To qualify to challenge certification in this trade, you must: Have experience performing job tasks listed as per Section D; and Have worked a minimum of 5,400 documented hours of which 1,600 hours must be operating time This form is used to declare work experience for periods of employment. The information provided is used to verify the applicant s work experience in this trade. This form must be completed by a direct supervisor of the applicant who will be contacted by BC Crane Safety or ITA. te: An Employer of Work Experience form must be completed by each Employer listed on the applicant s completed application form. A Statutory of Work Experience form must be completed for periods during which the applicant was selfemployed or a previous employer is unavailable to complete an Employer. For more information, see Instructions for Certification Challenge. Once your challenge application is approved, you must first pass the ITA Level 1 Standardized Written Examination. You will then be approved to attempt the ITA Level 3 Standardized Written Examination and the Mobile Crane Operator Interprovincial Red Seal Examination. Once all three written examinations are passed, you will be required to pass the ITA Standardized Practical Assessment. For more information on fees and scheduling of the written exam, refer to the Instructions for Certification Challenge. A. Applicant Name Enter the name of the individual for whom this form is being completed. Legal First Name: Legal Middle Name(s): Legal Last Name: B. Supervisor Contact Information Enter the name and contact information for the person who directly supervised the applicant at this employer. Ensure the information given is current as the application will be denied if this person cannot be contacted by ITA. Name of Organization/Employer/Business: First and Last Name of Applicant s Direct Supervisor: Supervisor Position or Title: Suite Number: Street Number and Name: City: Province: Postal Code: Business Number: ( ) Mobile Phone Number: ( ) Supervisor E-Mail Address: Page 1 of 6 The Industry Training Authority is an agency of the Government of British Columbia. June 2017
C. Employment Information of Applicant Dates of Employment (MM/DD/YYYY): From: To: Total number of hours of Mobile Crane Operator experience accumulated in that period: Company: Location: Total number of hours of Mobile Crane Operator operating time (actual operation of the crane) accumulated in that period: Job Title of Applicant: Page 2 of 6 The Industry Training Authority is an agency of the Government of British Columbia. June 2017
D. Supervisor of Job Task Performance By checking or in the column, indicate whether or not you, as the direct supervisor of the applicant, have personally witnessed the applicant performing the job tasks listed. Job Tasks D1 must check to a minimum 25 of 35 job tasks in this section SAFETY Comply with regulations, policies, and manufacturers manuals Maintain a safe working environment Follow emergency procedures Be aware of power line hazards Practice effective worksite communications CRANE SYSTEMS AND COMPONENTS Inspect carrier systems, outrigger systems, and turntable assemblies Inspect power plants and drive systems Inspect pneumatic systems, hydraulic systems, and electrical systems Inspect steering systems and braking systems Inspect hoisting systems and attachments Inspect safety components, devices, and aids WIRE ROPE AND RIGGING Use wire rope Follow wire rope installation procedures Inspect wire rope, slings, and rigging hardware Use slings and rigging hardware Use rigging techniques Maintain and store wire rope, slings, and rigging hardware Page 3 of 6 The Industry Training Authority is an agency of the Government of British Columbia. June 2017
Job Tasks D1 (continued) must check to a minimum 25 of 35 job tasks in this section CRANE OPERATIONS Interpret operating manuals Perform a pre-operational inspection Perform a pre-operational setup Demonstrate hoisting techniques Leave a crane unattended according to proper procedures TRANSPORTING A CRANE Follow commercial transport regulations Prepare a crane for travel Prepare a crane for transport Assemble and disassemble a crane CRANE MAINTENANCE Use tools for basic crane maintenance Perform basic crane maintenance SPECIALIZED OPERATIONS Operate a crane with a suspended work platform Perform engineered lifts Perform heavy lifts Perform dragline and clamshell operations Perform foundation and shoring operations Perform multiple crane lifts Lift an object into or out of water Page 4 of 6 The Industry Training Authority is an agency of the Government of British Columbia. June 2017
Job Tasks D2 must check to all job tasks in this section LIFT PLANNING Follow site assessment procedures Determine load weights Determine crane lifting capacity Determine rigging requirements Conduct a site assessment Use a crane capacity chart Job Tasks D3 must check to a minimum 2 of 6 job tasks in this section TELESCOPING BOOM CRANE OPERATIONS Perform hoisting techniques for a telescoping boom crane Operate a telescoping boom crane, over 20 tonnes, with a slewing upper structure LATTICE BOOM HYDRAULIC CRANE OPERATIONS Perform hoisting techniques for a lattice boom hydraulic crane Operate a lattice boom hydraulic crane LATTICE BOOM FRICTION CRANE OPERATIONS Perform hoisting techniques for a lattice boom friction crane Operate a lattice boom friction crane Page 5 of 6 The Industry Training Authority is an agency of the Government of British Columbia. June 2017
E. Confirmation of Prerequisite Credentials or Certificates For some trades, evidence that the applicant has earned prerequisite credentials or certificates is required before the individual is permitted to challenge certification. For those trades, a current or previous employer must verify that the applicant has the required prerequisite credentials. There are no prerequisite credentials or certificates for this trade. F. Supervisor Signature I certify that the information I, as the current or former direct supervisor of the applicant, have provided is accurate. (te: Collection and protection of personal information on this form is in accordance with the provisions of the Freedom of Information and Protection of Privacy Act.) Supervisor name (Please Print): Supervisor Signature: Date Signed: (MM/DD/YYYY) Page 6 of 6 The Industry Training Authority is an agency of the Government of British Columbia. June 2017