Lifting Safety Method Statement Form
Document and review key details of your lifting operation safety plan. Complete all sections for compliance and safety assurance.
Operation Name or Reference
*
Date of Operation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location of Lift
*
Type of Lifting Equipment
*
Please Select
Mobile Crane
Tower Crane
Forklift
Hoist
Winch
Other
Names of Key Personnel Involved
*
Risk Assessment Completed?
*
Yes
No
Not Applicable
Primary Control Measures in Place
*
Barriers/Exclusion Zones
Spotter Present
Equipment Inspected
Communication Plan
Weather Checked
Other
Permit to Work Issued?
*
Yes
No
Not Required
Lift Supervisor Name
*
By signing below, you confirm that all safety procedures and requirements for this lifting operation have been reviewed and will be followed.
Supervisor Signature
*
Submit
Submit
Should be Empty: