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Full Narrative Report Sample Report Full Narrative Report Features PO Box 13010 - Prescott, AZ 86304 Email: [email protected] Web: asuservices.com Voice: 866-414-8995 Fax: 866-898-0103 Insured: CERICOM INCORPORATED Policy No: WC1598645 Loc. Surveyed: 13562 W. INDUSTRIAL PLACE - TUCSON, AZ 85712 Underwriter: JENNIFER HALLOWAY Job number: NAIC16597 Agent: INOVATIVE SPECIALTIES Survey Date: 2/23/2004 FULL NARRATIVE REPORT Recommendations: Yes No Opinion of Risk: Good Average Poor SPECIAL REQUESTED INFORMATION Chemicals here basically involve solvents for cleaning, such as acetone, methanol and isopropyl alcohol. Hazards in raw materials consist of silica based component powders, consisting of an estimated 40% of raw materials. Refer to SPECIAL HAZARDS section of this report for further details regarding controls. Outside subcontracted services include heat treating, machining and machine tooling, minor exposure. Larger exposure due to usage of independent contractors as consultants, refer to *PREMIUM BASIS section of this report for further details. GENERAL Time in business: 21 YEARS Contact: MR. HARMON Time at this location: 8 YEARS Title: GENERAL MANAGER OPERATIONS Insured is a designer and manufacturer of high tech ceramic products which are used for industrial, aerospace, defense and electronics applications. The insured has 28 employees and two owners, whom are fully active in the day-to-day operations of the business. This is a 24 hour operation with three shifts for production, the office is open fro 8-5 Monday-Friday. The insured has two buildings in this well established industrial neighborhood, no other tenants in either building. MANAGEMENT & HISTORY Fifty years of experience reported between two owners and one manager. This is a corporation with Mr. Harmon, president, involved in marketing and general management, Mr. Andrew, vice-president, fully involved in research and development. Insured here at this location for six years, expanding within this complex, two separate buildings are now occupied. No relatives employed. Business appears profitable and active. No future changes expected by contact. Confidential. The information contained in this report is intended for the sole usage of Advanced Safety & Underwriting Services direct customer only. Further distribution or sale of this submitted report is prohibited. Loss Control, Underwriting and Structural Valuations are the sole responsibility of your management. Our surveys are intended only to assist you in this activity and should not be construed to be comprehensive reports disclosing every feature of the insured property or loss-producing condition, which may arise. This report does not necessarily include every loss potential, exposure, code violation, or exception to good practice and is not to be construed as an undertaking to recommend compliance with imposed federal, state or local ordinances. Information provided in this report is made from limited observation and interviews upon which our fees are based. Any recommendations submitted were developed as a result of conditions observed or as reported to our inspector by the available contact person during our survey. In accepting this report, the requesting company, its reinsurors and all unauthorized parties privy to this report agree to hold “Advanced Safety & Underwriting, Services.” AKA: ASU Services, Inc. free and harmless from any claims or liability arising from damages where a report has been submitted. Premium Quality Service Since 1980 Member: “American Society of Safety Engineers” Digital Reports are automatically delivered directly to your PC via email. Report, Photographs, Diagrams and Customer Forms are one single PDF file for ease of use, forwarding & archiving. Full Narrative Reports are offered on all coverage’s based on the specific needs of your underwriting & loss control departments.

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Page 1: Full Narrative Report Sample Report - ASU Servicesasuservices.com/SampleReports/Sample_FullNar_WC2.pdf · Full Narrative Report Sample Report Full Narrative Report Features INOVATIVE

Full Narrative Report Sample Report

Full Narrative Report Features

PO Box 13010 - Prescott, AZ 86304 Email: [email protected] Web: asuservices.com Voice: 866-414-8995 Fax: 866-898-0103

Insured: CERICOM INCORPORATED

Policy No: WC1598645

Loc. Surveyed: 13562 W. INDUSTRIAL PLACE - TUCSON, AZ 85712

Underwriter: JENNIFER HALLOWAY

Job number: NAIC16597

Agent: INOVATIVE SPECIALTIES

Survey Date: 2/23/2004

FULL NARRATIVE REPORT

Recommendations:

