General information

Questionnaire for Property Insurance

Fire & Allied Perils

Insured :-

Insured object:-

Activity:-

Location :-

1) Purpose of Inspection:-

· Risk inspection

· Drawing up Recommendations

· MPL/EML Estimate

· Visit to risk

· Other :-

2) Summary

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

3) Risk Information :-

31 general

311 year of construction

312 work force

313 working hours

314 recent major changes

315 planned major changes

316 layout

317 neighborhood

318 special exposures(aircraft,

flood, storm, earthquake etc)

319 accessibility:

32 main activities

33 Buildings

Buildings no	Type	No. of Stores	Height (m)	Separations (fire walls)	Smoke & Heat Extraction	Remarks *

· P = Protected (nature of protection)

· UP= Unprotected

· OA= Open air plant

34 energy supply

341 electricity

342 Oil , coal , gas ,etc

343 steam

344 compressed air

345 process water

346 heating

347 air-conditioning

348 cooling

345 electrical installations

	Excellent	Good	satisfactory	unsatisfactory
Condition
maintenance

	Available	Not available
Lightning conductor
Grounding

Remarks:-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

36 materials and goods

Materials and Goods	Packing , storage (Quantities)

37 Process

Building / Plant Area	Processes	Special hazards

38 Maintenance

	excellent	good	satisfactory	unsatisfactory
General
Preventive
Building
Machinery
Unoccupied space

General impression / remarks:- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

39 general order

	excellent	good	satisfactory	unsatisfactory
Interior
Exterior
Warehouse
Waste disposal

	Yes	No
Observance of smoking bans
Hot work permit system

4 loss prevention measures

41 alarm

411 watchmen

412 automatic fire detection systems

- functions

- supervised areas

- central desk

413 push button alarms

414 telephone

415 alarm post

416 general impression/ remarks

42 fire fighting

421 hand held extinguishers

422 fire water

- source and amount

- pumps

- pressure

423 water distribution

- external hydrants

- fixed monitors

- hoses/ jet pipes , cabinets

- hose reels

424 works-fire-brigade / fire fighting team

- number of firemen

- equipment

425 public fire-brigade

- distance

- time required to arrive at site

- periodical risk inspection

426 general impression / remarks :

43 fixed installations

431 sprinklers systems

- water supply / pressure

- protected areas

- specifications

432 deluge systems

- water supply / pressure

- protected areas

433 standpipes

- wet

- dry

- area

434 other fire-extinguishing systems

CO2 , powder , halon , foam , light water , steam lances etc

Description

435 general impression / remarks

44 emergency exits

45 emergency lightning

46 safety organization

461 safety officer

462 safety team

463 training of personal

464 alarm plan ,evacuation , emergency measures , salvage etc

465 general impression / remarks

5 loss experience

6 Maximum possible loss:-

61 Definition of (European committee of insurance)

the maximum possible loss (MPL) is that which may occur when the most unfavorable circumstances are more less exceptionally combined and when as a consequence ,the fire is not or unsatisfactorily fought against and therefore is only stopped by impassable obstacles or by lack of combustible material .