[精品]公众责任保险风险问卷调查-公共场所

1、公众责任保险 风险调查问卷大卖场/超市/百货商场 shopping mall/supermarket/department store:是否设有儿童游乐区 are pleasure ground for children included?是否有铺位或柜台向第三方出租are there any business areas leased to third parties?商务楼/公寓 business officc/apartmcnt公园/游乐场 park/amusement centre医院/诊所 hospital/clinic宾馆hotel:是否是星级宾馆，多少星级no. of stars

2、 if you are qualified?若上述场所含有以下服务内容，则也须选择和回答 please complete the rest part if you provide the services as described below: 饭店/餐厅 rcstaurant/snack bar旱地溜冰场 skating rink:请告知何种地面 please advise what kind of ground :舞厅、卡拉 ok disco room, karaoke private:是否供应酒精度超过 15 的饮料 do you provide beverage with alcoho

3、l level above 15 degree? 是 yes 否 no 酒吧pub影剧院、放映厅cinema/theatre游泳馆/池 swimming pool :换水频度 frequency of changing water?采用何种措施保证水质way to guarantee quality of water? 健身中心 fitness club:有无配备专业教练指导instructed by professionals?器材定期保养维护 regular maintenance on equipment?美容中心 beauty parlor &/or hair dresser沐

4、浴中心bathe & sauna网球场 tennis court:是否禁止儿童进入场地 are child allowed in the premise?是 yes是 yes否no否no值班救生员人数no. of life guard?是 yes 是 yes是 yesn 否 否no否nopublic liability insurance risk evaluation questionnaire本表适用于公共场所的场所公众责任险投保。tliis form shall be applied to on premise cover of public liabilitv insuranc

5、e for public place.概 况 general information1投保人名称name of insured2. 总部地址 address of head office in p.r.china3. 企业性质 nauire of enterprise国营 slate-owned 集体 collective 私营 private-owned 股份制 shared 机关事业 government 中外合资joint外商独资，请告知外方的国籍:foreigner-owned, please advise nationality of the owner4. 保险地址 locatio

6、n under cover（连锁店请附地址清单 please attach list if you are operating a chain firm）5. 请在左栏选择被保险人所经营管理的场所的主要性质，然后选择或回答对应的右栏中的有关问题please make choice on the left handside first, then, if applicable, ch（x）se yes or no or answer the relevant question on the right handside.离尔夫球场golf court 游艺厅game room: 请说明 主要活动

7、项目please specify major project是否主要面向儿童开放mainly toward children?是yes否no停车服务 parking services:是机械化立体库 do you manage a mechanical hangar?是 yes否 no综合娱乐总汇nightclub其他 others:请具体说明 please specify6. 员工总人数n oof staff: ,其中保安员人数 no of security staff amidst: ,汽车数量 no. of vehicle: 7. 营业/活动场所面积 business area in s

8、quare meters: m28. 过去 12 个月的营业收入 turnover during the last 12 months: ,开业日期 date of opening: 9. 平均客流情况 average number of visitors: （例如：月均客流量二门票月收入/门票平均单价eg: average monthly number of visitors = monthly income from tickets/ average price of each ticket）管理 management1. 有无提供临时医疗救助服务is first aid service

9、included?若有，专业人员资质情况 if so, what are qualifications of these professionalstaff2. 有无提供按摩或美容服务massage or hairdressing?若有，专业人员资质情况 if so, what are qualifications of these professionalstaff3. 有无食品小卖部等类似的服务 are there any cafeteria / canteen related services?若冇，请问是被保险人自营还是向第三方转包if yes, is it managed by th

10、e insured or by a third party?若为转包，被保险人是否与其签订事故免责的协议if managed by third parties, has insured signed a contract to immunize the responsibility of such a third party?4. 有无提供餐饮服务 are meal facilities provided?若有，有无通过政府卫生部门的检查if yes, is it authorized by the kxxl health & hygiene regulatory department

11、 of government?若是，最近检查 日 期if yes, last inspection date请问是被保险人自营还是向第三方转包are the facilities managed by the insured or by a third party?若为转包，被保险人是否与其签订卫生事故免责的协议if managed by third parties, has the insured signed a contract to immunize the responsibility of such a third party?若为自营，有无建立各连锁店统一的关于控制食品或食品原料

12、进货渠道和更换过期食品的 专 门 制度 if self managed, has the insured established a systematic prescription for collective purchase of foods from standard suppliers and to keep all foods valid and safe?5. 遇雨天门厅内是否配有地面除湿设备或有专人对地面除湿？do you have fl（x）r dehumidifier or designate special serviceman to do this job?6. 是否配备

13、中央监控室和监视器 are you equipped with monitors and have a control center?如有 > 监视器数量if yes, no. of monitors7. 24 小时专人值班 is there a personnel on duty 24 hours?是 yes是 yes是 yes 自营by insured 是 yes是ws是 yes自营by insured 是 yes是 yes是 yes是ws是 yes否no否no否no转包by third party 否no否no否no转包by third party 否no否no否no否no否no消