Yes

No

Opinion of Risk:

Good

Average

Poor

SPECIAL REQUESTED INFORMATION

Chemicals here basically involve solvents for cleaning, such as acetone, methanol and isopropyl alcohol. Hazards in raw materials consist of silica based component powders, consisting of an estimated 40% of raw materials. Refer to SPECIAL HAZARDS section of this report for further details regarding controls. Outside subcontracted services include heat treating, machining and machine tooling, minor exposure. Larger exposure due to usage of independent contractors as consultants, refer to *PREMIUM BASIS section of this report for further details.

GENERAL

Time in business: 21 YEARS Contact: MR. HARMON Time at this location: 8 YEARS Title: GENERAL MANAGER

OPERATIONS

Insured is a designer and manufacturer of high tech ceramic products which are used for industrial, aerospace, defense and electronics applications. The insured has 28 employees and two owners, whom are fully active in the day-to-day operations of the business. This is a 24 hour operation with three shifts for production, the office is open fro 8-5 Monday-Friday. The insured has two buildings in this well established industrial neighborhood, no other tenants in either building.

MANAGEMENT & HISTORY

Fifty years of experience reported between two owners and one manager. This is a corporation with Mr. Harmon, president, involved in marketing and general management, Mr. Andrew, vice-president, fully involved in research and development. Insured here at this location for six years, expanding within this complex, two separate buildings are now occupied. No relatives employed. Business appears profitable and active. No future changes expected by contact.

Confidential. The information contained in this report is intended for the sole usage of Advanced Safety & Underwriting Services direct customer only. Further distribution or sale of this submitted report is prohibited. Loss Control, Underwriting and Structural Valuations are the sole responsibility of your management. Our surveys are intended only to assist you in this activity and should not be construed to be comprehensive reports disclosing every feature of the insured property or loss-producing condition, which may arise. This report does not necessarily include every loss potential, exposure, code violation, or exception to good practice and is not to be construed as an undertaking to recommend compliance with imposed federal, state or local ordinances. Information provided in this report is made from limited observation and interviews upon which our fees are based. Any recommendations submitted were developed as a result of conditions observed or as reported to our inspector by the available contact person during our survey. In accepting this report, the requesting company, its reinsurors and all unauthorized parties privy to this report agree to hold “Advanced Safety & Underwriting, Services.” AKA: ASU Services, Inc. free and harmless from any claims or liability arising from damages where a report has been submitted.

Premium Quality Service Since 1980 Member:

“American Society of Safety Engineers”

Digital Reports are automatically delivered directly

to your PC via email.

Report, Photographs, Diagrams and

Customer Forms are one single

PDF file for ease of use, forwarding

& archiving.

Full Narrative Reports are

offered on all coverage’s based

on the specific needs of your underwriting &

loss control departments.

Page 2: Full Narrative Report Sample Report - ASU Servicesasuservices.com/SampleReports/Sample_FullNar_WC2.pdf · Full Narrative Report Sample Report Full Narrative Report Features INOVATIVE

Full Narrative Report Sample Report (Cont’d)

Insured: CERICOM INCORPORATED

Policy No: WC1598645

WORKERS’ COMPENSATION REPORT

No. of employees: 28 *Ind. Contractors: Yes No *Total payroll: $732,000 **Safety program: Yes No

*PREMIUM BASIS

Four clerical, two draftsmen, 22 listed as pottery employees. Classifications appear incorrect and should be investigated. No drivers. Four clerical employees, payroll annually $92,000. Two draftsmen, payroll $90,000. 22 employees currently classified as pottery at $550,000 President and Vice President included at $58,500 each. Note that classification of pottery personnel would be difficult to agree with at this time due to various operations as previously described. This is a non-union shop, there is one employee over 60 years of age, none under 18. Contact unsure of number of W2 forms issued last year, however, six to seven reportedly hired as an estimate. Insured had a lay off for a short period of time of 12 persons. Business is typically non seasonal. Could be drastically effected by military budgets. No family members working in the business. Subcontractor costs are $108,000. Small amount of heat treating, machining and machine tooling are subcontracted out if the insured is not qualified or is too busy to handle these operations, certificates of insurance are obtained from subcontractors, these are established businesses in the local area. Independent contractor costs are $81,000. Exposure to independent contractors acting as consultants consist of one in house full time production design consultant, one sales consultant bids contracts in-house one time weekly, one accountant works in house two days monthly, one sales consultant bids contracts and proposals, this independent contractor in Eastern United States. No certificates of insurance obtained.

