Company details

  • What name /entity does the Insured operate as.

  • Responsible Persons seen / Interviewed

Cover Details

  • Perils covered

  • Sections and Values indicated on Service Request

  • Policy Number

  • Broker / Brokerage:

  • Which Region writes this policy?

Topographical Analysis

  • Is the site located within 2 Kilometres of any of the following? Select all that apply.

  • Is the site located in a Declared High Hazard Area

  • Which Fire Service classification does the risk fall under?

  • How far from site in terms of response time, is the nearest Fire Station?

  • Narrative / Remarks:

Building construction features?

  • Number of Floors (above grade level)

  • Is there a basement?

  • Brief Construction details.

  • Fire Divisions

  • Total Floor area of largest compartment

  • Floor Composition Details

  • Roof Condition

  • Risk Improvement requirement:
    The condition of a roof will often play a major role in the quality of risk and mitigation of loss, particularly against elements of nature such as precipitation and high wind. In order to retain a patent building envelope system, a roof is to be in a good state of repair.
    Observations to the roof have triggered indications that roof repair and maintenance is required.

  • RIA Building
  • Elaboration:

  • Briefly outline the principal site exposures.

  • Exposure Controls

  • Risk Improvement Action:

  • Briefly outline the relevant and predominant occupancy activities on site?.

  • Occupancy Hazard Grade

  • Estimated Percentage of Materials of Non -Combustible / Non-Flammable Construction.

  • Narrative / Remarks:

Management Systems

  • Electrical testing with certificates?

  • Risk Improvement Requirement:
    Energised systems have been identified as one of the leading causes of fire and injury. A system that is not in a full state of readiness presents undue risk.
    An electrical inspection by a qualified electrician with Wiremans certification is to be conducted and all faults rectified.
    A Certificate of Compliance is to be obtained from the service provider and retained in the Company Safety File.
    A copy of this certificate is required by Insurers.

  • RIA Electrical testing
  • Programme of machinery maintenance?

  • Risk Improvement Requirement

  • RIA Machinery Maintenance
  • Housekeeping and waste controls

  • Risk Improvement Requirement

  • RIA Housekeeping
  • Smoking Controls

  • Risk Improvement Requirement

  • RIA Smoking Controls
  • Contractor Control and Permit to Work Systems embedded in the business?

  • Risk Improvement requirement

  • RIA Control & Permit systems
  • Major Hazards installation inspections carried out annually?

  • Hazard Identification and Risk Management plan conducted at least once per year?

  • Occupational Health and Safety legislation requires that regular risk identification and hazard assessments be conducted at all work places. Non-compliance not only exposes persons and assets to undue risk, but could also lead to offenders being prosecuted by the authorities.

  • Advice
  • Safety Audits and meetings conducted, with minutes filed, on a regular and scheduled basis?

  • Occupational Health and Safety legislation requires that regular minuted safety meetings and audits be conducted at all work places. Non-compliance not only exposes persons and assets to undue risk, but could also lead to offenders being prosecuted by the authorities.

  • Advisory
  • Yard Storage Practices

  • Risk Improvement Requirement: Poor yard storage practices such as, but not limited to, goods stacked against or within 5 metres of a building, or staked insecurely present vulnerability to undesired acts such as theft, arson and potential spread of fire - all of which could adversely affect the profitability of a company.

  • RIA Yard Storage
  • Narrative / Remarks:

Site operations, staff etc.

  • Number of Staff on site at business as Usual periods

  • What are the standard operating hours and provide details of any shutdown periods.

  • Narrative / Remarks:

Fire detection

  • Fire detection system fitted.

  • Risk Improvement Advice:
    Early Fire detection and warning increases the possibility of a fire being brought under control at an early stage. This limits damage and reduces the severity of the fire. To be at optimum efficiency, all vulnerable areas should be covered by fire detection devices connected to an annunciation panel at a monitored alarm facility.

  • Advisory: Fire Detection
  • Risk Improvement Requirement - Fire Detection:
    Early Fire detection and warning increases the possibility of a fire being brought under control at an early stage. This limits damage and reduces the severity of the fire. To be effective, all vulnerable areas are required to be covered by fire detection devices connected to an annunciation panel at a monitored alarm facility.

  • RIA Fire Detection
  • Sprinkler system fitted.

  • Has the system been verified by an Independent Party?

  • Automatic Sprinkler Systems need to be verified by an independent third party on a regular basis.
    This is to ensure that
    (a) all omponents of the system, including pump reliability and water quality and supplies would in all likelihood be capable of controlling a fire outbreak in the area protected by the system.
    (b) the system installed is still relevant to the risk being protected - known as a risk review
    (c) the system is still in a full state of operational readiness
    To assure the owners / occupants of a protected site that these features are in fact correct, third party verification is required, as opposed to original installer verification. A certificate of compliance from the independant third party service provider indicating inspection and test results, as well as a list of deficiencies, if any is to be provided to the owner / occupant. A copy of this certificate needs to be furnished to Insurers.

  • RIA Automatic Fire Sprinkler Systems
  • Are scheduled tests conducted and logged on a regular basis?

  • Risk Improvement Requirement:
    Automatic Sprinkler Systems need to be tested by a responsible person on a regular basis.
    This is to ensure that the system is in a state of operational readiness, with sufficient fuel being available for pumps, a visual inspection to verify that all the relevant valves are open, a test to ensure that the alarm gong works and that pressure switches are operational as well as checking to ensure that sufficient spare heads are on hand if needed.
    As evidence of such tests, a log needs to be completed and retained on site. This will more than likely be required in the event of a claim occurring, as evidence of the system having been properly maintained and may determine the outcome of a claim.

