Title Page

  • Site conducted

  • Name of insured / client

  • Customer email

  • Name of Broker, if applicable

  • Broker contact number, if applicable

  • Broker email, if applicable

  • Location
  • Conducted on

  • What is the status of the survey?

  • Time and date of survey

  • Is the COPE information provided acceptable

  • What are the issues with the COPE information provided

  • Overview of the occupation

  • Are there any hazardous activities?

  • List the hazardous Activities

  • What is the core of the panel installed?

  • What type of core material?

  • What is the percentage of floor space?

  • Whats is the percentage of floor space?

  • What is the percentage of floor space?

  • Are hazards associated with the identified activity appropriately managed?

  • Survey allocated to:

  • Address of Survey

Recommendation definitions

Key risk improvement recommendations (definitions on priorities)

  • Actions marked as "High" – Recommendation to address significant deficiencies in relation to the level of controls where they do not meet best industry practice or internationally recognised standards. This must apply where there is a significant likelihood of a loss event and in the event of a loss, the consequence is expected to be significantly higher in comparison to where adequate controls are in place.

  • Actions marked as "Medium" – Recommendation to address deficiencies in relation to the level of controls whereas they do not meet best industry practice and internationally recognised standards. Deficiency may increase the likelihood of a loss event, or consequence in the event of a loss event.

  • Actions marked as "Low" – Considered to be best industry practice with a low likelihood and consequence in relating to loss exposure.

Overall Risk Summary

  • Hazard class

  • Occupancy Overview

  • Fire load/spread

  • Construction

  • Composite Panel/Insulated Panel

  • Overall percentage of floorspace

  • Fire separation exposures

  • Loss Record

  • Please provide details

Loss Projections

  • Amount Subject / Maximum Foreseeable Loss (AS/MFL)

  • Probable Maximum Loss (PML)

  • Please provide further details

  • Net Loss Expectancy (NLE)

  • Please provide further details

Construction

    Building details

Building/Structure Construction

  • Enter building name

  • Year of Construction

  • Floor Area ~m2

  • No. Storeys

  • Any other information

Structure

  • Walls

  • Floors

  • Roof

  • Provide further information

Insulated Panel

  • Is there insulated panel installed to the building

  • Position of insulated panel

  • FM Class 1

  • Core Thickness (mm)

  • Floor Area (%)

  • Surface Area (%)

  • Max Wall Height (m)

  • Are routine ISP inspections undertaken?

  • External Insulated Finishing Systems Type

  • Core Material

  • Provide details

  • Usage

  • Provide detail

  • Condition

  • Hot/Cold Work Procedure

  • Regular Self-Inspections

  • Panel faces along all sections are in good condition with no exposed core material

  • All electrical cabling/wiring is fully enclosed within approved plastic or metal conduit with appropriate seals/flashing/capping where it passes through insulated panels

  • All flues have appropriate clearances and flashing/capping through insulated panels

  • Diffusers (covers) are fitted to all light bulbs/lamps so that any failure of a bulb/lamp, or its associated ballast, will not result in heated components potentially falling onto combustible items stored below

  • Where insulated panels form external wall sections of a building, combustible items and/or rubbish bins are not stored within 6m of these external panels

  • All heat sources are kept at least 2 metres from any insulated panels

  • Battery chargers are positioned 2 metres from any insulated panels or non-combustible material such as Fyrchek or checkerplate has been installed between the chargers and the insulated panels

Other factors

  • Does the building construction include asbestos?

  • What building elements include asbestos materials?

  • Is the building heritage listed?

  • What elements of the building are heritage listed?

General comments about this building

  • General comments

Occupancy

Overall

  • What is the occupancy use / use of this property

  • Overview of activities with inherent risk
  • Are any hazardous processes are undertaken?

  • Commercial Kitchen Overview

  • No. of kitchens

  • Equipment

  • Provide details

Deep Fryers

  • Installed

  • Type

  • Heating source

  • Capacity (L)

  • Temp (C)

  • Frequency of changing oil

  • Where is waste oil stored?

