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 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