Professional Documents
Culture Documents
PROPOSER
GENERAL
OCCUPANCY
Occupancy DAI
FALO Coverage
SUM INSURED
CLAIM EXPERIENCE
Any claim experience(s) for over the past 5 years ?
NOTES :
* Compulsory
PT ASURANSI AXA INDONESIA
(6221) 3005 9000
(6221) 3005 9005
axaindo@axa-insurance.co.id
www.axa-insurance.co.id
GENERAL INFORMATION
The Insured
Situation
Occupancy
FALO DAI
Risk Category Category IV / V Survey Type
Conferred with Mr./Mrs./Ms. Business Source
Designation Proposer
- Building / Material Damage
- Machinery / Equipment / Bus. Interruption
Sum Insured
- Stock / Content / MB / Others
Total 0.00
THE INSURED
Business started
Type of final product(s
Type of production Brand
Designed Prod. Cap Actual capacity
Market orientation Local (%) Export (%)
Operating hours Number of workers
SURROUNDING EXPOSURES
Are Roads provided within and around premises for free moving of local fire truck?
CONSTRUCTION
If multiple buildings :
(a) Any Connection (canopy, basement, piping, electrical wirings, etc) between the buildings ?
(b) If NO, is distance * between the buildings adequately provided to prevent fire spreading ?
Building occupancy
Number of storey
Floor area (m2)
Age of building More than 20 Years
Roof
Wall
Floor
Construction class Class 1B
Fire extinguisher ?
Hydrant ?
Fire detector ?
Auto sprinkler ?
STORAGE ARRANGEMENT
Raw & Supporting Material (s) Form Quantity Location Storage Type Storage Height
Hazardous Material (s) Location Quantity Container Storage Type Storage Height
(a) Any Special * protection (safety measure) adopted for the above hazardous materials ?
(b) Is there adequate Ventilation for storage area ?
(a) Is the provision of Access (i.e. aisle, gangway, stairway, etc) adequately provided ?
(b) Is there any obstruction observed due to Improper storage arrangement ?
(c) Floor condition ?
(d) Is there any kind of Open storage ?
Waste Handling Wastes* are disposed from designated areas risk on WEEKLY basis
PRODUCTION PROCESS
Brief description of main occupation or manufacturing process carried out *) :
OR
Spray Painting / Inflammable Material or Processe Spray Painting / Inflammable Material or Process area Isolated, Well Vent
PRODUCTION MACHINERY
Main Production Machinery Designed Cap. Quantity Mfg Year Fuel Condition
UTILITY
(a) Is there a Standby Power Supply (i.e., generator) available ?
(b) Is there a Boiler available ?
MAINTENANCE
(a) Type of Maintenance ?
(b) Maintained by
ELECTRICAL INSTALLATIONS
(a) Are cables Properly run in conduit or metal trays or securely fastened in position ?
(b) Are cables, fixtures and equipment in Good condition ?
(c) Are there any Combustible goods near the electrical installations ?
BATTERY CHARGING ACTIVITY If (a) is Yes, please answer (b), (c) & (d)
(a) Is there any Battery Charging activities present within the premise ?
(b) Is the Battery Charger isolated from other goods (i.e. combustible etc) ?
(c) Is the Battery Charging area well-ventilated ?
(d) Is there adequate signage displayed at the Battery Charging area ?
Battery Charging (Heavy Electricity Usage) Charging area Not Isolated but Well Ventilated with Proper Signage
SMOKING CONTROL If (a) is Yes, please answer (b), (c) & (d)
(a) Is Smoking strictly-prohibited within the premise ?
(b) Is there any area designated for smoking within the non-smoking areas ?
(c) Is there any evidence of smoking within the non-smoking areas ?
(d) Is there adequate ‘No-Smoking’ signage display at non-smoking areas ?
HOT WORKS CONTROL (i.e. welding, cutting etc) If (a) is Yes, please answer (c) & (d)
(a) Is there any Hot Works implemented within the premise ?
(b) Is there any Engineering Workshop available within the premise ?
(c) Is Hot Work Permit Scheme established within the premise ?
(d) Is Hot Work Control practiced by the management satisfactory ?