Solid Fuel

  • None at this siteIs there any soild fuel cooking at this site?

  • What type of solid fuel cooking?

  • List types

  • Are the charcoals extinguished and allowed to cool before closing at the end of the day?

  • Are charcoals removed from the building when extinguished?

  • What type of meat smoking?

  • Heat source

Cleaning and maintenance

  • Cookers/fryers/ovens within commercial kitchens are adequately maintained and in a clean condition with no build-up of food debris around the cooker rings or heating elements

  • Cookers/fryers/ovens are appropriately separated to/from internal wall linings to eliminate the potential of radiant heat transfer

  • A gas isolation/shut-off valve is readily available to kitchen workers so that the gas can be quickly isolated in an emergency situation

  • Fire blanket and extinguisher/s installed and accessible, with appropriate extinguishing agent (CO2 or dry chemical powder for general kitchen areas and wet chemical for deep fryers)

  • Deep fryers are fitted with appropriate flame failure controls, thermostat controls and automatic over-temperature cut-out provisions

  • The oil is skimmed to remove any food scraps and replaced regularly (timing of replacement based on the frequency of fryer use)

  • Cleaning frequencies are adequate based on the amount and type of cooking being carried out in the kitchen. In general, we use the standards advised by IKECA in this regard

  • Lighting within canopies is fully enclosed

  • Canopy exhaust fans are maintained so that they run freely with no evidence of excessive bearing noise or vibration

  • How often is the canopy and filters cleaned/replaced?

  • How often is the ducting cleaned to the external atmosphere?

  • Is the cooking equipment hoods / exhaust duct subject to cleaning?

  • How often are the hoods / exhaust cleaned?

  • Who is engaged to conduct the cleaning?

  • Is there photographic evidence to support the cleaning schedule?

  • Is there a routine cleaning programme to remove combustible dust build-up?

  • Has hazardous area assessment been undertaken with an up to date dossier available complete with hazardous area zoning?

  • Is electrical equipment adequately rated for hazardous areas?

  • Number of spray booths

  • Number of open spray booths

  • Number of enclosed spray booths

  • What material are the spray booth walls and ceilings constructed of?

  • What is the spray booth constructed of?

  • Is the Spray Booth Heated?

  • What is the heating source?

  • Are the heating burners well separated to/from internal walls (no radiant heat transfer issues)?

  • Has the spray booth been designed, constructed and installed to comply with AS/NZS 4114.1 – Spray Painting Booths?

  • Are procedures available and up to date for the operation and maintenance of all spray booths?

  • Are all persons who operate spray booths trained in the operation, use of and storage hazardous materials being used in the the booth?

  • Is health monitoring being conducted based on the chemicals sprayed in the spray booths?

  • Are records stored in a secure place?

  • Is the Spray Booth fitted with an exhaust capture system or ventilation system that includes a filter for removing airborne contaminants?

  • Is the system operational?

  • Are filters cleaned regularly and free of built up overspray?

  • Is the ducting to the external environment cleaned at least annually and free from built up overspray?

  • When was the last service conducted and is it maintained to manufacturer’s specifications?

  • Are spray guns pneumatically actuated?

  • Are spray gun nozzles cleaned regularly and tested?

  • When was the last service conducted?

  • Are employees required to wear appropriate PPE?

  • Are lights fitted with diffuser covers and cleaned regularly from overspray?

  • Are spray paints stored in a separate area well separated to/from ignition sources

  • Are solvents and other flammable liquids stored in a compliant Dangerous Goods Storage Unit

  • Are solvent soaked clean up rags disposed of in a non-combustible bin with well fitting lid and removed from the building at the end of the day?

  • Are suitable fire extinguishers readily available to spray paint booths, painting areas and paint storage areas?

  • Are they kept free from obstruction?

  • Are extinguishers fully charged?

