Affinity Insurance Services - Cafe and Restaurant

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• This section is a risk survey for each location. The factfinders for sums insured is in the next section.

General business details

• Estimated annual turnover (if applicable to survey)

• Number of staff including directors ( if applicable to survey)

• Number of years in operation or year established

• Does the business export?

• List countries exported to and percentage of sales to each country.

• Does the business directly Import?

• List countries imported from and percentage of products imported from each

• Number of outlets or locations

• Tick if the client has a seasonal increase during the year where they have a higher than normal turnover?

• List all date ranges through the year when the business has a seasonal increase

Locations

• Click here to add a new location

Location

Construction

• What are the walls made of

  Select Brick concrete tilt slab metal weatherboard sandwhich panels timber

  • Brick
  • concrete
  • tilt slab
  • metal
  • weatherboard
  • sandwhich panels
  • timber

• What is the ground floor made of?

  Select Concrete floating timber on concrete slab timber on foundations timber on raised piers dirt

  • Concrete
  • floating timber on concrete slab
  • timber on foundations
  • timber on raised piers
  • dirt

• What is the upper floor made of

  Concrete

  floating timber on concrete slab

  timber on foundations

  timber on raised piers

  n/a

• What are the stairs made of?

  Timber

  steel

  concrete

  n/a

• What is the age of the building

• Is there any internal or external use of sandwhich panels?

  Yes

  No

  N/A

• Does the client know what type of materials are inside the sandwhich panels as the insulator? (EPS, XPS, MWRF, PIR, LPBC) some are fire resistant, is there a fire authority certificate to prove the materials?

• As a percentage of the total wall space, what percentage is constructed from sandwhich panels?

  Select None present 0 - 10% 10 - 20% 20 - 30% 30 - 40% 40 - 50% 50% or greater

  • None present
  • 0 - 10%
  • 10 - 20%
  • 20 - 30%
  • 30 - 40%
  • 40 - 50%
  • 50% or greater

• Photo of the front of the building

  Media

• Photo of the left of the building (standing from the front of the building looking toward the rear of the property)

  Media

• Photo of the right of the building (standing from the front of the building looking toward the rear of the property)

  Media

• Photo of the rear of the building

  Media

Fire safety

• Are there monitored heat or smoke alarms hardwired at the site<br>

  Yes

  No

  N/A

• Did the site have extinguishers

  Yes

  No

  N/A

• What type of extinguisher was present?

  Select Co2 a b powder water foam wet chemical vapourising liquid

  • Co2
  • a b powder
  • water
  • foam
  • wet chemical
  • vapourising liquid

• What was the date of last service?

• Photo of extinguisher or the service tag

  Media

• Does the site have hose reels?

  Yes

  No

  N/A

• Does the site have a hydrant point?

  Yes

  No

  N/A

• What is the distance to the nearest fire station if known

• Does the site have single source sprinklers?

  Yes

  No

  N/A

• Does the site have dual source sprinklers? Mains and a backup supply?

  Yes

  No

  N/A

• Was there an escape plan on the wall?

  Yes

  No

  N/A

• Photo of the fire safety or evacuation plans

  Media

• Has the business conducted a fire drill or emergency evacuation drill in past 12 months

  Yes

  No

  N/A

• Were there any obstructions blocking free access to equipment or fire exits

  Yes

  No

  N/A

• Are emergency exits marked with correct signage?

  Yes

  No

  N/A

• Other fire safety notes

Security measures

• Describe door security

• Describe window security

• Do all display windows have 11mm plate glass?

  Yes

  No

  N/A

• Type of alarm system

  Select None local back to home back to monitored company (b2b) b2b with gsm phone backup b2b with securitel line

  • None
  • local
  • back to home
  • back to monitored company (b2b)
  • b2b with gsm phone backup
  • b2b with securitel line

• Described security guard useage

• Does the business utilise CCTV

  Yes

  No

  N/A

• Is there a 2m high full perimiter fence

  Yes

  No

  N/A

• Does the business have bollards or other ram raid prevention measures?

