RSA SuppoRt questionnaire

RSA SuppoRt questionnaire RSA SUPPORT Risk Management Survey

What you need to do Just take a few minutes to complete this RSA SUPPORT Risk Management Survey and return it in the freepost envelope provided. Please answer all the questions truthfully as your answers will enable us to provide a Risk Control Plan specific to your business and the risks you may face this service is provided by RSA completely free of charge. The information and guidance we provide is designed to help identify areas of risk that may affect your business, employees, customers and members of the public. If the Risk Control Plan identifies areas where it is advisable to take steps to minimise the risks identified, we will provide free advice and guidance on implementation. Thank you for taking the time to complete this Survey and should you have any questions or queries please call the RSA SUPPORT Helpline on 01305 215521. Your Information For details of how we use your information, please look for the padlock symbol on page 10. Please complete the information below in BLOCK CAPITALS Contact name (including title) Business name Address Postcode Telephone number 1

Your policy type will only require you to complete the following sections of this Survey General Question (Page 2) Section 1 Property Questions (Page 3) Section 2 Liability Questions (Page 4) Section 3 Motor Trade Questions (Page 5) Section 4 Additional Property Questions (Page 6) Section 5 Business Interruption Questions (Page 7) Section 6 Additional Liability Questions (Page 7) General Question 1. Please indicate the main activity of the business: Agriculture, Forestry & Fishing Cafes, Restaurants and Public Houses Community, Social and Personal Services Activities Construction / Contractor Education Electricity, Gas and Water Supply Finance Health and Social Work Hotels and B&B Manufacturing Mining and Quarrying Motor Trade Professional Services Property Owners As the Property Owner, please ensure Sections 1 & 4 are completed by your tenant or your managing agent in conjunction with the tenant. Recreational Services Transport & Storage Wholesale Retail Other (None of the above) 2

Section 1 Property Questions 2. Do you carry out a recorded annual inspection Yes No of the property to ensure it is in good condition and safe for occupants and visitors? N.B. The inspection should include roofs, gutters, downpipes and drains, surrounding yards, paths, driveways and external lighting. 3. Do you have formal procedures for the regular Yes No removal of combustible / flammable trade or general waste? 4. Are you aware of any incidents of arson, Yes No malicious damage or graffiti at or near your property? 5a. Do you externally store combustible materials, Yes No waste or pallets? If No to 5a, please move to Question 6a. 5b. If Yes to 5a, please indicate how closely they Within 10 metres of any property are stored to any property: Over 10 metres from any property 6a. Has your fixed electrical installation been Yes No inspected / installed by a qualified electrician within the last 5 years? If No to 6a, please move to Question 7. 6b. If Yes to 6a, do you have an inspection / Yes No installation certificate? N/A We have not had an inspection / installation within the last 5 years 7. Do you have a Portable Appliance Testing (PAT) Yes No procedure for your portable electrical appliances, e.g. kettles, fan heaters, radios, extension leads N/A We do not have any portable appliances or fans? 8. Do you use portable heaters with naked flames Yes No or hot radiant surfaces? 9. Has a competent person completed or Yes No reviewed a Fire Risk Assessment within the last 12 months in accordance with your legal responsibilities? 3

10a. Do you have a cooking extraction system? Yes No If No to 10a, please move to Question 11a. 10b. If Yes to 10a, is your extraction system Yes No regularly maintained and cleaned? N/A We do not have an extraction system 11a. Have you taken steps to identify asbestos Yes No within your property? 11b. If Yes to 11a, has a formal documented Yes No asbestos plan been developed? N/A We have not identified any asbestos Section 2 Liability Questions 12. Do you have a written Health & Safety Policy? Yes No N/A We have less than 5 employees 13. Does a senior person have overall Yes No responsibility for health and safety? 14. Do you have a training programme for all Yes No new and existing employees? We do not have any employees 15. Do you have documented Risk Assessments Yes No covering all of your work activities (including work away from your property)? N/A We have assessed that our work activities do not require documented Risk Assessments 16. Have you carried out a Manual Handling Yes No Assessment in relation to the activities that you or your employees undertake? N/A Our activities do not involve any Manual Handling 17. Has a Control of Substances Hazardous to Yes No Health (COSHH) Assessment been carried out for any hazardous substances, e.g. cleaning N/A We do not have substances hazardous to health detergents, cellulose based paints, thinners or poison? 18. Have you completed a Risk Assessment for Yes No any employee who works at a height where there is a risk of a fall liable to cause N/A We do not have any employees who work at height personal injury? 4

