Risk Management Consultation Survey...Pet Wash Detailing Other (please describe): Car Wash Risk Management Survey 02/14/13 Car Wash Risk Management Survey 2 2 EMPLOYEE PRACTICES N/A

Car Wash Risk Management Survey 02/14/13

1Car Wash Risk Management Survey

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Risk Management Consultation Survey

Date of Survey: Field Representative:

Contact: Phone:

Account Name:

Location:

Any dba (name):

dba as: Individual Partnership Corporation

Joint-Venture Other:

Years in Business: Total Number of Locations:

Annual Gross Sales:

Operations and % of sales from each operation:

Car Wash Gas Lube Convenience Store

Pet Wash Detailing

Other (please describe):



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EMPLOYEE PRACTICES

N/A (please check if there are no employees at any locations and skip this section)

Is there a New Employee Orientation program? YES NO

If YES, please describe:

Is there a formal training program for all employees? YES NO


Are temporary or seasonal employees ever hired? YES NO

Are all employee references checked and previous employment verified? YES NO

Are all employees trained in proper lock out /tag out procedures? N/A YES NO

Are employees required to wear uniforms? YES NO

If NO, are all employees trained in what clothing is

acceptable and appropriate to wear in their job environment? YES NO

Are all employees trained to use appropriate Personal Protective Equipment? YES NO

Is employee use of Personal Protective Equipment enforced? YES NO

Is there a written Sexual Harassment policy available to all employees? YES NO

Is there a written Workplace Violence and Bullying policy available

to all employees? YES NO

Is there a written Drug and Alcohol policy available to all employees? YES NO

If YES, does it cover Drug and Alcohol testing of employees? YES NO

Are regular safety meetings held for all employees? YES NO

GENERAL RISK MANAGEMENT INFORMATION

Are written policies and procedures available to all employees on how to handle the following:

Employee accident or injury YES NO

Customer accident or injury YES NO

Vehicle accidents involving company vehicles YES NO

Vehicle accidents or damage to customer vehicles YES NO

Property damage or vandalism YES NO



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Are claims forms readily available for all of the above incidents? YES NO

If YES, are all employees trained on how to fill forms out properly? YES NO

PLEASE INCULDE A COPY OF ALL FORMS WITH THE REPORT.

Are fire arms kept on premises at any location? YES NO

If YES, are they properly secured? YES NO

If YES, are the proper permits or authorizations on file? YES NO

Are employees trained on how to properly report any chemical spills? YES NO

Are employees trained on how to properly clean up small chemical spills? YES NO

Is any work contracted out? (i.e. snow plowing, building maintenance,

laundering services, hazardous material pick up, etc.) YES NO

If YES, are Certificates of Insurance on file? YES NO

For Workers Compensation? YES NO

For General Liability? YES NO

Does the organization provide any off-site vehicle cleaning services? YES NO


Is all mechanical equipment on a routine maintenance and inspection plan? YES NO

If YES, please describe (include frequency of inspections):

Are maintenance logs kept? YES NO

How are logs stored and for how long?



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DRIVERS

Are employees ever required to drive any vehicles at any time? YES NO

***If NO, you do not have to answer the following DRIVERS questions.***

If YES, are vehicles (check all that apply)

Company owned

Customer owned

Both

Total Number of employee drivers: Number of Full Time Drivers:

Are MVR’s (motor vehicle reports) reviewed for all drivers? YES NO

If YES, do you review annually? YES NO

Frequency if not annually:

If MVR’s are reviewed, what criterion is used for driver selection?

If MVR’s are NOT run annually, are employee licenses checked for

validity periodically? YES NO

If YES, how often are licenses checked?

Is driver training conducted with all employees? YES NO

If YES, how often is it conducted?

Please describe training:

Is there a pickup and delivery service offered at any location? YES NO

If YES, please list locations:



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ADDITIONAL VEHICLE INFORMAION

Does the organization have a vehicle accident review policy in place? YES NO

If YES, please briefly describe:

Does the organization have a procedure in place that notes any pre-existing

damage to vehicles? YES NO

Are any vehicles sold, loaned, leased, or rented? YES NO


Does the organization have any company owned vehicles? YES NO

If YES, please fill out the following chart:

Type of Vehicle Number of Vehicles Average Mile Radius

Trucks

Vans

Pick-Ups

Passenger Autos

Are company vehicles on a scheduled maintenance plan? YES NO


Are company vehicles ever garaged at employee’s homes? YES NO

If YES, please list vehicles:

Are employees ever permitted to use company vehicles for personal use? YES NO

If YES, under what circumstances?