  Yes

  No

  N/A

• Is there after hours security lighting

  Yes

  No

  N/A

• Other security notes

Housekeeping and external risk questions

• Are all roof gutters free from debris and free flowing?

  Yes

  No

  N/A

• Are all roof downpipes connected to a drain system, unblocked and free flowing?

  Yes

  No

  N/A

• Is there any evidence of lime, moss, or calcium buildup on the external walls or ground around the premise which may indicate a long term water flow problem with guttering or drainage?

  Yes

  No

  N/A

• Photo of any potential drainage risks

  Media

• Photo of any potential drainage risks

  Media

• Is there any evidence of smoking adjacent to the building, check gardens and directly outside staff exits?

  Yes

  No

  N/A

• Where there are truck deliveries or pickups; is there a designated turning area and is it sufficient? I.e. is there any evidence of impact damage to the building perhaps by a delivery vehicle or garbage truck or tyre marks through the dirt or garden off the concrete?

  Yes

  No

  N/A

• Are bollards installed in delivery areas to mitigate risk of impact damage?

  Yes

  No

  N/A

• How frequently is the waste removed from the location

  Daily

  weekly

  fortnightly

  monthly

  as needed

• What is the distance of the waste area to the main building?

• Are any pallets or flammable items stored against or adjacent to the building?

  Yes

  No

  N/A

• A photograph of the waste storage area

  Media

Carparks

• Does the restaurant have a car park for which they are responsible for?

• How many car park spaces are there?

• Is each car space clearly marked and well defined?

  Yes

  No

  N/A

• Is the surface of the car park ashphalt or concrete ?

  Yes

  No

  N/A

• Is the car park surface in good condition with no pot holes or divets that may cause scratches to cars or trip hazards to pedestrians?

  Yes

  No

  N/A

• Are all handrails or balustrades in good condition solidly fixed into the ground or walls?

  Yes

  No

  N/A

• Does the car park have sufficient drainage?

  Yes

  No

  N/A

• Are the drains of the car park free free flowing and unlikely to be blocked by organic growth such as weeds or dirt buildup?

  Yes

  No

  N/A

• Notes on the carpark

• Photo of the carpark

  Media

Locale risks

• What is the occupation and distance to the neighbouring building (left)

• What is the occupation and distance to the neighbouring building (right)

• What is the occupation and distance to the neighbouring building (rear)

• Type of location

  Select Industrial unit complex freestanding in industrial or commercial park suburban road main road strip of shops with street frontage multi tenure office block multi tenure shopping mall or arcade secure shopiping centre (westfield etc)

  • Industrial unit complex
  • freestanding in industrial or commercial park
  • suburban road
  • main road
  • strip of shops with street frontage
  • multi tenure office block
  • multi tenure shopping mall or arcade
  • secure shopiping centre (westfield etc)

• Are there any immediate neighbours or businesses in the same complex that have a late friday or saturday trading hours such as dominos, kfc, mcdonalds etc

  Yes

  No

  N/A

• Is there any graffiti or other evidence of a high pass through pedestrian traffic such as general rubbish buildup like drink bottles, snack foods or mcdonalds wrappers?

  Yes

  No

  N/A

• Photo of any graffiti

  Media

• Notes

Office risk questions

• Does the restaurant have an office of more than 3 desks?

• Was there evidence of testing and tagging on electrical appliances such as computers and laptops.

  Yes

  No

  N/A

• Was there any evidence of the use of power leads, double or multi point adapter boards?

  Yes

  No

  N/A

• Do any power leads, extension cables, or powerboards cross over walkways which may present a tripping hazard?

  Yes

  No

  N/A

• Where there is use of multi point adapter boards, are they surge protected and to what voltage or surge level?

• Was there a server for the office?