  • Tested on a 6 monthly basis as per AS1851?

  • What other hazardous activities are in place and are safety controls adequate?

  • Cabinet Making Hazards

  • Equipment

  • Raw Materials

Extraction bags for internal systems are emptied regularly and removed to bulk waste bins

  • Built up dust and other combustible materials are removed from around the extraction system

  • External extraction system empties into bulk waste bin which is replaced regularly and not allowed to overfill at any time

  • Dust collector is fitted with appropriate blast doors

  • Ducting and filters are cleaned regularly to avoid sawdust building up within the system

  • There is no built up sawdust or combustible materials around the motors of the extraction system

  • Dust collector is adequately separated from the building or installed against a full height non-combustible wall

  • Sawdust and other combustible materials are regularly removed from around the machines including motors and other ignition sources

  • Machines have appropriate safety guards and safety cut offs installed and are not disabled

  • All production plant/equipment including air compressors and similar are subject to preventative maintenance

  • Electrical/electronic control panels and distribution boards are enclosed within non-combustible cabinets which remain closed to prevent ingress of dust and other raw materials

  • Appropriate PPE is worn by operators at all times

  • There is no significant accumulation of packaging materials and/or finished products adjacent to the machines (they are transferred to an appropriately separated storage section)

  • Moulding Type

  • What type of moulding?

Raw Material

  • What type of plastics are used in the production processes?

  • Provide details

  • Bulk silos

Storage configurations, quantity and transfer

  • Storage of raw materials - bags, palletised, bulk 1 tonne bags, silos?

  • Provide details

  • How many silos?

  • Capacity of silos (metric tonnes)

  • Bags/palletised - volume or quantity stored - metric tonnes

  • Bulk storage silos are non-combustible, structurally well supported, impact protected, fully enclosed and appropriately grounded.

  • Plastic raw materials (beads/granules) pumped into bulk silos utilising pumps positioned on delivery tankers, and then vacuumed into the building to individual moulding units via fully enclosed, appropriately supported and impact protected non-combustible piping

  • Filters installed within the pipes and/or the pipes are blown out regularly to prevent accumulation of fines

  • Vacuum pumps/motors appropriately enclosed and separated from the plastic raw materials so as not to present a potential ignition source

  • There is no significant accumulation of plastic raw materials adjacent to the moulding units (they are stored in an appropriately separated section of the building/site)

  • There is no significant accumulation of packaging materials and/or finished products adjacent to the moulding units (they are transferred to an appropriately separated storage section)

Moulding Units maintenance & housekeeping

  • The moulding units are state of the art with electronic controls with integrated cut-out provisions and audible alarms for over/under temperature or other abnormal operating conditions

  • Moulding units are electrically heated, with no gas heating as part of the production processes

  • There is no operating any production plant/equipment on an unattended basis after hours (automated pre-warming of electrically heated equipment prior to employees arriving on site in the morning is acceptable)

  • Pre-warming processes are electronically controlled and do not involve production/manufacturing

  • Finished products are appropriately cooled prior to being packed into cardboard cartons

  • All production plant/equipment including the moulding units, chillers (if installed), air compressors and similar are subject to preventative maintenance

  • Electrical/electronic control panels and distribution boards are enclosed within non-combustible cabinets which remain closed to prevent ingress of dust/plastic raw materials

  • The floor and other surfaces in the production areas are kept clear of plastic raw materials, oils/lubricants and other combustibles

  • Plastic waste/offcuts are stored appropriately separated from potential ignition sources and regularly removed from the site

  • Granulating of recyclable materials takes place in an appropriately separated area utilising a state of the art granulator that is supervised at all times when operating and fitted with readily accessible emergency stop provisions that shut down the conveyor and granulator

  • There is no accumulation of waste plastic products or granulated products around this granulating unit

What type of ovens

  • Please select the type of ovens used

  • Please specify type of ovens

  • What is the fuel source?

