activities near lifting operations been considered? o Yes 0 No 19_| Has the effect of wind on crane been considered? 3 Yes c No 20 | Has the effect of wind on load been considered? 3 Yes c No 21_| Have overall ground conditions been verified? 0 Yes o No 22_| Has visibility (such as due to haze) been considered? 0 Yes o No EQA Structure Incharge: Section incharge: HSE officer cross checket - Project inchargé Management Representative Issued Byoun ‘ASHOKA BUILDCON LTD, ASHOKA HOUSE, ASHOKA MARG, ASHOKA NAGAR, NASHIK - 422 | ASHOKA Health, Safety and Environment Work Instructions Doc. No.: WI/CO/DO/PR/HSE/PTW/08 | REF: QMS:7.5.2 /EMS:7.5.2 / OH&SMS:7.5.2 Page 7 of 8 Issue No: O1 Issue Date:03" July 2019 Revision Date: 03" July 2019 Title: Lifting Permit ‘Sample Drawing or sketch q a ia sowene a Q O g q gon Proatcncia @ ove ote LALLA & Management Representative Issued By 8‘ASHOKA BUILDCON LTD, ASHOKA HOUSE, ASHOKA MARG, ASHOKA NAGAR, NASHIK - 422 ASHOKA out Health, Safety and Environment Work Instructions Doc. No.: W1/CO/DO/PR/HSE/PTW/08 T REF: QMS:7.5.2 /EMS:7.5.2 / OH&SMS:7.5.2 Page 8 of 8 Issue No: O1 Issue Date:03" July 2019 | Rev. No.: 00 Revision Date: 03 July 2019 Title: Lifting Permit Management Representative Issued By