Title Page

  • Name of the insured (what entity will be on the policy)

  • Trading as:

  • Location address:

  • Broker Name

  • Broker Email Address

  • Name and role of person conferred with on site:

  • Mobile number of person conferred with on site:

  • Email of person conferred with on site:

  • What is the status of the survey?

  • Time and date of survey

  • Overview of the occupation

  • Survey allocated to / Report prepared by:

  • Date of survey booking:

  • Policy Type:

  • Policy number:

  • Allocated to which Underwriter

  • Policy Values:

  • Buildings:

  • Contents / Plant:

  • Stock:

  • Removal of Debris:

  • Insurable Gross Profit:

  • Indemnity Period (months):

  • Additional Increased Cost of Working:

  • Claims Costs:

  • Theft:

  • Money:

  • Equipment Breakdown Item Limit

  • Number of Items:

  • Public & Products Liability:

  • ANZSIC Code Description / Occupation (as per Policy)

  • ANZSIC Property Hazard Index (as per Policy):

  • Is the ANZSIC Code Description accurate?

  • What is the issue with the occupation desciption?

  • Is the Construction and Protection information supplied accurate?

  • Discrepancies between the Construction and Protection information supplied and what was identified during the virtual survey relate to:

  • Year of Construction should be:

  • Floor construction should be changed to:

  • Wall construction should be changed to:

  • Roof construction should be changed to:

  • Number of Stories construction should be changed to:

  • Asbestos construction should be changed to:

  • Aluminium Compostite Panel / Cladding construction should be changed to:

  • Insulated Panel construction should be changed to:

  • Water Supply should be changed to:

  • Fire Extinguisher protection should be changed to:

  • Fire blanket protection should be changed to:

  • Sprinkler protection should be changed to:

  • Monitored Smoke Detection protection should be changed to:

  • Hore Reel protection should be changed to:

  • No Fire Protection protection shoud be changed to:

  • Other, should include the following details:

  • Construction
  • Building name / identifier

  • Building Type:

  • External Walls:

  • Roof:

  • Floors:

  • Number of levels ground and above:

  • Number of below ground levels:

  • Lowest occupied level:

  • Building age:

  • Heritage considerations:

  • Building Condition:

  • Building floor area (sq metres):

  • Building footprint area (sq m) :

  • Total building area of all levels (sq m):

  • Tenancy floor area (sq m):

  • Building fire divisions / compartmentation

  • Asbestos materials:

  • Asbestos Management:

  • Asbestos Percentage:

  • Plastic construction materials:

  • Panel core material:

  • Percentage of ISP by floor area of the building:

  • Panel Management Controls:

  • Condition of Panels

  • Cladding / ACP combustibility

  • Cladding / ACP percentage:

Construction Overview

  • Is there more than one building on site

  • Overall percentage of asbestos materials over total of all buildings on site:

  • Overall percentage of ACP / combustible cladding materials over total of all buildings on site:

  • Overall percentage of Insulated Sandwich Panel materials over total of all buildings on site:

Occupation

  • Overview of occupation, including any issues and non-standard features:

  • List of process activities:

  • Type of cooking equipment:

  • Rangehood Filter cleaning:

  • Rangehood internal duct / flue cleaning:

  • Woodworking controls:

  • Spray booth:

  • Flammable liquids controls:

  • Smash repair controls:

  • Plastic moulding controls:

  • Plastic moulding controls:

  • Plastic moulding controls:

  • Printing controls:

  • Hot work controls:

  • Are hazardous process activities adequately controlled?

  • Details of deficienciesies with process controls:

  • Housekeeping:

Electrical

  • Thermal imaging of electrics:

  • Test & Tagging of portable equipment:

  • Solar PV System

  • Solar system capacity:

  • Power Generators

  • Generator maintenance:

  • External housekeeping:

Fire Protection

  • Fire protection provided:

  • Fire Blanket:

  • Fire Extinguishers:

  • Fire Extinguisher maintenance:

  • Fire Hose Reels:

  • Fire Hose Reels maintenance:

  • Fire Hydrants:

  • Fire Hydrants maintenance:

  • Fire Detection type:

  • Fire Detection maintenance:

  • Localised Fire Supression coverage:

  • Fire Supression maintenance:

  • Sprinkler System design:

  • Sprinkler System maintenance:

  • Sprinkler System monitoring:

  • Sprinkler System Adequacy:

  • Fire water supply:

  • Exit Signs and Emergency Lighting:

  • Occupant Warning System:

  • Emergency Procedures:

  • Staff Fire Training:

  • Fire Brigade:

  • Other Fire Protection:

Security

  • Electronic Security Alarm System:

  • CCTV System:

  • Security Guards:

  • Adequate security measures in place

Exposures

  • Neigbouring Exposures:

  • Natural Perils

Business Interruption

  • Business Interruption

  • Computer Records Back-up

  • Indemnity Period we recommend

Risk Improvement Recommendations

  • Actions marked as "Critical" actions address major deficiencies in controls that fall short of best industry practices or recognised standards. These actions are necessary when there's a high likelihood of a loss event, and the potential consequences are significantly greater due to inadequate controls.

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

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

  • Are there any risk recommendations?

  • Fire and Life Safety Recommendations
  • undefined

  • Recommended Priority

  • Electrical Risk Recommendations
  • undefined

  • Recommendation Priority

  • House Keeping Recommendations
  • undefined

  • Recommendation Priority

  • Occupation Recommendations
  • undefined

  • Recommendation Priority

  • Management Controls
  • undefined

  • Recommendation Priority

  • Security Recommendation
  • undefined

  • Recommendation Priority

  • Cash Management Recommendations
  • undefined

  • Recommendation Priority

  • Natural Perils / Other Exposures Recommendations
  • undefined

  • Recommendation Priority

  • Separation Recommendations
  • undefined

  • Recommendation Priority

  • Values at Risk Recommendations
  • undefined

  • Recommendation Priority

  • Liability Recommendations
  • undefined

  • Recommendation Priority

  • Other Risk Recommendations
  • undefined

  • Recommendation Priority

Survey Summary

  • Survey Status

  • Hazard class

  • Construction Classification

  • Fire load and fire spread risk

  • Loss Expectancy:

  • Values at risk

  • Client attitude towards risk management?

  • Attach PDF of visual report from Blitz as media

  • Visual report

  • Acceptability

  • Are there any expected changes in the next twelve months

  • What are the changes?

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

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

  • When does this risk need to be surveyed next?

  • Action includes re-setting the survey booking for 3 months prior to renewal in 1, 2 or 3 years time
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.