  • Please specify

  • Are the ovens extinguished and allowed to cool at the end of the day?

  • Best practise risk mitigation is to extinguish the fuel and allow to cool before leaving for the day to prevent re-ignition and a fire spreading through the business

  • Please specify what is done with the charcoal or burnt wood once extinguished - choose as many as appropriate

  • Best practise if to remove the coals/charcoal from the oven in a non-combustible sealed container and remove from the building. Alternatively if using a traditional wood fire oven the oven should be completed seal and flue closed once the coals are extingusihed.

  • Are flues and chimneys cleaned regularly removing any built up creasote (black tar like substance that lines the chimney or flue)?

  • Chimneys and Flues of wood fired ovens need regular cleaning and maintenance - creosote build up not only impacts the efficiency of the wood fired oven but is highly combustible and can ignite in the chimney and rapidly spread throughout the building. Please arrange to have your chimney serviced and cleaned as soon as practiable.

  • How many ovens in total

Flour storage

  • How is the flour stored?

  • How many silos?

  • Capacity of the silos

  • Bulk storage silos are non-combustible, structurally well supported, impact protected, fully enclosed and appropriately grounded

  • Flour is pumped into bulk silos utilising pumps positioned on delivery tankers, and then vacuumed into the building to individual moulding units via fully enclosed, appropriately supported and impact protected non-combustible piping

  • How is the flour in bags/sacks stored?

  • Please provide details

General Risk Management

  • Baking ovens within commercial bakery are adequately maintained and in a clean condition with no build-up of food debris around the heating elements

  • Baking ovens are appropriately separated to/from internal wall linings to eliminate the potential of radiant heat transfer

  • A gas isolation/shut-off valve is readily available to kitchen workers so that the gas can be quickly isolated in an emergency situation

  • Baking ovens are not operated when facility is unattended, and ovens are shut down and allowed to cool before facility closes at the end of the day

  • Extinguisher/s installed and accessible, with appropriate extinguishing agent (CO2 or dry chemical powder for general kitchen areas and wet chemical for deep fryers)

  • Filters installed within the pipes and/or the pipes are blown out on a regular basis to prevent the accumulation of flour

  • Vacuum pumps/motors appropriately enclosed and separated from the flour products so as not to present a potential ignition source

  • There is no significant accumulation of flour near ignition sources (bulk flour is stored in an appropriately separated section of the building/site)

  • Are all electrical installations including plant and equipment adequately static protected to eliminate static discharge leading to the risk of explosion?

  • There is no operating any baking equipment on an unattended basis after hours (automated pre-warming of electrically heated equipment prior to employees arriving on site in the morning is acceptable)

  • Pre-warming processes are electronically controlled and do not involve production/manufacturing

  • Finished products are appropriately cooled prior to being packed

  • All production plant/equipment including the ovens, refrigeration units, freezers and blast freezers and similar are subject to preventative maintenance

  • Electrical/electronic control panels and distribution boards are enclosed within non-combustible cabinets which remain closed to prevent ingress of flour dust and other raw materials

  • The floor and other surfaces in the production areas are kept clear of flour and other combustibles

  • Cleaning frequencies are adequate based on the amount and type of cooking being carried out in the kitchen. In general, we use the standards advised by IKECA in this regard

  • Lighting within the canopy is fully enclosed

  • Canopy exhaust fans are maintained so that they run freely with no evidence of excessive bearing noise or vibration

Utility

  • Utilities that present site exposures?

  • Describe hazards associated with utilities.

Storage

General storage

  • List any storage arrangements, height and material stored

  • Is racking provided with impact protection on uprights?

  • Are racking inspections undertaken?

  • Is lighting adequately separated from storage?

  • Are forklifts or other mobile plant utilised

  • What type of forklift

  • Are electric forklift charging areas provided with >2m separation from storage?

Dangerous goods

  • What dangerous goods are stored and in what arrangement?