DESCRIPTION OF OPERATIONS

Insured is a designer and manufacturer of high tech ceramic products which are used for industrial, aerospace, defense and electronics applications. One of major applications is that of manufacturing a ceramic tile (floor tile type product in appearance) that is used in the aerospace defense industry for bullet proof armor. All of the insured's operations are here at this facility, with the exception of minor off premise operations, which will be discussed further in this section. No reported company vehicles, no delivery operations. Insured maintains offices, research and development departments, full manufacturing facility, shipping, receiving and quality control operations here.

Full coverage and section headings

are provided throughout the

report to simplify locating needed

information.

Page 3: Full Narrative Report Sample Report - ASU Servicesasuservices.com/SampleReports/Sample_FullNar_WC2.pdf · Full Narrative Report Sample Report Full Narrative Report Features INOVATIVE

Full Narrative Report Sample Report (Cont’d)

Insured: CERICOM INCORPORATED

Policy No: WC1598645

Contact reports two corporate officers are involved in minor usage of commercial airlines, typically to the Midwest and eastern portions of the United States, trips an average of one time every two months. Contact reports one engineer/employee was sent to the Midwest on one occasion, maintained at a customer's location for two weeks for various related duties. No exposure to racing vehicles, private aircraft, sponsored sporting events or the like. Insured occupies two separate buildings separated by 60 ft. Both buildings are Class C construction, concrete on earth floors, pre-cast concrete tilt up walls and flat wood roofs. Original building at noted address is 15,400 sq. ft., secondary location equals 16,000 sq. ft. Both buildings are leased, both buildings are fully protected by automatic sprinkler systems. Buildings estimated at possibly eight years of age, in good condition and repair. Appear suitable for insured's operations at this time.

COMMON HAZARDS

Small second story area accesses Research & Development department to 16,000 sq. ft. building, stairs are well maintained and in good condition, adequate hand rails. Small step ladders are used for maintenance of this facility, maximum size noted approx. six foot A-frame, the insured states these are OSHA certified ladders. Interior floors of manufacturing areas create a slip/fall exposure due to raw materials dust which is difficult to control here, however, note that employees are not required to wear specialized shoes and this would be very helpful, see recommendations at end of report. Slippery exposure is created by dust of various raw materials and graphite used as lubricant throughout numerous areas. Each building area hallways and aisles are considered adequate, basically non-congested, stock storage is well maintained to storage racks. Slightly congested operations for forklift, however, considered satisfactory. Overall housekeeping and sanitation are considered good, deficiencies noted in dust build up as previously described do not appear to create an unusual housekeeping problem. Both buildings are fully protected by automatic sprinkler systems, both are activated and controls are locked in open position. Adequate distribution of fire extinguishers (both ABC and class D, as required) properly serviced within the past year. Flammable chemicals include acetone, methanol and isopropyl alcohol, several five gallon metal cans maintained of each dispensed into smaller approved dispensing units for usage in R&D department and for clean up activities. Five gallon containers are located in a UL Listed fire cabinet. No dirty rags noted lying about facility. Ovens are set clear. General fire safety controls appear acceptable.