  Yes

  No

  N/A

• Is the server isolated within a temperature controlled environment?

  Yes

  No

  N/A

• Is it secured by UPS systems that have been tested within the last 3 months?

  Yes

  No

  N/A

• Is there any evidence of water damage to the ceiling nearby to the server?

  Yes

  No

  N/A

• Other notes about the office

• Photo of the server room if applicable

  Media

• General photo of the office or reception

  Media

Commercial kitchen risks

• Is there deep frying?

  Yes

  No

  N/A

• Are fryers thermostatically controlled with an automatic shut off at 218 degrees celcius?

  Yes

  No

  N/A

• What is the total capacity of fryers in litres?

• Does the business use wok cooking?

  Yes

  No

  N/A

• What is the total number of wok burners?

• Is the cooking or deep frying area protected by an automatic fire retardant or foam supression system such as the ANSUL system?

  Yes

  No

  N/A

• What type of canopy is installed in the cooking area?

  domestic style rangehood

  commercial exhaust system

• How frequently is the canopy and filters cleaned?

• Are canopies professionally cleaned by external contractors or internally by staff?

  professional cleaning contractors

  internal cleaning by staff

• Is there a readily accesible fire blanket in the kitchen?

  Yes

  No

  N/A

• Are the extinguishers in the kitchen the correct type for oil or cooking fires?

  Yes

  No

  N/A

• Describe the condition of the floor with respect to oily, wet, or slippery floors in the kitchen area

• Is there an emergency exit?

  Yes

  No

  N/A

• Is the exit free from rubbish or stock, easy to open and escape on both sides of the exit (check if locked and external access to door)

  Safe

  At Risk

  N/A

• Other notes about the kitchen

• General Photo of the kitchen area

  Media

• Photo of the deep fryers or wok area

  Media

• Photo of the waste area in the kitchen

  Media

Cold Storage

• Are there any cool rooms, freezer rooms or temperature controlled areas made from any kind of sandwhich panneling or insulating materials?

  Internal

  external

• What is the size of the cool room in m2?

• Add photos of all cool rooms

  Media

• Draw a map of the location of the cool room or freezer room relative or within the restaurant to determine overall floorspace

  Drawing

• Notes

Electronics and machinery

• Please indicate type of Electrical switchboard or mains system that best describes the system in use at the location

  Select External (enclosed) external (open) Internal (enclosed) Internal (open) analogue or aged system modern or digital system

  • External (enclosed)
  • external (open)
  • Internal (enclosed)
  • Internal (open)
  • analogue or aged system
  • modern or digital system

• Photo of the electrical mains board

  Media

• Is the power mains or switchboard protected by a UPS

  Yes

  No

  N/A

• Does the premise have a backup generator

  Yes

  No

  N/A

• Is the backup generator manually started?

• Does the business or occupier have access and training sufficient enough to turn on the generator if manual?

  Yes

  No

  N/A

• What type of fuel is used in the generator?

  Solar backup

  gas

  diesel

  petrol

• When was the generator system last serviced and tested?

• What is the total number of overhead cranes, elevators, lifts and hoists?

• What is the total number of escalators, travellators, or conveyor belts in use?

• What is the toal number of cool rooms or freezer rooms, plus any domestic style or drink fridges, and chilled displays? Total refrigeration units:

• Other than the cold rooms above, Are there any temperature controlled environments or rooms, what is the total mumber of areas and an approximate total floorspace %

• Describe the Space heating or cooling?

• Notes

Completion

• Signature of surveyor

  Sign

• Signature of client

  Sign

• Time completed

  Date

• Click here to add a location

Location

Fire and Defined events

• Is cover required for this section at this location?

• Building declared value

• Contents declared value

• Stock declared value

• Total value of any live stock such as lobsters and fish

• Other section 1 declared values

• Total declared value section 1

• Preferred excess

  $100

  $250

  $500

  $1,000

• Is cover required for flood?