  • Please list types of Dangerous Goods

  • Are gas cylinders adequately secured (for stability)?

  • Are dangerous goods (such as cylinders) segregated? <br>(e.g. oxygen away from flammable gases)

  • Are appropriate hazards material placard in place?

Flammable liquids/dangerous goods

  • What flammable liquids are stored and in what arrangement?

  • Are suitable storage and containment practices in place?

  • Are flammable liquid transfer practices, e.g. earthing and bonding in place? <br>(e.g. placing a fuel tank on the bottom to reduce static discharge)

Loss prevention management controls

Contractor controls

  • Are contractors vetted, insurance details and licencing details confirmed?

  • Are contractors supervised on site?

  • Are the contractors provided induction training?

  • Do contractors follow site loss prevention management controls?

Hazardous works

  • Is there a documented hot works procedure and permit system in place and implemented?

  • Does the hot works permit require a fire watch during and 30 minutes after the completion of work?

  • Is a monitoring period undertaken after the completion of fire watch (minimum 1 hour)?

  • Is a minimum of 10m separation from combustible materials, or fire resistant shielding / covers required?

  • Is equipment checked prior to use and the flashback arrestors fitted?

Fire impairment mangement

  • Is a fire impairment procedure in place?

Smoking controls

  • Is there a dedicated smoking area provided with adequate signage?

  • Are self-extinguishing bins provided?

  • Is the smoking area separated from any entry door or combustible storage by at least 4 meters?

Building maintenance

  • Is housekeeping adequate?<br>(Note: no build up of combustible materials around electrical switchboards and waste materials removed from building?)

  • How often are self-inspections undertaken and by whom?

  • Is vegetation appropriately cut back from buildings?

  • Is roofing (gutters & drains) subject to routine inspections and clearing?

Liability exposure & emergency planning

  • Is liability coverage required?

  • How often are inspections of public accessible areas undertaken? <br>(Eg. identification of trip hazards, etc)

  • Are public accessible areas in adequate condition?

  • Is emergency lighting and exit signs operational and maintained?

  • Do you undertake regular fire drills?

  • Are emergency egress routes clear?

  • Is an evacuation plan in place and is it displayed in common areas?

Summary / wrap up

  • General comments about occupancy

Fire Protection

Fire water supply

  • What is the fire water supply to site?

  • What type of fire water supply is available?

  • Has a water supply proving test been undertaken? <br>(Attach the results of the test via a photo/image if possible)

  • Do the results meet the system design requirements?

  • Are all fire water isolation valves adequately secured?

Automatic sprinkler protection

  • Sprinklers/drenchers

  • Classification

  • Compliance To

  • Impairment Handling

  • Pumpsets - Diesel

  • Pumpsets - Electric

  • Pump Testing

  • Water Supply

  • Mains

  • Town main size (mm)

  • Tank/s

  • Eff Capacity (kL)

  • Status

  • Monthly Testing

  • Annual flow test

Private Hydrants

  • Private Hydrants

  • Pumpsets - Diesel

  • Pumpsets - Electric

  • Pump Testing

  • Water Supply

  • Mains

  • Town main size (mm)

  • Tank/s

  • Eff Capacity (kL)

  • Valve inspections

  • Locking caps

  • Annual flow test

Automatic Fire Detection System

  • Detection Systems

  • What type of automatic fire detection system is installed?

  • undefined

  • Coverage

  • Monitoring

  • Online

  • Inspected to AS1851

  • Isolation Procedure

Fire Hose Reels, extinguishers and fire blankets

  • Hose Reels

  • Adequate Coverage

  • Tested to AS1851

  • Extinguishers

  • Adequate Coverage

  • Inspected to AS1851

  • Fire Blankets

  • Adequate Coverage

  • Inspected to AS1851

Safety Controls

  • Special Haz System

  • Occ Warning System

  • Evacuation Procedure

  • Water Supply

  • Additional Comments

Fire response

  • Is the local fire brigade a full time or volunteer?

