Attn: MHSA Crane and Rigging Advisor

Date: required

Attn: MHSA Crane and Rigging Advisor

201, 292060 Wagon Wheel Link Rocky View, AB

T4A 0E2

Re: OVERHEAD CRANE RIGGING EXPERIENCE VERIFICATION

This letter is to verify that Name of Applicant

1)  has accumulated a minimum of 500 hours of direct hands-on overhead crane operation and rigging experience WITHIN THE PAST 3 YEARS while employed at Name of Company

2)  is a competent overhead crane operator who is adequately qualified, suitably trained and has sufficient experience to capably and safely perform the role of our in-house Overhead Crane and Rigging Trainer.

APPLICANT PROFILE (Please attach a current resume)

Name: required Job Title: required

Number of years employed at current company: required

Types of cranes operated within last 3 years: Single Girder ☐ Double Girder ☐ Pendant ☐ Remote ☐

Gantry Crane ☐ Jib Crane ☐ Monorail Hoist ☐ Chainfall ☐ Lever Hoist ☐

Current crane use: Daily ☐ Few times per week ☐ Few times per month ☐

Types of lifts made within last 3 years: Symmetrical ☐ Non-Symmetrical ☐

Flipping Loads ☐ Dual hoist ☐ Dual crane ☐

Other experience: Tag Lines ☐ Signalling ☐ Spotting ☐ Lift Directing ☐

Sling use: Synthetic Web ☐ Chain Sling: 1 leg ☐ 2 leg ☐ 3 leg ☐ 4 leg ☐

Polyester Roundsling ☐ Wire Rope Sling: 1 leg ☐ 2 leg ☐ 3 leg ☐ 4 leg ☐

Rigging hardware use: Shackles ☐ Eyebolts ☐ Swivel Hoist Rings ☐ Links ☐ Link brackets ☐

Below-the-hook lifting device use: Spreader Bar ☐ Lifting Beam ☐ Equalizer Beam ☐

Vertical Plate Clamps ☐ Horizontal Plate Clamps ☐ Magnets ☐ Sheet Lifters ☐ Vacuum Lifters ☐

Training Experience: Tool Box Meetings ☐ Safety Training ☐ Mentoring ☐ Training Course ☐

Best Regards,

Name of person verifying the information: required

Title: required

Company: required

Address: required City: required Postal Code: required

Rev 4 – July 2016