  • RIA Sprinkler tests
  • Are adequate water supplies in terms of quantity and flow available?

  • Risk Advice:
    Insufficient water supplies to a sprinkler system would most likely lead to the failure of the system in controlling a fire. This would lead to the spread of fire being unconstrained. Where water supplies are questionable it is prudent for auxilliary tanks to be installed, together with diesel powered pumps which would ensure adequate pressure delivery of water to the entire system.

  • ADvisory
  • Has the Insured been made aware of the Sprinkler System Impairment procedure?

  • Risk Advisory:
    Whenever an element of a sprinkler system is shut down for a period exceeding 8 hours, the Insurer is required to be notified of this event. On reinstatement of the system, it is important to convey this information to the Insurer.

  • Risk Advisory
  • Fire brigade access to the site, taking into consideration tight corners, ledges, road widths and overhang heights?

  • Portable Fire Extinguishing Appliances provision

  • Is there Unobstructed access to all fire equipment?

  • Risk Improvement Requirement:
    In the event of a fire, it is a natural reaction of persons to be under stress. It is important that rapid, unhindered access to portable fire equipment be provided so that a rapid deployment and activation of the fire extinguishing media can be assured. Delays in such will exacerbate the fire and lead to further damage and potential injury or death. It is also important that equipment be conspicuous. To this end signage should indicate the position of all fire equipment. All equipment must remain clearly visible.

  • RIA Fire Equipment
  • Has all fire equipment been serviced within the past 12 months?

  • In order to have some measure of certainty around the operational readiness of fire extinguishing equipment, such needs to be serviced on at least an annual basis, or more frequently, depending on OEM requirements. Such servicing is required in terms of legislation as well.
    Servicing of fire equipment may only be undertaken by duly accredited and qualified service providers.

  • RIA Fire Equipment
  • Have members of staff been trained in the correct selection and use of fire equipment?

  • Risk Advisory:
    The incorrect selection, approach and application of incorrect fire extinguishing media to a fire could result in not only the spread of fire, but also serious injury and even death. It is a legal requirement, as well as a matter of prudence, that persons be trained in the selection and proper use of fire extinguishing equipment. This type of training is generally provided by companies supplying and servicing the fire equipment but may also be offered by other institutions. Certificates of such training should be retained in the company safety file and be renewed on a regular basis, normally every 12 months.
    Larger enterprises, and those holding high hazard are required to have in place organised Fire Teams who would be responsible for marshaling persons to safety, directing the fire brigade to the scene of the fire and where safe to do so, initiating an attack on the fire in an effort to confine or extinguish the fire.

  • Advisory
  • Is there a well documented and posted Fire Plan?

  • Risk Advice

  • Advisory
  • Narrative / Remarks:

Security

  • Intruder Alarm and system.

  • Risk Improvement Requirement:

  • RIA Security
  • Risk Advice;

  • Advisory
  • Door locks and other security measures.

  • Risk Improvement Requirement

  • RIA Security
  • Cash handling, safe and amounts.

  • Risk Improvement Requirement:

  • RIA Security
  • Any history of, or predisposing factors to Arson risk?

  • Artificial lighting of areas at risk

  • Risk Improvement Requirement

  • RIA Security
  • Yard Storage Practices

  • Risk Improvement Requirement

  • RIA Security
  • Management of Incidental Hazards

  • Risk Improvement Requirement

  • RIA Incidental Hazards
  • Narrative / Remarks:

Special perils and Malicious Damage.

  • Type of peril noted

  • Flood risks

  • Risk Improvement Requirement

  • RIA Flood Risk
  • Windstorm risk.

  • Risk Improvement Requirement

  • RIA Natural Perils
  • Narrative / Remarks:

Loss history

  • Have there been any losses or claims noted?

  • Narrative / Remarks:

Utilities

  • Mains Gas or Gas supplies and shut offs

  • Risk Improvement Requirement

  • RIA Utilities
  • Mains Electricity Low voltage

  • Risk Improvement Requirement

  • RIA Utilities
  • Mains Electricity High Voltage

  • Risk Improvement Requirement

  • RIA Utilities
  • Bulk LPG Tank Installations Protections.

  • Risk Improvement Requirement

  • RIA Utilities
  • Mains Water.

  • Risk Improvement Requirement

  • RIA Utilities
  • Transformer units.

  • Risk Improvement Requirement

  • RIA Utilities
  • Narrative / Remarks:

Health and Safety Organisation.

  • Is there a formal Health and Safety organisation?

  • Risk Advice

  • Advisory
  • Are any Occupational Health arrangements in place.

  • Risk Advice

  • Advisory
  • Narrative / Remarks:

Primary Hazards and Exposures.

  • Materials and Manual Handling.

  • Risk Advice

  • Advisory
  • Cut and Burn Hazards.

  • Risk Advice

  • Advisory
  • Slips Trips and Falls.

  • Risk Advice

  • Advisory
  • Machinery, Plant and Equipment Safety (Guards - limit switches, lock outs, etc).

  • Risk Advice

  • Advisory
  • Maintenance and Process Safety ( heights,isolation, confined spaces)

  • Risk Advice

  • Advisory
  • Emergency Planning.

  • Risk Advice

  • Advisory
  • Narrative / Remarks:

Conclusion

  • Narrative / Remarks:

  • Add media

  • Add media

  • Add media

  • Add media

  • Add drawing

  • Predictable Loss Scenario:

  • Possible Maximum Loss: This is the highest loss scenario envisaged where all protections and risk mitigation measures have been considered to be effective in marginalizing the loss.

  • Estimated Maximum Loss

  • Remarks

  • Overall Opinion of Risk

  • Narrative / Remarks:

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