  • What's the local fire brigade response time?

  • Is fire brigade access available to all aspects of the building?

  • General comments about fire protection

Exposures

Security controls

  • Are site and building physical access controls adequate?

  • Is the building provided with an intruder detection system?

  • What monitoring is provided?

  • What response on alarm is provided?

  • Is there a business process / roster in place to ensure a staff member is on call?

  • Where is CCTV installed?

  • Is CCTV coverage adequate?

  • Is CCTV monitored offsite?

  • Is there remote access to the CCTV

  • Where are CCTV recording retained?

Security patrols

  • Are security patrols undertaken?

  • Where are security patrols undertaken?

  • What types of security patrols undertaken?

Cash management

  • Is cash retained or collected onsite?

  • Is cash handling undertaken in a secure area?

  • Do you vary cash handling protocols?

  • Do you vary banking of cash protocols?

  • Is there a cash handling procedure including checks to deter employee theft and dishonesty?

Onsite external exposures

  • Are idle pallets adequately separated from the building? <br>(>10 meters)

  • Are waste bins adequately separated from buildings?<br>(>10 meters)

  • Is there any other combustible storage within 10 meters of the building?

Offsite external exposure (neighbouring facilities)

  • Is the building set back from the boundary (10 metres)?

  • What is the neighbouring premises exposure?

  • Is there any combustible storage along adjoining boundary?

Natural and other hazards (note any previous incidents/claims)

  • Flood

  • Windstorm

  • Storm surge

  • Bushfire

  • Earthquake

  • Lightning

  • Hailstorm

  • Collapse / subsidence

  • Impact damage

Business interruption and continuity

  • Is there business interruption coverage?

  • Are there any interdependancies / Internal single point dependencies?<br>(Such as a specific component that is only produced in one area of the business)

  • Are there any suppliers that provide greater than 25% of supplies to the business?

  • Are there any customers that account for greater than 25% of output to the business?

  • Is there any critical equipment that accounts for 25% of reduction?

  • Is there a high dependency on any of the following utilities?

  • Which of the following IT backup and disaster recovery planning is in place?

  • Is there a documented and tested business continuity plan in place?

  • Is the business continuity plan reviewed annually?

Risk summary & overall findings

Follow up & final comments

  • Overall summary

  • Is the COPE Information supplied accurate?

  • What are the discrepancies between the COPE information supplied and what was identified as part of the virtual survey?

  • Any issues with the occupation?

  • Are there any risk recommendations?

  • What areas do the risk recommendations relate to?

  • Select the relevant Fire and Life Safety risk recommendation

  • What is the risk recommendation?

  • What are the related House Keeping Risk Recommendations

  • What is the Risk Recommendation?

  • What are the Electrical Risk Recommendations?

  • What is the risk recommendation?

  • What are the risk recommendations relating to plant and equipment?

  • What is the Risk Recommendation?

  • What are the risk recommendations relating to Insulated Panelling?

  • What is the risk recommendation?

  • What are the risk recommendations to the sums insured and values at risk?

  • What is the risk recommendation?

  • What are the risk recommendations relating to the occupation?

  • What is the Risk Recommendation?

  • What are the risk recommendations to contractor management and liability?

  • What is the risk recommendation?

  • What are the risk recommendations relating to cash management and handling?

  • What are the risk recommendations?

  • What are the risk recommendations relating to security?

  • What is the risk recommendation?

  • What are the risk recommendations relating to building maintenance?

  • What is the risk recommendation?

  • Other Risk Recommendations
  • What are the risk recommendations?

  • Please create an action to the UW advising of the above Risk Recommendations

  • Recommended that the client uses the SC Platform (Inspections, Training, Sensors etc)

  • Notify Anna Lorimer and Luke Robinson via action created to Anna Lorimer

  • Survey Status

  • Attach PDF of visual report from Blitz as media

  • Visual report

  • Recommend onsite assessment?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.