Hotwork Control Hot Work without Hot Work Permit Scheme in place
SECURITY FEATURE
Sec Arrangement No of Guard Shifts Mean of Communication Armed ? Patrolling ? Any ALARM ?
Security Team Contracted Security Forces with more than 2 guards with patrolling
SAFETY COMMITTEE
Any Safety Committee ? Any Safety Officer ? Safety Meeting Frequency Type of Plans / Procedures Available
Any Private Fire Team ? Nos of Member Fire Drill Conducted Fire Training Conducted Trained By :
Private Fire Team Fire Fighting Team with more than 6 members
Public Fire Brigade Located between 5km to 10km from risk premises
FIRE PROTECTION SYSTEM
Fire Alarm / Auto Fire Detector Installation Manning of Fire Alarm Panel Linked to Public Fire Brigade
Type of Detectors Available
PERILS
FLOODING
Exposure No reported loss due to impact damage for the past 5 years
Exposure No reported loss due to storm & tempest for the past 5 years
Exposure No reported loss due to explosion & SC for the past 5 years
RSMD
SUBSIDENCE / LANDSLIP
AIRCRAFT DAMAGE
FALLING TREES
EARTHQUAKE
BURGLARY/THEFT
CLAIM EXPERIENCE
Amount
Desciption of Loss Date Remedial Action Taken after Loss
USD IDR
0.00 $ -
3 OTHERS
Comment:
Management
- Company history, nature of business/trade, ownership, year of establishment, expansion plans for the future, state of business
Construction
- Comment on compartmentation and segregation of utility buildings
- Condition of the buildings
Occupancy
- Name the main production machinery and building facilities in the risk
- Condition of the above machinery
- Comment on cleaning, servicing, maintenance, overhaul and statutory inspection
Protection
- Comment on the physical and working condition of fire protection equipment
- Any deficiency/defect in the system
- Described any other firefighting facilities provided (e.g. private fire truck, portable pumps, alternate water source, etc.)
Exposures
- External (surrounding buildings and natural perils)
- Internal (Inflammability process/activity or materials)
Any recommendations ?
Fire extinguisher Available and meet RFT Fire Protection System 17%
Perils *
Flooding 0 Landslide / Landslip 0
Impact Damage 0 Aircraft Damage 0
Storm & Tempest 0 Falling Trees 0
Fire, Explosion & Self Combustion 0 Earthquake 0
RSMD 0 Burglary / Theft 0
* (High - Moderate - Minimal - Negligence)
/ RISK APPRAISAL GUIDE
Last Revised : 15 Dec 09
A well ventilated area has natural ventilation (i.e. open sided wall, or with window opening etc) or mechanical/forced
ventilation (i.e. installation of ventilation fan) to ensure good air movement/circulation.
Poor standard of housekeeping attributed by badly congestion of goods obstructing fire protection & electrical appliances, high
accumulation of dusts, poor handling practise of flammable / hazardous materials & poor management of waste disposal leading to an
increased in the overall risk exposure. Recommendation to decline risk acceptance can be exercised at discretion of the risk engineer upon
consultation with the underwriters.
Poor maintenance standard of electrical appliances / wirings attributed by extremely old wiring system (i.e. >25 years) with no regular
maintenance, upkeep & inspection by qualified electrician leading to an increased in the overall fire exposure. Recommendation to decline
risk acceptance can be exercised at discretion of the risk engineer upon consultation with the underwriters.
7.0 PERILS
7.1 FLOOD EXPOSURE
No incident of flood at locality for the past 10 years 5
No incident of flood at locality for the past 5 years 3
One (1) incident of flood at locality for the past 5 years 1
Flood loss in excess of RM1mil or 50% of the Sum Insured within the past 5 years, can be regarded as high exposure. Recommendation to
decline risk acceptance can be exercised at discretion of the risk engineer upon consultation with the underwriters.
General requirements II - Hydraulic Hose Reels and Internal Hydrants with small bore hose atta
Back
(1) The hydraulic hose reels and/or internal hydrants must be sited in prominent and easily accessible p
(2) The flow rate at the most hydraulically remote hose reel or internal hydrant must not be less than 2
(3) The hoses for hydraulic hose reels must be of reinforced rubber and that for internal hydrants must
(4) The hoses must not exceed 45 metres (148 feet) in length.
