Amateur Sports Facilities

1

Email* This field is required.

example@example.com

2

Has insured had insurance coverage previously?

Yes

No

3

If Yes, please provide 5 years currently valued loss runs.

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4

Have coverages ever been canceled or non-renewed during past 5 years?

Yes

No

5

If Yes, please provide an explanation:

6

Does the applicant operate a concession stand or have any other food/beverage sales?

Yes

No

7

If yes, is it self-service?

Yes

No

8

If yes, are there designated eating areas?

Yes

No

9

If yes, cooking equipment is:

Electric

Gas

Propane

10

Are there any grills and / or deep fryers on premises?

Yes

No

11

Are they equipped with hoods, automatic fire suppression systems and automatic fuel shutoff controls?

Yes

No

12

List type of foods / beverages sold:

13

Are there any liquor sales?

Yes

No

14

If yes, what percent of sales?

15

Estimated TOTAL Gross Receipts:

16

Breakdown of Receipts: Rentals

17

Breakdown of Receipts: Practice

18

Breakdown of Receipts: Competition

19

Breakdown of Receipts: Concessions/Food

20

Breakdown of Receipts: Merchandise

21

Breakdown of Receipts: Shows/Events

22

Breakdown of Receipts: Parties

23

Breakdown of Receipts: Parking Receipts

24

Breakdown of Receipts: Liquor Receipts

25

Breakdown of Receipts: Other

26

Are there procedures in place to verify that the individuals and parents carry their own health insurance?

Yes

No

27

Does the applicant belong to any national, state, or localsports associations?

Yes

No

28

If yes, which?

29

Is the applicant or your staff trained / certified in CPR or First Aid?

Yes

No

30

Are all participants required to provide waiver and release and/or assumption of risk forms?

Yes

No

31

(Please provide a copy)

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32

Who signs the waivers?

33

When are the waivers signed?

Date

34

How long are the waivers retained?

35

Where are the waivers stored?

36

Does the applicant have a written incident report procedures in place?

Yes

No

37

Does the applicant keep a log of all incidents?

Yes

No

38

Does the applicant have a concussion awareness and management program in place?

Yes

No

39

If a concussion is suspected, does the applicant comply with state requirements to leave a game or practice immediately and return only after at least 24 hours and with permission of a health care professional?

Yes

No

40

Does the applicant currently utilize any concussion impact monitoring technology?

Yes

No

41

Are coaches, managers, trainers, officials, referees, statisticians or scorekeeper’s independent contractors that are paid a fee for their services?

Yes

No

42

If yes, does the applicant want to add them as additional insureds on their policy?

Yes

No

43

If yes, does the applicant require certificates of insurance?

Yes

No

45

If you selected "Subcontractor/Other" in any of the rows, please list the responsible party below:

46

Type of medical facility/ambulance provided?

47

Who is responsible for pre-event inspection of the event premises?

48

Will any other underlying coverage be provided for this event?

Yes

No

49

If yes, describe:

50

Are athletic members covered by Workers Compensation?

Yes

No

51

If yes, please explain:

52

Is there any form of athlete compensation or prize money awarded for participation?

Yes

No

53

Please provide details of the management experience (include number of years under present management):

54

Describe in detail the nature of the operations:

55

Does insured own or lease premises?

Owned

Leased

56

Other occupancies?

57

What are the staffing guidelines per number of patrons?

58

Number of full-time staff:

59

Number of part-time staff:

60

Number of volunteers:

61

Number of security staff:

62

Is there a pre-employment screening procedure?

Yes

No

63

If yes, Please describe:

64

Is a criminal background check made?

Yes

No

65

What training is required prior to a new employee being deployed? And who trains them?

66

Does the applicant have equipment rentals?

Yes

No

67

If yes, who operates the rental operation?

Applicant

Sub-Contractor

68

If sub-contractor, do they furnish a certificate of insurance?

Yes

No

69

Is spectator seating provided by your facility?

Yes

No

70

If yes, maximum seating capacity:

71

If yes, type of seating:

Permanent

Portable

72

If yes, type of seating:

Wood

Metal

Concrete

Other

73

Is there a barrier between field and seats?

Yes

No

74

If yes, type of barrier:

Glass

Net

Other

75

Are non-slip surface treads used on all stairs?

Yes

No

76

Describe the precautions taken to prevent spectators from entering restricted areas:

77

Does the applicant have locker rooms?

Yes

No

78

If yes, are the rooms monitored?

Yes

No

79

Does the applicant have shower rooms?

Yes

No

80

If yes, are they open to the public?

Yes

No

81

If yes, are non-slip surfaces used in the shower area?

Yes

No

82

Does the applicant operate a babysitting service?

Yes

No

83

If yes, what is the ratio of adults to children?

84

Are all curbs, steps and ledges highlighted?

Yes

No

85

Does facility comply with ADA?

Yes

No

86

Are parking lots & curbs maintained during winter storms?

Yes

No

87

If yes, it is done by:

Applicant

Sub-contractor

88

Are you contemplating any demolition, new construction or structural alterations?

Yes

No

89

If Yes, please describe:

90

Is the facility in compliance with all governmental safety and fire codes?

Yes

No

91

Describe the medical support system:

92

AEDs on premises:

Yes

No

93

# First Aid/CPR Trained staff:

94

If Yes, how many and are staff trained on use?

95

Distance to nearest Medical Facility (miles):

96

Distance to nearest Fire Station (miles):

97

Is there a formal emergency evacuation

Yes

No

98

If Yes, provide a copy plan?

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99

Describe the fire alarm system – central station, local alarm, etc.:

100

Are all fire extinguishers easily accessible in all buildings?

Yes

No

101

Are they checked:

Monthly

Annually

Other

102

Are they checked – please describe:

103

Do you have fire extinguishers located in all buildings, at all attractions?

Yes

No

104

Describe the burglar alarm system:

105

Does the facility have back-up emergency lighting or generators:

Yes

No

106

Are all exits well marked:

Yes

No

107

How many exits are in the facility?

108

Are there any security cameras in place?

Yes

No

109

Type a question