19. Have you completed a Noise Assessment Yes No for areas where you have to shout to be heard 2 metres away? N/A We do not have any noisy activities Section 3 Motor Trade Questions 20. Do you have any highly flammable liquid spraying Yes No processes, e.g. motor vehicle painting? 21a. Are vehicles (customer s or your own) stored Yes No outside of working hours in the open? If No to 21a, please move to Question 22a. 21b. If Yes to 21a, is anti ram-raid protection used? Yes No N/A We do not store vehicles in the open 22a. Do you manage the security of any vehicle keys? Yes No If No to 22a, please move to Question 23. 22b. If Yes to 22a, do you store vehicle keys Yes No within a locked key cabinet and/or remove the keys from the property outside of N/A We do not manage the security of vehicle keys business hours? 23. Do you manage a motor fleet or any Yes No employee-sourced vehicles? 24. Are your own vehicles subject to a documented Yes No maintenance programme? N/A We do not operate our own vehicles 25. Do you allow employees to utilise customer Yes No vehicles outside of office hours? N/A Our business does not involve customer vehicles 26. Do you place usage restrictions on the type Yes No of vehicle any employee under the age of 25 can drive? N/A We do not have any employees under the age of 25 27. Do you have a formal documented process Yes No for the management of all courtesy cars? N/A We do not utilise any courtesy cars 28. Do you include a prospective employee s driving Yes No history within any employment application process? N/A We do not have any employees driving as part of their role 5

29. Do you check prospective employee s driving Yes No licences within any employment application process? N/A - We do not have any employees driving as part of their role 30. Do you annually re-check your employee s Yes No driving licences to assess any change since their last review? N/A - We do not have any employees driving as part of their role 31. Do you work on fuel tanks, e.g. correcting a Yes No mis-fuelled vehicle, repairing a hole, changing fuel lines? Section 4 Additional Property Questions 32. Is your property occupied by more than Yes No one business? 33. Do you use or store highly flammable liquids? Yes No 34. Do you use or store Liquid Petroleum Gas (LPG) Yes No Cylinders or other flammable gases, e.g. Calor gas, butane, propane or acetylene? 35. Do you have any combustible materials within Yes No 1 metre of electrical switchgear distribution panels, light fittings or heating appliances? 36. Do you ensure a non-combustible smoking Yes No waste receptacle is utilised in areas where smoking is legally permitted? N/A We do not allow smoking in or on our property 37a. Do you have any fire extinguishing appliances, Yes No e.g. fire extinguishers or fire blankets? If No to 37a, please move to Question 38a. 37b. If Yes to 37a, are all your fire extinguishing Yes No appliances covered by a service contract which regularly maintains them? N/A We do not have any Fire Extinguishing Appliances 6

38a. Do you undertake Hot Work at your property? Yes No N.B. Hot Work involves open flames, sparks or heat generating activities, e.g. welding, blowtorches, cutting, roof repairs or plumbing work. If No to 38a, please move to Question 39. 38b. If Yes to 38a, do you operate a Hot Work Yes No Permit system? N/A We do not undertake Hot Work 39. Does your work involve fork-lift or pallet Yes No truck battery charging? 40. Do you have any highly flammable liquid Yes No spraying processes, e.g. spray painting? 41. Are any of your properties unoccupied? Yes No Section 5 Business Interruption Questions 42a. Do you regularly back up business data from Yes No your computers? N/A We do not have any computers If No to 42a, please move to Question 43. 42b. If Yes to 42a, is the data securely stored Yes No off-site or kept in a fire safe? N/A We do not back up data 43. Do you have a documented contingency plan Yes No that will assist the recovery of the business in the event of a major disaster, e.g. fire, loss of services etc? Section 6 Additional Liability Questions 44. Please indicate how many employees you 0 1-4 5-19 have (this includes casual labour, part time and family if on the payroll): 20-49 50-99 100+ 7

