Property Protect Risk Questionnaire (To be completed for all risks containing high hazard activities / processes)
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1 Property Protect Risk Questionnaire (To be completed for all risks containing high hazard activities / processes) Insured Name: Risk Address: New Business Construction: Walls Renewal Policy Number: Building 1 Building 2 Building 3 Building 4 Frame Roof Internal Separation - Material - Slab to Ceiling or Roof? Floors Ground Floors Upper Building age Zoning (industrial, commercial or residential) Services: Electricity source Switchboards Date wiring installed Water source Mains Generator Open Closed Date last thermo graphically tested Town Main Storage Tanks Other please specify below Town Gas Yes If used for processing, please provide details below Security Protection Do security guards regularly patrol the property Yes Is there perimeter fencing in place Is there external lighting in place Yes Yes Other Neighbouring Risks: North Neighbour South Neighbour East Neighbour West Neighbour V Page 1 of 6
2 Occupancy: Please provide a list of tenants and details of the activities / processes undertaken at the location. Unit # Building Number Tenant activities / processes Wok Cooking *Are any of the following activities undertaken? Deep Frying (Ltr) Fibreglass Wood working Cool rooms % floor area Welding Upholstering Polishing * Please refer to individual risk addendums at end of questionnaire V Page 2 of 6
3 Flammables: Are flammables (including paints and varnishes) used and / or stored? Yes please specify below Gases? Yes please specify below Unit Number Type Class Use Quantity How Stored Flammable Liquids Store / Storage devices Please provide detail of their construction Unit Number Unit Number Unit Number Unit Number Unit Number Unit Number Walls Floor Roof Fire Doors Electrical System Ventilation If other hazardous materials and chemicals are stored on site, please provide details below Fire Protection Extinguishers - Number installed - Date last serviced Hydrants Number of hose reels installed Public Private Fire Brigade Public Volunteer Private - Distance from location - Response time Are automatic fire alarms installed Yes - What are they connected to Are hard wired smoke detectors installed Yes Are fire sprinklers designed to Australian Standard AS 2118 / AS installed at the location? Yes If yes please complete the following: Date installed Type Single water supply Double water supply Regularly maintained Yes Is maintenance agreement in force Date last serviced Yes V Page 3 of 6
4 EPS Does any unit consist of sandwich foam panels? Yes - please provide details below Unit Number % of floor area Storage Is any form of storage undertaken at the location? Yes please provide details below Unit Number Type of material stored Method (free standing, palletised, racks) Height Management / housekeeping Are all external areas clean and tidy? Yes please provide details below Are all defined walkways, staircases, passageway, lobbies and fire escapes clearly marked and unobstructed? Yes please provide details below Are waste materials removed from premises daily? Yes please provide details below Do smoking restrictions apply? Yes Are smoking and non smoking areas adequately signposted? Yes V Page 4 of 6
5 Building Plan Please sketch brief plan setting out approximate position of buildings. Note: If more than 1 building please number each building on the sketch. Risk questionnaire completed by: Name: Organisation: Signature: Date: Please fully completed risk questionnaire to qus@qus.com.au V Page 5 of 6
6 Industry Addendums per unit Woodworking: Are dust extractors fitted to all woodworking machinery? Are waste materials removed daily? List any house keeping measures implemented? Yes No Yes Note: If more than one unit undertaking this activity please provide separate responses for each unit Cooking: Does the fryer / wok have an automatic thermostat cut off? Yes No Are the filters and flues cleaned by professionals? Yes No How often are the filters and flues cleaned? Yes Note: If more than one unit undertaking this activity please provide separate responses for each unit V Page 6 of 6
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