Builders Risk - Drag N' Drop FormBuilder

Builders Risk

GENERAL INFORMATION

Inspection Date *
- Month
- Day
- Year

Project Description: *

Is this a Ground Up Construction *
- Yes
- No

Number of buildings in this project *

Is this a modular construction project *
- Yes
- No

Has the construction begun *
- Yes
- No

The date the project started or is expected to start *
- Month
- Day
- Year

Expected Completion Date *
- Month
- Day
- Year

Expected cost of the final construction *

How far along is the Project? Percent Complete. *

Name of General Contractor *

General Contractor: Years doing this Type of Construction *
- Less than 2 years
- 2 - 5 years
- 5 - 10 years
- 10 - 15 years
- 15 - 20 years
- More than 20 years
- Unavailable

Address of General Contractor *

General Contractors Website *

Contact Person and contact information for the person interviewed *

General Contractor: Any past, pending, or planned Bankruptcy or judgment for unpaid taxes *
- Yes
- No

Entity or name and title of the person involved *

The actual or planned date of the filing / judgment *
- Month
- Day
- Year

Has the General Contractor been cited for any OSHA violations in the last 4 years *
- Yes
- No

Describe the violation(s) *

OPERATIONS

Has a plot plan been attached to the report (a plot plan is required for projects of more than $10M) *
- Yes
- No

Proper removal of trash/refuse daily at jobsite *
- Yes
- No

Comment on the improper disposal of trash *

Does the General Contractor have a written "No Smoking" policy *
- Yes
- No

Comment about any "No Smoking" policy (Not a written policy but no smoking allowed, No policy, etc.) *

Rate the jobsite housekeeping on a scale of 1 to 5 *
- 5 - A very well kept jobsite
- 4 - An above average jobsite
- 3 - An adequately kept jobsite
- 2 - An below average jobsite
- 1 - A very poorly kept jobsite

Comments on the Housekeeping *

Does the General Contractor have a written safety program in place compliant with OSHA 29 CFR/1910 *
- Yes
- No

Comments on any Safety program *

Does the General Contractor have a job site risk manager *
- Yes
- No

What is the name of the risk manager *

How often does the risk manager visit the site *

Is there a building permit *
- Yes
- No

Building permit number *

Explain why there is no building permit *

Is the General Contractor Licensed *
- Yes
- No

License Number *

Explain why the General Contractor is not licensed *

EXPOSURES AND CONTROLS

Is the project on filled land *
- Yes
- No

Explain about the landfill (what was it before the landfill, how long ago was the land filled, what was used to fill the land, etc.) *

Any Structural Work Being Performed *
- Yes
- No

Describe the Structural Work *

Is the construction lift slab, tilt up, or have open atriums equaling 3 stories or more *
- Yes
- No

Explain special construction techniques and/or tall atriums *

Does the project include any tandem crane lifts, high values being lifted by a single crane, underground or waterborne exposures *
- Yes
- No

Explain unusual exposures for the construction *

Does the scope of the project include work on antennas; chemical plants; bridge; tunnel; bubble building; greenhouse; waste water facility; petroleum or energy co-generation facility; tanks; radio,... *
- Yes
- No

Explain unusual exposures *

Are pilings used *
- Yes
- No

Explain what circumstances require pilings to be used *

Is blasting required for this project *
- Yes
- No

Explain what circumstances require blasting to be done *

PROTECTION

Is site protected by a fence *
- Yes
- No

What type of fence (check all that apply) *
- Chainlink Only
- Chainlink topped with barbed or razor wire
- Wood fencing
- No fence
- Other

Describe other fencing *

Will a watchman be on premises during non-working hours *
- Yes
- No

Comment on the watchman *

Is the project area locked and secured during non-working hours *
- Yes
- No

Describe how the site is secured *

Are building materials protected from theft at jobsite *
- Yes
- No

Describe the protection of the building materials *

Does the project require areas to use portable/temporary heat *
- Yes
- No

Please describe the temporary heat *

Are there adequate precautions during welding *
- Yes
- No

Describe the deficiencies in the welding precautions *

NARRATIVE

Have there been any Losses or Claims *
- Yes
- No

Describe the Losses and/or Claims *

Are there any unusual hazards *
- Yes
- No

Please describe hazards *

Comments and Narrative *