14、防安全 fire prevention1.是否通过消防局年检 have you been inspected by the local fire prevention department? 若是，则请告知最近一次检查的时间 if yes, please advise the date of latest qualified inspection?是 yes否no2.内部分隔和装潢材料是否大量使用阻燃材料did you substantially adopt fire resistance material for partition or decoration?是 yes否no3.有无内部防

15、火阻隔is there an internal segregation architecture for protection against fire in the building?是 yes否no4.是否安装烟感报警装置 do you have smoke detectors and automatic fire alarm system?是 yes否no5.若楼高超过 5 层，楼内有无封闭楼梯 do you have fire stair case when no. of floor of your是 yes否nobuilding is in excess of 5 levels?有

16、无烟火道 are there smoke & fire byways in building?是 yes否no6.是否安装喷淋系统或其他自动灭火装置do you have an automatic sprinkler system or other automatic fire extinguishing system in crucial是 yes否no7.uieas 有无足够的太平门或疏散通道arc emergency exits or evacuating gateways located on all floors?是 yes否no通道内是否畅通 arc gateways un

17、blocked at all time?是 yes否no疏散通道标志是否明显 are gateway clearly marked and well lighted?是 yes否no关键地点有无贴有疏散程序和疏散通道指引图are guide maps showing emergent evacuation ways put on all the room-d（x）rs?是 yes否no&是否配备应急电源或应急照明do you have emergency electric power supplier or illumination?是 yes否no9.工作人员是否经过消防知识和紧急疏

18、散培训have the staff practice or been trained for fire extinguishing or emergent evacuations?是ws否no10.楼道内是否配置足够的灭火器 are there sufficient portable extinguishers provided in corridor?是 yes否no建筑装潢 building & decoration1.建筑物内部结构是否经过改建has any alterations, additions or structural repairs been implemented

19、 to the building(s) ?是 yes否no2.若是，是否通过市建筑安全管理局的检查if yes, have you past through inspection or been qualified by safety regulatory sector of government?建筑物完工年份 year of completion of building stnicture是 yes否no3.楼梯和台阶是否釆用防滑材料或经过防滑处理 are the stairs and steps processed with anti-skip design?是 yes否no4.fl 厅

20、入 口 是否有玻瑪转门 do you have revolving door at the entrance of lobby?是 yes否no5.营业场所内是否有锐角的器具？比如废物箱、装饰台等arc there any furniture with metal acute angle within the business premises, such as litter-bin?是 yes否no6.有无落地玻瑪弹簧门do you have plated glass door?是 yes否no若有，玻璃fl的包角是否有脱落或产生锐角if yes, are there any detachm

21、ent?是 yes否no玻璃门底部、包角和其他地方有无保护do the bottom, angle or other position of the door adopt protection design?是 yes否no7.有无停车库/场 do you have garage or car parking lots? 如有» 请告知 if yes, please advise:是 yes否no地面 on the ground地下 under the ground是 yes否no层数 no. of storage:车位数 no of unit:面积 square meters:进出

22、和出口数 no. of inlets and outlets24 小时专人值班 is there a personnel on duty 24 hours?车道是否规定单向行驶 are signs directing vehicles sufficiently installed and marked? 车道究度 broadness of driving pathm是 yes否no&有无自动扶梯 do you have escalators in business premises?是 yes否no若有，则是否通过有关部门的检査have they been inspected by g

23、overnmental regulatory department?是 yes否no楼层交角处有无警告标志或采用保护措施？are there any warning signs or protection devices at the corner of inter-floor ?是 yes否no9.电梯是否经过年检 have the lifts or elevators been inspected? 若是，则最近年检的日期 if yes, please advise the latest date of inspection是 yes否no周围环境surroundings是 yes 否no

24、 是 yes 否no1.被保险人的营业场所是否与第三方位于同一建筑物内或与其他建筑物相连is the insured's business premise located in same one building with other business or in the building attaching to other?若为不相连的独立建筑，则周围是否有相距10米以内的建筑物if no, please advise if there is any special exposure factors around the business location of insured w

25、ithin the periphery of 20 meters radius?若有，则请告知下列内容 if yes, please provide the details as follows:东面西 面北面eastwestnorth南 面south名称 name使用性质 occupancy距离是 yes 否nodistance2.被保险人的营业场所是否位于人流密集的商业中心区？is the insured business premise located in central area of metropolitan with heavy traffic?既往保险史/过去索赔个案previ

26、ous insurance / previous claims1.投保人过去是否在其他保险公司购买过保险have you previously been insured with other insurer(s)? 若是、请说明具体情况：if so, please specify:是 yes 否no保险公司名称 name of insurer保单期限policy period踣偿限额limit of indemnity2.过去五年中是否有索赔记录？has anyone requested for payment for bodily injury or properly damage by your products during the past five years?