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CRIME

Are accounting functions and pay disbursements performed by more

than one employee? YES NO

How often are accounts examined (audited) internally?

By whom?

When were these accounts last examined?

How often are accounts examined (audited) externally?

By whom?

When were these accounts last examined?

Approximately what percentage of daily sales are cash? %

Are alternate forms of payment accepted at any location? YES NO

If YES, please check all forms of payment accepted:

Personal Checks Debit Cards

Credit Cards Gift Certificates

Tokens (provided by a cash exchange machine)

If gift certificates are accepted, where can customers buy them?

If tokens are used, how often is the machine emptied of cash?

Do any locations have cash registers? YES NO

If YES, which locations?

How often do registers get emptied of excess cash?

Are registers counted and checked with receipts? YES NO

Describe frequency( each time a register is emptied, daily, hourly, etc.):



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Does the frequency increase on busy days? YES NO

Please describe:

Are automated attendants or machines used to accept payments? YES NO

If YES, how often are machines emptied of cash?

How is cash from machines stored?

How is cash from machines counted and kept track of?

Are bank deposits made daily? YES NO

Are bank deposits made on a staggered schedule to avoid suggesting

a pattern? YES NO

Do employees travel in pairs to make bank deposits? YES NO

Are employees in pairs when making large cash deposits YES NO

Do all locations have a lockable safe for storing excess cash until

bank deposits can be made? N/A YES NO

Are checks, charge or debit card receipts also stored in a safe

until they can be deposited? N/A YES NO

Are all safes tool, torch, and explosive resistant, NRLT listed, and

time delayed? N/A YES NO

If NO, please describe safes:

Are checks received immediately stamped “For Deposit Only?” N/A YES NO

Are all employees that handle payment trained in proper credit card

card verification procedures? N/A YES NO

Are all overnight or late night workers scheduled in pairs? N/A YES NO

Are all attendant or cashier booths equipped with hold-up alarms? N/A YES NO



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Have all employees handling payments been trained not to flash or

show large wads of cash to customers? N/A YES NO

Have all employees been trained on how to handle themselves

should there be a robbery attempt? N/A YES NO

Do any locations have any Automated Teller Machines (ATMs)? YES NO

If YES, which locations:

Are all ATM areas provided significant lighting at night? YES NO

Do all ATMs have closed circuit television cameras (CCTV’s)? YES NO

Do indoor ATMs have locking entry doors? YES NO

Are ATM’s equipped with reflective mirrors for users to monitor

their surroundings? YES NO

Are ATM’s located in open areas to discourage robbers from

hiding nearby? YES NO

Do ATMs have 911 buttons on screens? YES NO



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PROPERTY

Location ID:

Facilities are:

Owned by the Organization

Tenants

Co – Tenants

Please list co-tenants:

Number of Years at the Location:

Business Hours/Days:

Car Wash is:

Full Service In-Bay

Exterior Only Self-Serve

Number of Bays at the location:

Year Built: Building Area: square feet

Property Area: acres

Construction Type:

Frame Joisted Masonry Non-Combustible

Masonry Non-Combustible Modified Fire Resistive

Fire Resistive Combination

Exterior Walls Material: Floors:

Interior Walls Material:

Roof Type: Roof Covering:

Roof Condition:



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Are there any roof leak indications? YES NO

If YES, please describe (and take a photo):

Are building roofs equipped with hurricane clips? N/A YES NO

If YES, are the hurricane clips installed all year round? YES NO

Are gutters properly installed and free of debris that could clog them? YES NO

Are there any additions to the original structure YES NO

If YES, year built?

Are there any unusual construction features? YES NO

If YES, please describe (and include a photo):

List any Property Exposures:

DISTANCE TYPE OF EXPOSURE USE/CONSTRUCTION

FRONT

REAR

LEFT

RIGHT

Please check the appropriate neighborhood description for the property:

(check all that apply)

Commercial Urban Improving Residential

Suburban Stable Industrial Rural

Deteriorating

Is there evidence of vandalism in the area? YES NO

If YES, is there evidence of vandalism on the property? YES NO

(Please include a photograph of any vandalism on the property)

Are all electrical panels accessible for the location? YES NO

Are all electrical panels enclosed properly? YES NO



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Are lightning rods installed on the premise? YES NO

Are surge protectors installed for the electrical service on the premise? YES NO

Electrical Service: Amps Volts

Fuses Circuit Breakers

Age of electrical:

Date of last electrical inspection:

Who conducted the inspection?