Burglary

• Is cover required for this section at this location?

• Contents sum insured

• Stock excluding tobacco and alcohol sum insured

• Tobacco sum insured

• Alcohol sum insured

• Customers goods

• Goods in the open air (outside of the building)

• What is the preferred excess

  $100

  $250

  $500

  $1,000

Glass section

• Is cover required for this situation?

• Type of premise

  single shop front

  dual shop front

  multiple shop front

• What is the size of the largest pane of glass in m2

• Is cover required for internal glass

• Is cover required for external glass?

• Is cover required for external glass, plastic or neon signs?

• What is the replacement value of the external sign(s)

• Preferred excess for this section

  $100

  $250

  $500

  $1,000

Money / cash

• Under this section money and cash can also mean pre paid gift cards such as coles myer gift cards or similar items redeemable for cash. It is important to ask if the client keeps such items on the premise as they are not considered stock.

• Is cover required for this section

• Cash in transit

• Cash at the office during business hours

• Cash at the location after business hours

• Cash in private residence

• Cash in a locked safe

• Damage to safe

• Preferred excess for this section

  $100

  $250

  $500

  $1,000

Business interruption

• Is cover for this section required?

• Tick here if client knows the sum insured and terms they require for this section.

• What is the indemnity period

• What type of cover does the client require

  Gross Profit

  Gross Income

  Weekly Income

  Increased Cost of Working Cover only

• Gross Profit Sum Insured

• Does this include payroll?

• Payroll Sum Insured

• What percentage of the payroll is insured

• Rental income sum insured

• Increased Cost of Working (subject to financial condition)

• Additional Increased Cost of Working (not subject to a financial condition)

• Professional fees for Claims preparation costs

• Accounts receivable

• Gross income sum insured

• Does this include payroll?

• Payroll sum insured

• What percentage of the payroll is insured

• Rental income sum insured

• Increased Cost of Working (subject to financial condition)

• Additional Increased Cost of Working (not subject to a financial condition)

• Professional fees for Claims preparation costs

• Accounts receivable

• What is the weekly income maximum sum insured?

• Does this include payroll?

• What is the payroll weekly sum insured?

• What percentage of the payroll is insured

• Increased Cost of Working (subject to financial condition)

• Additional Increased Cost of Working (not subject to a financial condition)

• Professional fees for Claims preparation costs

• Accounts receivable

• Increased Cost of Working (subject to financial condition)

• Additional Increased Cost of Working (not subject to a financial condition)

• Professional fees for Claims preparation costs

• Accounts receivable

• List all uninsured working expenses

• List any customer or supplier premises for which the client wishes to insure their directly related income.

• List details of any nearby attraction (other business, natural attraction, hotels etc) which directly attributes income for which the customer wishes to insure threir lost income related to that attraction. List the type of attraction, location, proximity in km, construction details.

• Tick here if the client would like for us to calculate and recommend a sum insured (limit of indemnity) based upon their financials and detailed information?

• Date of the financials used

• Date of the policy commencement

• Indemnity period required

• Total income / revenue / turnover

• Growth rate past 12 months as a percentage

• Estimated Growth rate as a percentage for the next 12 to 36 months

• Opening stock

• Closing stock

• Wages estimate including PAYG and super

• List all variable expenses that vary directly with income

• Details of customer or supplier premise, location, construction, fire safety equipment, and percentage of income or stock

• List details of any nearby attraction (other business, natural attraction, hotels etc) which directly attributes income for which the customer wishes to insure threir lost income related to that attraction. List the type of attraction, location, proximity in km, construction details.

• Is cover required for loss of income, payroll or other limits in this section following a flood?

Equipment Breakdown Insurance

• There are two options. The client can insure for motor breakdown or electronic breakdown in a business pack with a maximum limit of $20,000 with no loss of income or payroll covers. Or client can cover both types of breakdown and consequential loss of income cover, the second type is more expensive but offers far greater cover.