Page 4: Full Narrative Report Sample Report - ASU Servicesasuservices.com/SampleReports/Sample_FullNar_WC2.pdf · Full Narrative Report Sample Report Full Narrative Report Features INOVATIVE

Full Narrative Report Sample Report (Cont’d)

Insured: CERICOM INCORPORATED

Policy No: WC1598645

Egress from interior areas are considered satisfactory adequate pedestrian and overhead doors available throughout the complex area. Each building has multiple entry/exits, with no obstructions noted to either building. Electrical Systems are professionally installed throughout entire area, conduit throughout, overload protection via circuit breakers, no unusual temporary wiring noted. All stationary equipment noted is hard wired. Florescent lighting throughout office and manufacturing area is satisfactory. Ventilation systems are extensive throughout manufacturing areas. Clean room is installed for mixing and processing of raw materials which use aluminum oxide silica carbide whiskers as a component material, dust benches are installed so that product can be mixed by hand within same enclosure, which is large enough for small pails and hands only. There is also a small amount of dry forming completed using hydraulic type press is arranged in a small Plexiglas enclosure, which can be rolled to the cleaning room environment area, the dust created by compressing is evacuated via collection system. Dust collection systems are installed to all dust producing machinery and equipment, predominantly within the milling and finishing departments. Dust collection systems are monitored by ADEQ (Arizona Department of Environmental Quality). Although ventilation systems are considered adequately installed, there is an exposure to excess, unmonitored dust buildups throughout the entire manufacturing facility, which does create excessive lung damage exposure.

SPECIAL HAZARDS

Machinery and equipment used includes typical office related equipment which creates no unusual exposure. Research and Development departments maintain small curing ovens for testing procedures, electric. Other related equipment is maintained throughout R&D departments, appears typical. Throughout the manufacturing areas heavy machinery and equipment noted throughout as follows: air compressors, lathes, horizontal mills, sand blaster, glee bar machine, band saw, see recommendations. Horizontal mill, sand blaster. Pallet jacks, two forklifts, hand truck, walk behind lift, two five ton electric hoists. Gas welder, hydraulic floor jack, pedestal grinder, horizontal mill, fixture grinder, see recommendations at end of report. Horizontal lathe, seven surface grinding machines, pedestal grinder, gang slicer, three rotary grinders, centerless grinder, see recommendations at end of report. Numerous heat processing ovens include pressureless and pressure sintering ovens, burn out ovens, vacuum hot press pressurized oven, hot furnace, nitrogen vacuum furnace, all electric. All vary in size from 1-1/2 ft. by 1-1/2 ft. in Research & Development departments to large sintering ovens/furnaces which measure approx. six ft. in diameter and an estimated 7 ft. to 8 ft. in height.

Page 5: Full Narrative Report Sample Report - ASU Servicesasuservices.com/SampleReports/Sample_FullNar_WC2.pdf · Full Narrative Report Sample Report Full Narrative Report Features INOVATIVE

Full Narrative Report Sample Report (Cont’d)

Insured: CERICOM INCORPORATED

Policy No: WC1598645

Average lifting exposure reportedly 15 lbs., maximum 50 per employee. Material handling machinery and equipment appears to be in satisfactory condition and adequate for type of operation including pallet jack, forklifts, hand truck, walk behind electric lift, two five ton electric hoists. We noted no unusual repetitious handling exposures here, animated machinery and equipment is available for moving about product as needed.

MEDICAL PROGRAM

Insured provides full, 100% paid health and dental insurance program for all employees, employees pay for dependents. Insured has a small profit sharing and bonus program planned, however, not in place as of yet. The insured has a designated local medical provider for the employees.

** LOSS CONTROL MANAGEMENT

Insured is somewhat lax in formulation of IIPP (Injury and Illness Prevention Program) which is in finishing stages at this time, full manual is maintained. Mr. Payne is designated safety coordinator. They have the written safety program instigated and outlined, safety committee is assigned to each of the department heads with them directly responding to Mr. Lance so as to communicate hazardous activities or conditions to management. Accident investigations reportedly handled by Mr. Payne and department heads. Contact reports they have brought in a chiropractor to conduct back/lifting clinic. OSHA300 logs are maintained and up to date. Safety related equipment includes dust collection systems as previously described, fume hoods, NIOSH (National Institute of Occupational Safety & Health) approved respirators, uniforms are provided to employees which are removed in small decontamination room for laundering, face shields, goggles, welding goggles are also provided. ADEQ monitors insured's burn out ovens for exposure of solids into atmosphere, grinding sludge has a minor non-classified nickel content which must be hauled away, as well as waste and pump oil. Sludge and oils are maintained in 55 gallon drums until removed by licensed hazardous waste removal company. New employees are hired by the owners, with hiring procedures being application, interview, reference check and drug test. The insured requires all new employees to work alongside the department heads for a duration of two weeks, with a written training program documenting the specific training features for new employees. The insured has a formal/written RTWE (Return To Work Early) program for employees. Employees are able to start back at work with light duties.

