RSA SuppoRt questionnaire

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RSA SuppoRt queStionnAiRe

RSA SUPPORT

Risk Management Survey

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Please complete the information below in BLOCK CAPITALS

Contact name (including title) Business name

Address

Telephone number

Postcode

Your Information

For details of how we use your information, please look for the padlock symbol on page 10.

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.

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General Question

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)

Your policy type will only require you to complete the following sections of this Survey

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)

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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?

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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

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

12. Do you have a written Health & Safety Policy? Yes No

N/A – We have less than 5 employees

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?

13. Does a senior person have overall Yes No

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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

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

19. Have you completed a Noise Assessment Yes No

for areas where you have to shout to be heard

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Section 4 – Additional Property Questions

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

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

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

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

31. Do you work on fuel tanks, e.g. correcting a Yes No

mis-fuelled vehicle, repairing a hole, changing fuel lines?

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Section 5 – Business Interruption Questions

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?

42a. Do you regularly back up business data from Yes No

your computers?

N/A – We do not have any computers

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

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+

Section 6 – Additional Liability Questions

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

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.

38b. If Yes to 38a, do you operate a Hot Work Yes No

Permit system?

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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

53. Do you have any young employees under the Yes No

age of 18?

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

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?

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

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)?

45a. Are all accidents / incidents recorded within Yes No

your accident book?

N/A – We do not have an accident book

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

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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?

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?

55a. Do you use any machinery in your company? Yes No

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?

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Data Protection Notice

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

Declaration

Signature Print name Position Date

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.

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.

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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.