Farmers Habitational Farmers Habitational Survey Form Scope Of Risk arrowup6 Company Structure — select —LPLLCCORPSOLE PROPNOT FOR PROFITPARTNERSHIPASSOCIATIONTRUST # Units Year purchase of current ownership Approx Payroll $ (WC Only) Property Management –select–Owner-Staff ManagedHired Property Management Company Property Management # Years of Experience Is this a condo/townhouse No Yes # Owner Occupied Units Vacant Unit Handling –select–Owner-StaffProperty Management CompanyUnit Owners Owner Monthly Dues $ Reserve Study — select —CompletedScheduledNot Completed Reserves Available $ Reserve Funded % Is this an apartment No Yes % Occupancy on Survey Day Range of Rental Rates (low to hight) HUD Property No Yes Planned Capital Improvements (describe improvements and timelines to roof, HVAC, electrical, etc) Total # of Employees # Full time # Part time # Living Onsite Check All That Apply Written App Criminal Background Check Temp-to-Hire Reference Check Drug Test Interns Hours of Operation Emergency on Call? No Yes Holiday? Name/Title of who is on call Loss Analysis arrowup6 Losses in last 3 years? No Yes Loss Analysis Discussion Property Section arrowup6 Electrical Updates Plumbing Updates? Roof Updates? HVAC Updates? Smoking in Units? No Yes Policy Enforced? Smoking in Common Areas No Yes Policy Enforced? Grill Use & Enforcement No Yes Grill Policy? Elevator Service No Yes Name of Elevator Company Fire Sprinklers? No Yes Fire Sprinkler Service Company Security / Burglar Alarm System? No Yes Contractor General Liability arrowup6 Banquet & Event Use No Yes Describe Pet Policy No Yes Describe Pet Policy Cyber Liability (offering wi-fi) No Yes Protected? Who maintains? Resident & Contractor Risk Transfer No Yes Resident & Contractor Risk Transfer — select —lease contains indemnification/hold harmlesscriminal & financial background checkedrules against sublettinglandscaping/snow removalcontractors required to provide COI or Additional Insuredvendor management platform utilized Stove Tipover & Secure Shelving in Common Areas No Yes Describe Onsite Businesses Embedded with the Community No Yes Onsite Businesses Embedded within the Community — select —home businesses allowed from unitsCOIs and/or additional insured obtainedtracked for businessesonsite businesses observed Describe Business Operations Commercial Auto Section arrowup6 Does Risk Own/Operate Vehicles No Yes # of Scheduled Vehicles for Risk # of Scheduled Drivers for Risk # of Non-Owned Vehicles Driven by Risk Driver Qualification Program Elements No Yes Elements — select —NoneAnnual In-House MVR ReviewMVR Review CriteriaNames Submitted to Agent for Review Vehicle Maintenance Programs No Yes Programs — select —NoneOutside ShopSystematic by mileage or time spanAs Needed Describe Fleet and Operations Workers Compensation arrowup6 WC Exposure to Incidental Board Members Activity Only? No Yes Formal Programs and Recordkeeping comprehensive written occupational safety policy OSHA 300/300A maintained employee handbook PPE provided by risk formal accident reporting policy effective informal programs Slips/Trips non-slip shoes required risk has HIGH slip/trip exposures due to hazards safety toed boots/shoes required effective informal programs Manual Material Handling risk utilizes devices to transport heavy objects staff workers install/remove appliances vendor(s) used to install/remove replacement appliances digging/trenching lifting objects weighing 50 lbs or more at least once per week planting trees/shrubs MMH injury prevention informally managed (explain) snow shoveling Falls from Elevation roof inspections/repairs tree trimming fall prevention/protection equipment used light bulb changes lift equipment used Max. height above ground (feet) Industrial Hygiene heat illness formal policy chemical exposures adequately controlled Hearing Conservation Program implemented exposure to insect/bug/snake bites fertilizers utilized and controlled Chemical/Toxin Handling swimming pool/spa chemicals handled fuel dispensing fertilizers/pesticides applied PPE provided by risk paints/solvents handled health department/AHJ certifications obtained for handling Bloodborne Pathogens formal written policy evidence of drug use on-site sharps containers provided tools provided to minimize stick exposure Machine Guarding guarding in place and in good condition after-market guards installed factory guarding installed mobile equipment guarding in place SUBMIT If you are human, leave this field blank.
