Church Insurance Intake — Hale Street Insurance

  • Church Intake Form - Hale Street Insurance

    Please complete this form to help us understand your needs and assess any relevant risks.

  • Organization

  • Format: (000) 000-0000.

  • Congregation and Operations

  • List all community services provdied
  • Does the organization lease premises to outside groups
  • Does the organization have foreign travel exposure in the next 12 months?

  • Physical Properties and Buildings

    Complete for each building
  • How many buildings do you own or lease?
  • Building occupancy / primary use
  • Building 2 occupancy / primary use
  • Construction type
  • Building 2 construction type
  • Is the building on a historical register?
  • Building 2: Is the building on a historical register?
  • Is the building over 100 years old?
  • Building 2: Is the building over 100 years old?
  • Type of roof (check all that apply)
  • Building 2 type of roof (check all that apply)
  • Type of foundation
  • Building 2 type of foundation
  • Primary heating source
  • Building 2 primary heating source

  • Plumbing and Electrical

  • Is there any knob and tube wiring present?
  • Building 2: Is there any knob and tube wiring present?
  • Is there any aluminum wiring present?
  • Building 2: Is there any aluminum wiring present?
  • Type of electrical panel
  • Building 2 type of electrical panel
  • Primary plumbing type (check all that apply)
  • Building 2 primary plumbing type (check all that apply)

  • Fire and Life Safety

  • Does every building have a functioning fire alarm system?
  • Does every building have smoke detectors?
  • Does every building have emergency lighting?
  • Does every building have sprinkler system?

  • Staffing and Volunteers

    Enter number of employees, volunteers, and contractors in each category
  • Rows

  • Counseling and Professional Services

  • What kind of counseling does the organization provide? (select all that apply)
  • Does the organization verify licenses and credentials for all counselors?
  • Have all clergy completed degrees at accredited theological seminaries?
  • Is staff required to report all incidents that may result in a claim?

  • Children and Youth Programs

  • Is a nursery available during worship services?
  • Is a youth group program offered?
  • Does the organization operate a daycare or preschool?
  • Does the organization operate a school?

  • Abuse and Molestation Screening

  • Does the employment process include criminal background checks for employees, volunteers, and contractors?
  • Does the organization use written applications for volunteers?
  • Are personal interviews conducted for all employees and volunteers?
  • Are personal references checked?
  • Is at least 5 years of employment history verified?
  • Has the organization ever had an incident resulting in an allegation of sexual abuse?
  • Does the organization's current insurance program provide abuse and molestation coverage?

  • Security

  • What security measures are in place?

  • Vehicles and Transportation

  • Does the organization lease or own any vehicles?

  • Special Events and Fundraising

  • Does the organization hold special events or fundraisers?
  • Does any event have attendance over 500?
  • Does any event involve alcohol? (do not answer yes if only for communion)

  • Special Property

  • Does the building have stained glass?
  • Does the organization have an organ or other significant musical instrument?
  • Does the organization have any artifacts or artwork valued over $5000?

  • Finance and Legal Profile

  • Has the organization had any insurance claims or losses in the past 3 years?
  • Should be Empty: