公众责任保险风险问卷调查-公共场所

《公众责任保险风险问卷调查-公共场所》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、公众责任保险PublicLiabilityInsurance风险调查问卷RiskEvaluationQuestionnaire本表适用于公共场所的场所公众责任险投保。ThisformshallbeappliedtoonpremisecoverofPublicLiabilityInsuranceforpublicplace.概况GeneralInformation1．投保人名称NameofInsured_______________________________________________________

2、__________________2．总部地址AddressofHeadOfficeinP.R.China_________________________________________________________________________3．企业性质NatureofEnterprise□国营state-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-own

3、ed,pleaseadvisenationalityoftheowner4．保险地址LocationunderCover(连锁店请附地址清单Pleaseattachlistifyouareoperatingachainfirm)_________________________________________________________________________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。Pleasemakechoiceontheleft

4、handsidefirst,then,ifapplicable,chooseYesorNooranswertherelevantquestionontherighthandside.□大卖场/超市/百货商场shoppingmall/supermarket/departmentstore：是否设有儿童游乐区Arepleasuregroundforchildrenincluded？□是Yes□否No是否有铺位或柜台向第三方出租Arethereanybusinessareasleasedtothirdparties

5、？□是Yes□否No□商务楼/公寓businessoffice/apartment□公园/游乐场park/amusementcentre□医院/诊所hospital/clinic□宾馆hotel：是否是星级宾馆，多少星级No.ofStarsifyouarequalified？_______若上述场所含有以下服务内容，则也须选择和回答Pleasecompletetherestpartifyouprovidetheservicesasdescribedbelow:□饭店/餐厅restaurant/snackbar

6、□旱地溜冰场skatingrink：请告知何种地面pleaseadvisewhatkindofground:____________________________________□舞厅、卡拉OKdiscoroom,karaokeprivate：是否供应酒精度超过15的饮料Doyouprovidebeveragewithalcohollevelabove15degree？□是Yes□否No□酒吧pub□影剧院、放映厅cinema/theatre□游泳馆/池swimmingpool：换水频度frequencyo

7、fchangingwater？_______；值班救生员人数No.oflifeguard？_____采用何种措施保证水质waytoguaranteequalityofwater？_____________________________________________________□健身中心fitnessclub：有无配备专业教练指导Instructedbyprofessionals？□是Yes□否No器材定期保养维护regularmaintenanceonequipment？□是Yes□否No□美容中心b

8、eautyparlor&/orhairdresser□沐浴中心bathe&sauna□网球场tenniscourt：是否禁止儿童进入场地Arechildallowedinthepremise？□是Yes□否No□高尔夫球场golfcourt□游艺厅gameroom：请说明主要活动项目pleasespecifymajorproject__________________________________