Do all receptacles have covers? YES NO

Are all outlets in ‘wet areas’ equipped with ground fault circuit receptacles? YES NO

Proper use of electrical extension cords? YES NO

Are there any electrical hazards present? YES NO

If YES, please describe (also take photo):

Is there a backup generator? YES NO

Are any locations in areas prone to natural disasters (hurricanes, tornadoes,

floods, blizzards, earthquakes, etc.) ? YES NO

If YES, have any mitigations techniques been put in place? YES NO

Please describe:

Does the property have any underground tanks? YES NO

Products Stored Capacity Age (of tank) Last Test Date

How are inventories tracked?



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Does the property have any above ground tanks? YES NO

If YES, please take pictures.

Products Stored Capacity Diked or Double Walled Need Vehicle Protection

Are all above ground tanks labeled properly? YES NO

Are all above ground tanks equipped with fire extinguishers? YES NO

Are all above ground tanks clear of brush and debris? YES NO

Are no smoking signs posted around all above ground tanks? YES NO

HVAC:

Fuel Type (check all that apply):

Natural Gas Oil Electric LPG

Other (list):

Heating Source (check all that apply):

Central Boiler; please also list the last date of inspection:

Units Roof Mounted

Radiant Heat Forced Air Furnace

Other (list):

Is there a heating system maintenance contract? YES NO

Date of last inspection:

Air Conditioning: % of the Building, (check all that apply):

Central Air Window Units

Roof Units

ALARM/FIRE PROTECTION:

Are automatic sprinklers present? YES NO

If YES, what % of the property? %

What type?



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Are there sprinkler water flow alarms? YES NO

Are there sprinkler water tamper alarms? YES NO

If YES, Alarm Transmission: Local Monitored

If monitored, by whom?

Is there an inspection/maintenance contract? YES NO

Who is the contractor?


Are smoke detectors present and functioning in all appropriate areas? YES NO



Are carbon monoxide detectors installed in all public enclosed areas? YES NO



Are heat detectors installed in appropriate areas? YES NO



Is there a security (burglar alarm) system installed? YES NO



Does the system have a radio back up for power outages? YES NO

Please describe features of system:

Do the police patrol location areas often? YES NO

Distance to the closest police department: miles

Are all doors or entrances that are not electronically operated equipped

with double-cylinder, deadbolt locks? N/A YES NO

If NO, please describe present locks:

Are windows equipped with tamper proof locks? N/A YES NO



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Are signs visibly present indicating the property is equipped with

a security system or alarms? N/A YES NO

Does the property have portable fire extinguishers? YES NO

Are fire extinguishers present in all required areas? YES NO

Are all fire extinguishers properly mounted? YES NO


Please list any other Fire Suppression Systems or fire protection methods present at this location:

Public Fire Protection provided by:

Distance to the closest fire station: miles

Nearest fire hydrant is feet from the property.

PROPERTY LIABILITY:

Property EXTERIOR

CONDITION OF GOOD FAIR POOR N/A

Sidewalks

Entrance ways

Handrails/Railings

Lighting

Handicap Access

Describe any conditions above that resulted in a ‘fair’ or ‘poor’ rating:



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Property INTERIOR

CONDITION OF: GOOD FAIR POOR N/A

Floor Coverings

Doorways

Stairs

Handrails/Railings

Lighting

Emergency Lighting

Exit Signs

Elevators (# )

Describe any conditions above that resulted in a ‘fair’ or ‘poor’ rating:

Are an adequate number of exits provided for the location? YES NO

Is there a secondary means of egress for all areas? YES NO

Are all exits unobstructed and properly functioning with illuminated

exit signs? YES NO

Is there adequate aisle space? YES NO

Is all stock and storage displayed safely so it will not fall? YES NO

Is all shelving in good condition? N/A YES NO

Are ‘Employee Only’ signs posted in restricted areas? N/A YES NO



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Are restricted employee only areas locked? N/A YES NO

If YES, are areas locked at all times? YES NO

Who has access to keys?

