Commercial Insurance Risk Assessment Form

Commercial Insurance Risk Assessment Form
Use this form to evaluate a business’s commercial insurance risk profile and operational exposures. Please provide accurate and complete information for underwriting review.
Business Profile
Business legal name
DBA / trading name
Industry type
Years in business
Business structure
Primary business address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Website URL
Operations and Exposure
Number of Employees
Number of Locations
Operating Hours
Main Products / Services
Annual Revenue Band
Other
Work Distribution by Location Type (%)
Hazardous Materials or High-Risk Operations
Property and Asset Risk
Does the business own or lease the property?
Other
Building type
Other
Year building was built
Sprinkler and fire alarm systems present
Other
Security systems present
Other
Flood, wind, or earthquake exposure by location
Other
Estimated replacement value of key equipment, furniture, and fixtures
Claims, Incidents, and Loss History
Any claims in the past 5 years?
Number of claims in the past 5 years
Types of claims
Other
Brief description of the largest or most recent claim
Any pending litigation or regulatory actions related to operations?
If yes, please provide a brief explanation
Safety, Compliance, and Protection Measures
Written safety procedures in place
Employee training frequency
Other
Background checks conducted for relevant roles
Maintenance inspection frequency for equipment and facilities
Other
Business continuity or disaster recovery plan exists
Rate the following risk mitigation practices
Rows Poor Fair Good Very Good Excellent
Housekeeping
Supervision
Equipment maintenance
Loss prevention practices
Should be Empty:

Select theme:

Rows	Poor	Fair	Good	Very Good	Excellent
Housekeeping
Supervision
Equipment maintenance
Loss prevention practices

Commercial Insurance Risk Assessment Form

Business Profile

Operations and Exposure

Property and Asset Risk

Claims, Incidents, and Loss History

Safety, Compliance, and Protection Measures