(5) The hydraulic hose reels and/or internal hydrants must be permanently connected to a constant wat
(6) Where the hydraulic hose reel and/or internal hydrant system is connected to a suction tank, the tan
(7) Where stationary pumps are provided the pumps must be capable of discharging at a rate of not les
(8) Each pump must be housed in an easily accessible position where it will not be liable to be damaged
(9) Each pump must be so arranged that it will start automatically in the case of automatic pumps; or c
(10) There must be kept on hand at all times sufficient fuel to run the pumps at full load for not less than
(1) The internal hydrants must be positioned in such a way that no portion of the building floor is more
(2) The internal hydrant system can be fed from an independent water supply having a minimum capac
(3) The internal hydrant mains and hose for use in connection therewith must have a clear waterway of
(4) Every internal hydrant must be provided with a canvas / rubberised hose of at least 30 metres (100
(5) The internal hydrants must be protected against mechanical impact damage.
(6) A trained private fire brigade complying with General requirements IX must be available at all times
minent and easily accessible positions at each floor level in such a way that no part of the floor is more than 6 metres (20 feet) from a ho
drant must not be less than 24 litres (5 gallons) of water per minute through a nozzle and capable of achieving a water throw of not less
at for internal hydrants must be rubber lined. The hoses must not be less than 19.05 mm (0.75 inch) nor more than 31.75 mm (1.25 inch
han 30.5 metres (100 feet) above fire appliance access level (usually ground level).
of the building floor is more than 15 metres (50 feet) from a hose nozzle when the hose is fully extended.
pply having a minimum capacity of 54,552 litres (12,000 gallons) of water with manual or automatic pumps complying with General requ
ust have a clear waterway of at least 63.5 mm (2½ inch) diameter.
se of at least 30 metres (100 feet) length and a nozzle permanently connected to the internal hydrant or kept under cover in a convenien
y point in the area to the detector nearest to that point should not exceed 5.3 metres (17 feet) for heat detectors or 7.5 metres (25 feet)
he horizontal distance given in (1)a above may be increased by half the difference between 5 metres (16 feet) and the width of the corri
n turn, must be linked directly to a Fire Services Department (BOMBA) station or alternatively the central fire control panel may be conne
ntral fire control panel is connected to the BOMBA station via a remote central monitoring station, the remote central monitoring station
per working order.
dustrial Research Institute of Malaysia (SIRIM).
feet) away from the external wall of the building.
of external wall measurement of the building.
of external wall measurement of the building for purpose of fire fighting.
r supply having a minimum capacity of 54,552 litres (12,000 gallons) of water with manual or automatic pumps complying with G
have a clear waterway of at least 63.5 mm (2½ inch) diameter.
hose of at least 30 metres (100 feet) length, 1 nozzle and 1 coupling kept under cover in a convenient place. However, there must
capable of discharging at a rate of not less than 900 litres per minute (200 gallons per minute) of water.
sition where it will not be liable to be damaged by fire or otherwise.
matically in the case of automatic pumps; or can be readily started by one person.
to run all the pumps at full load for not less than 4 hours and power must always be available for each pump.
f 26A supplied by 2 portable fire extinguishers.
metres (20 feet) from a hose nozzle when the hose is fully extended.
a water throw of not less than 6 metres (20 feet).
han 31.75 mm (1.25 inch) internal diameter.
rs or 7.5 metres (25 feet) for smoke detectors. For line or beam detectors, the distance should be taken as the distance to the nearest p
and the width of the corridor, e.g. in a corridor of 3 metres (10 feet) wide the distance may be increased by 1 metre (3 feet). A corridor w
ntrol panel may be connected to a remote central monitoring station which must be directly linked to a BOMBA station. Under both circu
entral monitoring station must also be manned 24 hours a day and the Insured must obtain a certification to this effect.
umps complying with General requirements VIII(9) or permanently connected to an adequate constant supply of water from the p
ce. However, there must be a minimum of 4 hoses of 30 metres (100 feet) length each, 2 nozzles and 2 couplings for each protect
access may be used.
om the public mains.