• Does the client use any of the following types of equipment: <br>- cnc routers or CAD / CAM machinery<br>- temperature controlled environments or servers<br>- equipment that is reliant on computer controls in addition to motors or machinery

  Yes

  No

  N/A

• What is the average age of the equipment?

• What is the total value of the machinery

• Does the business have redundant machines or equipment to protect the business financially if the equipment breaks down?

• In the event of an outage what would be the estimated recovery time to order, install, callibrate and recommence operations if the machine could not be repaired.

• Would such an outage cause loss of income or inability to pay wages?

• Would the client like simplified business pack cover?

• What is the sum insured required?

  $5,000

  $10,000

  $15,000

  $20,000

• Please list the total number of each machine type locatedat the premise that the customer wishes to insure

• Cool rooms

• Freezer rooms

• Display or drink fridges

• Any other type of fridge unit

• Coffee machines or grinders

• Mixers, blenders, processors

• Mincers

• Air conditioners - split system (wall mount)

• Air Conditioners - ducted system (number of motors)

• Would client like a comprehensive breakdown cover combining mechanical breakdown and electrical failures and resulting loss of income or payroll?

• The fire and business interruption figures above will be used for this section if this option is selected.

• Preferred excess for this section

  $100

  $250

  $500

  $1,000

General / portable property cover

• Is cover for this section required

• Unspecified items are typically only covered up to $1000 per item

• Unspecified tools of trade sum insured

• Unspecified stock or travel samples

• Click to add specified items

Specified item

• Describe item, include manufacturer details and model description / model number

• What is the replacement value for a similar item

• What is the serial number for this item

• What is the preferred excess

  $100

  $250

  $500

  $1,000

Marine cargo

• Is cover for importing required?

  Yes

  No

  N/A

• Describe the goods imported

• How are they packed and shipped (air sea road rail etc)

• What are the INCOTERMS of the imports?

• What is the maximum value any one import?

• What will be the average value of each import

• Total number of imports in 12 months

• Is cover for exports required?

  Yes

  No

  N/A

• Describe goods exported

• Describe how goods exported are packed and sent (air sea rail road etc)

• What are the INCOTERMS of the export?

• What is the maximum value of any one export

• What is the average value of each export

• What is the total number of exports planned in 12 month period

• Is cover for transits within australia required?

  Yes

  No

  N/A

• Describe goods sent within australia

• Describe the packaging and how the items are sent (road, sea, air, rail etc)

• For what purpose is the deliveries in australia (purchases, sales, stock transfers and or returns)

• What will be the maximum transit value within australia

• What will be the average transit value within australia

• How many transits are expected each week within australia?

Other risks and insurance options

• Management Liability, statutory liability insurance and Employment Liability cover

  Yes

  No

  N/A

• Workers compensation nsw, act, vic, nt, sa or wa?

  Yes

  No

  N/A

• Corporate travel insurance and, extra territorial workers comp

  Yes

  No

  N/A

• Online or cyber crime cover

  Yes

  No

  N/A

• Product recall

  Yes

  No

  N/A

• Trade Credit and Political Risks insurance

  Yes

  No

  N/A

• Event management or organisers liability including corporate product or development conventions or seminars

  Yes

  No

  N/A

• Professional indemnity insurance for design, conduct and services?

  Yes

  No

  N/A

• Motor fleet

  Yes

  No

  N/A

• Ctp and fleet ctp

  Yes

  No

  N/A

• Aviation risks

  Yes

  No

  N/A

• Keyman, life insurance or income protection - refer to a financial planner

  Yes

  No

  N/A

• Common due date

  Yes

  No

  N/A

• Premium funding required?

  Yes

  No

  N/A

End of section

• This information does not represent the schedule of insurance simply the information collected which may be used to produce a sample schedule of insurance. Contact the writer of this document for a copy of the schedule of insurance.