Page 6: Full Narrative Report Sample Report - ASU Servicesasuservices.com/SampleReports/Sample_FullNar_WC2.pdf · Full Narrative Report Sample Report Full Narrative Report Features INOVATIVE

Full Narrative Report Sample Report (Cont’d)

Insured: CERICOM INCORPORATED

Policy No: WC1598645

LOSSES

00-01 policy period 01-02 policy period 02-03 policy period 03-04 policy period 04-05 policy period

Six claims Eight claims Three claims Seven claims Six claims

$14,948 paid $2,708 paid $11,868 paid $3,007 paid $7,059 paid

Typical claim history for this type of risk. One employee by the name of Meza experienced three claims, has been laid off, no longer employed. Employee, Mr. Byford, is mill write and maintenance person, has experienced four claims and is in good standing. Slip and falls and back injuries appear to be correctable problems, see recommendations at end of report.

OPINION OF RISK

Operationally this appears to be a well managed risk in class, predominant hazard in usage of raw materials and dust exposures which would be very difficult to control better than already handled. Recommendations could improve this risk to a satisfactory rating on a temporary basis, however, long lasting effects of inhalation of silica based powders creates excessive exposure in the future. Classification of pottery manufacturing employees by the bureau also should be questioned.

Losses & Opinion of Risk,

Are fully discussed in our

Full Service Narrative Reports.

Page 7: Full Narrative Report Sample Report - ASU Servicesasuservices.com/SampleReports/Sample_FullNar_WC2.pdf · Full Narrative Report Sample Report Full Narrative Report Features INOVATIVE

Full Narrative Report Sample Report (Cont’d)

Insured: CERICOM INCORPORATED

Policy No: WC1598645

RECOMMENDATIONS

02-04-01 IMPERATIVE. Band saw to machine shop area lacking blade guard. Please retrofit this machine with adequate blade guarding so as to reduce injury exposure which exists.

02-04-02 IMPERATIVE. Excessive slip/fall exposure throughout interior manufacturing areas due to slippery powder/dusty floor surfaces. Require all employees working in the manufacturing areas to obtain non-slip / steel toed approved working shoes so as to minimize slip hazard which exists.

02-04-03 IMPERATIVE. Fixture grinder having exposed belt creates excessive injury exposure to employees. Please purchase and reinstall missing belt guard/enclosure immediately.

02-04-04 IMPERATIVE. Center less grinder lacking belt guard creates excessive injury exposure. Please retrofit or reinstall adequate belt guard/cage so as to reduce injury exposure which exists.

02-04-05 IMPERATIVE. Although dust control equipment is professionally installed, fine layers of dust throughout the manufacturing areas denote a possible serious long term environmental hazard to employees due to extensive usage of silica based raw materials. Please hire a qualified air quality test engineering firm and have air tested throughout manufacturing areas so as to determine extent and type of airborne particles. Please comply with recommendations submitted by testing engineer so as to further minimize loss exposure that exists.

Full Recommendations are submitted on a separate page

for ease of printing and electronic

forwarding to your insured and producing agent.

Page 8: Full Narrative Report Sample Report - ASU Servicesasuservices.com/SampleReports/Sample_FullNar_WC2.pdf · Full Narrative Report Sample Report Full Narrative Report Features INOVATIVE

Full Narrative Report Sample Report (Cont’d)

Insured: CERICOM INCORPORATED

Policy No: WC1598645

PHOTOS

Note: The content and

photographs included in this

report have been edited, or do not apply to this risk

to protect the confidentiality

of the insured and ASU’s customer.

Digital Photographs are

included in all Full Service Narrative

Reports.