45a. Are all accidents / incidents recorded within Yes No your accident book? N/A We do not have an accident book If No to 45a, please move to Question 46. 45b. If Yes to 45a, do you assess accident / incident Yes No trends in order to reduce similar events happening again? N/A We do not record accidents / incidents within an accident book 46. Are you aware of your requirements for the Yes No notification of incidents at work under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR)? 47. Do you have any pending prosecutions, or Yes No outstanding Prohibition / Improvement Notices following an Enforcing Authority Visit / Inspection? (E.g. Health & Safety Executive (HSE), Environmental Health Authority (EHA), Environment Agency (EA) or Scottish Environment Protection Agency (SEPA)) 48. Have you appointed trained employees to deal Yes No with incidents requiring first aid? N/A We do not have any employees 49. Have you completed a Risk Assessment for Yes No every employee that uses Display Screen Equipment (including CRT or LCD displays)? N/A - We do not use Display Screen Equipment 50. Do you issue your employees with Personal Yes No Protective Equipment (PPE), e.g. boots, gloves, goggles, where necessary? N/A We have no requirement for PPE 51. Do you have a stress management policy? Yes No 52. Have you completed a Lone Worker Yes No Assessment for those employees who work on their own? N/A We do not have any lone workers 53. Do you have any young employees under the Yes No age of 18? 54. Do you have a documented process for Yes No maintaining housekeeping of all areas, e.g. removal of trailing cables, clean up of oil N/A We do not operate from a property spillage and reduction of other slip/trip hazards? 8

55a. Do you use any machinery in your company? Yes No If No to 55a, please move to Question 56. 55b. If Yes to 55a, is your machinery maintained Yes No in accordance with the manufacturer s guidelines? N/A We do not use machinery 55c. If Yes to 55a, are applicable guards always Yes No used on your machinery? N/A We do not use machinery 55d. If Yes to 55a, do you have a documented Yes No process for dealing with unexpected machinery failure e.g. breakdowns, obstructions and N/A We do not use machinery cleaning of your machinery? 56. Do you have an engineering inspection Yes No contract that ensures all lifting equipment is regularly inspected and maintained, e.g. hoists, N/A We do not have any lifting equipment passenger lifts and/or forklift trucks? 57. Do you utilise any pressure vessels, e.g. air Yes No compressor or boilers? 58. Do you operate a Permit system for Hot Work Yes No carried out away from your property? N/A We do not undertake Hot Work away from the property N.B. Hot Work involves open flames, sparks or heat generating activities e.g. welding, blowtorches, cutting, roof repairs or plumbing work. 59. Do you have documented control procedures in Yes No place for Contractors working on your property / sites, e.g. Access controls, Permits N/A We do not use Contractors to Work, Method Statements and Risk Assessments? 60. Do you have arrangements in place relating Yes No to the prevention of pollution from the storage and use of fuel oils, solvents and other N/A We do not store fuel oil or solvents hazardous substances, e.g. bunding, drip trays and/or spillage kits? 61. Do you prepare any ingredients or food for Yes No human consumption? 9

Declaration I/We declare that the statements and particulars contained in this Survey are true and that I/we have not misstated or suppressed any material facts. I/We agree that this Survey and the proposal together with any other information supplied by me/us shall form the basis of any contract of insurance effected thereon. I/We undertake to inform RSA of any material alteration to these facts occurring before completion of, or during the course of the contract of insurance. In the context of this Survey, the applicant agrees the Intermediary (which the applicant has appointed to advise in relation to this policy) is acting on behalf of the applicant and not as an agent of the Insurer. I/We acknowledge that where there has been an Intermediary involved in the placement of this insurance they are acting as our agent and not on behalf of the insurer. Signature Print name Position Date Thank you for completing this Survey, please sign and return it in the pre-paid envelope or post to RSA Support, Mey House, Bridport Road, Dorchester, Dorset. DT1 3QY Data Protection Notice Your Information All personal information supplied by you will be treated in confidence by the RSA Group of companies and will not be disclosed to any third parties except where your consent has been received or where permitted by law. In order to provide you with products and services this information will be held in data systems of the RSA Group of companies or our agents or subcontractors. The RSA Group of companies may pass your personal information / data to other companies for processing on its behalf. Some of these companies may be based outside Europe in countries which may not have laws to protect your personal information / data, but in all cases the Group will ensure that it is kept securely and only used for the purposes for which you provided it. Details of the companies and countries involved can be provided to you on request. 10

RSA SuppoRt questionnaire Royal & Sun Alliance Insurance plc (No. 93792). Registered in England & Wales at St. Mark s Court, Chart Way, Horsham, West Sussex, RH12 1XL. Authorised and Regulated by the Financial Services Authority. xxxxx (xx/xx/xx) (xxxxx) Produced and published by RiskSTOP Ltd