Woodworking - Questionnaire - Genesis Underwriting

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Woodworking - Questionnaire

Please complete the fields and declaration below. To ensure your submission reaches your insurance broker, please include their name and email address.

Broker name(Required)

Broker email address(Required)

Business name(Required)

Location(Required)

Street Address City/Suburb State Postcode Country

Building

When was a Thermographic scan last carried out on the main switchboard?(Required)

Are all switchboards protected from dust?(Required)

Yes

No

Are the light fittings protected from dust?(Required)

Yes

No

Are the power points protected from dust?(Required)

Yes

No

Processes

Building Process(Required)

Cutting/Sanding

Lacquering/Spraypainting/Adhesives Application

Upholstering

Housekeeping

Floors and machinery cleaned:(Required)

Daily

Weekly

Roof frame and walls cleaned:(Required)

Monthly

6 Monthly

Annually

Waste & off-cuts removed from site(Required)

Daily

Weekly

Is there any dust accumulation in the premises, especially on horizontal surfaces?(Required)

Yes

No

Dust Extraction System

Is Dust Extraction System installed?(Required)

None Installed

Ducted system to central internal hopper

Portable/Mobile bag system

Ducted/fixed system to external hopper

How often is it cleaned out?

Does it work?(Required)

Yes

No

Smoking

Permitted without restriction(Required)

Yes

No

Designated external areas only(Required)

Yes

No

Designated internal areas of building(Required)

Yes

No

Finishing Processes

Vented spray booth(Required)

Yes

No

When are the filters cleaned?

Open air(Required)

Yes

No

Heating/Drying tunnels/Ovens?(Required)

Yes

No

Fired/powered by?

Is it safe?(Required)

Yes

No

Flammable Liquids

Solvents/flammable spray materials above 100 litres stored on premises:(Required)

Yes

No

Where?

Approved Flammable liquids storage cabinet/compound installed(Required)

Yes

No

Where?

Storage

To what height?(Required)

Method of storage (palletised/racks/solid pile)(Required)

Floor area taken up?(Required)

Separation to/from Neighbours

How far?(Required)

Fire Equipment

Extinguishers serviced(Required)

Yes

No

When?

Hose reels serviced(Required)

Yes

No

When?

Hydrants serviced(Required)

Yes

No

When?

Fire alarms & detectors installed/serviced(Required)

Yes

No

When?

Fire Equipment Training(Required)

Yes

No

Print Name(Required)

Date(Required)

DD slash MM slash YYYY

Signature(Required)

CAPTCHA

URL

This field is for validation purposes and should be left unchanged.

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+61 2 8412 3500

P.O. Box 873 Manly NSW 1655

GENESIS UNDERWRITING

ACN 163 862 502
AFSL 450191