Are change machines, vending, and auto tellers equipped with shock YES NO

or tamper sensors/alarms?

If YES, who do the sensors notify if tripped?

Are local alarms attached? YES NO

Is the location equipped with freeze alarms? YES NO

Does the location have video surveillance? YES NO

If YES, describe all areas that are monitored:

Is video surveillance recorded (vs. live feed only)? NA YES NO

If YES, where are the recordings stored?

For how long?

Is this location open for business 24 hours? YES NO

Are restrooms available to all persons (employees, customers, public)? N/A YES NO

Are restrooms ADA compliant? YES NO

Is there a maintenance log posted? YES NO

Are all restrooms clean and orderly? YES NO

Are all bathroom chemicals locked for safety? YES NO

Is the location equipped with any automatic doors? YES NO

If YES, is there a routine maintenance plan in place? YES NO

Please describe:

Is a snow removal contract maintained? N/A YES NO

Is appropriate ice removal maintained? N/A YES NO

Are ice/salt logs present? N/A YES NO



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Are there ever any dogs present on the premise? YES NO

If YES, are all dogs properly restrained? YES NO

Please explain:

Does the location have appropriate Eye Wash stations? YES NO

Are all Eye Wash stations functioning? YES NO

Are all Eye Wash stations clearly labeled? YES NO

Are all Material Safety Data Sheets (MSDS) readily available? YES NO

Are all chemicals properly labeled? YES NO

Are all labels clearly visible? YES NO

Are chemicals stored at a safe distance from any ignition source? YES NO

Any other flammable liquids, explosives, or poisonous materials present? YES NO

If YES, are they stored properly? YES NO

Please list materials, storage, and quantity (include photos):

Is there any air, water, or soil pollution present? YES NO


Is all appropriate employee Personal Protective Equipment readily accessible? YES NO

Is all Personal Protective Equipment maintained properly? YES NO

Are Personal Protective Equipment signs posted in areas requiring it? YES NO

Are all dryers used on premise free of lint buildup? N/A YES NO

Are ladders secured and in good working order? N/A YES NO



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Are all rags stored in an appropriate noncombustible container? YES NO

Is all machinery properly guarded? YES NO

Is all water run off properly drained? YES NO

Is all drained water run off properly contained to prevent pollution? YES NO

Is good housekeeping maintained through the entire property? YES NO

If NO, please describe (include photo):

Are parking and driving areas in good condition? YES NO

If NO, please describe (include photo):

Do all parking and driving areas have clearly visible directional signage? YES NO

Do all parking and driving areas have appropriate warning signs for

vehicle height and width? YES NO

Does the location have appropriate signs warning that the wash could

potentially cause damage to the vehicle? YES NO

Does the location have signs reminding customers to roll up windows or

lower antennas? YES NO

Do any bays at the location have overhead doors? YES NO

If YES, does the overhead door completely open? YES NO

Are all walkways free of debris or other trip hazards (both inside and outside)? YES NO

Are all curbs or step ups properly identified with colored paint? YES NO

Are all walkways afforded proper lighting? YES NO

Is excess water directed away from walking areas? YES NO



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Are appropriate mats used in walkways? YES NO

Are all steps or rises in walkways clearly and properly marked? YES NO

Are all customer waiting area floors dry and not slippery? YES NO

Does the location have vacuum areas? YES NO

If YES, please answer the following:

Are vacuum areas afforded proper barriers? YES NO

Are vacuum areas free of debris? YES NO

Are vacuum areas equipped with proper signage? YES NO

Are vacuum areas equipped with adequate lighting? YES NO

Are raised surfaces properly identified? YES NO

Are all hoses properly hung? YES NO

Please check any of the following operations that are present at this location and fill out the

additional corresponding supplement for EACH operation:

Full Service Car Wash Self-serve Car Wash

Automatic Car Wash Gas Station

Convenience Store Lube or Oil Change

Pet Wash Laundry Mat

Other Operations



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PLEASE LIST ANY ADDITIONAL COMMENTS OR RECOMMENDATIONS:

Documents

Risk Management Consultation Survey...Pet Wash Detailing Other (please describe): Car Wash Risk Management Survey 02/14/13 Car Wash Risk Management Survey 2 2 EMPLOYEE PRACTICES N/A