Data Request

LIGHTNING RISK ASSESSMENT

Sheet

Organizational Information
Name of Company :
Address :

Contact Person :
Designation :

Electrical Safety Construction Safety Pro c e s s S a f e t y Lo g i s t i c s S a f e t y E n v i ro n m e n t C o n s u l t i n g Insurance Support

Page 1 of 11
Chola MS Risk Services Ltd.  Parry House, 4 th Floor, No. 2, NSC Bose Road, Chennai 600 001  Toll Free: 1-800-200-1991  www.cholarisk.com
 Data Request
LIGHTNING RISK ASSESSMENT
Sheet

Contact Phone : Contact Email :

Electrical Safety Construction Safety Pro c e s s S a f e t y Lo g i s t i c s S a f e t y E n v i ro n m e n t C o n s u l t i n g Insurance Support

Page 2 of 11
Chola MS Risk Services Ltd.  Parry House, 4 th Floor, No. 2, NSC Bose Road, Chennai 600 001  Toll Free: 1-800-200-1991  www.cholarisk.com
 Data Request
LIGHTNING RISK ASSESSMENT
Sheet

Information Required for Thermography Study

Sl. No. Details Description

1. Brief description of the Plant/facility (No of plant blocks)
including the operations / process

Electrical Safety Construction Safety Pro c e s s S a f e t y Lo g i s t i c s S a f e t y E n v i ro n m e n t C o n s u l t i n g Insurance Support

Page 3 of 11
Chola MS Risk Services Ltd.  Parry House, 4 th Floor, No. 2, NSC Bose Road, Chennai 600 001  Toll Free: 1-800-200-1991  www.cholarisk.com
 Data Request
LIGHTNING RISK ASSESSMENT
Sheet

Information Required for Thermography Study

Sl. No. Details Description

2. Number of personnel employed ( Inclusive of contractor
employee )

Electrical Safety Construction Safety Pro c e s s S a f e t y Lo g i s t i c s S a f e t y E n v i ro n m e n t C o n s u l t i n g Insurance Support

Page 4 of 11
Chola MS Risk Services Ltd.  Parry House, 4 th Floor, No. 2, NSC Bose Road, Chennai 600 001  Toll Free: 1-800-200-1991  www.cholarisk.com
 Data Request
LIGHTNING RISK ASSESSMENT
Sheet

Information Required for Thermography Study

Sl. No. Details Description

3. Certifications if any – ISO 9001 / 14001/ OHSAS 18001 etc..

Electrical Safety Construction Safety Pro c e s s S a f e t y Lo g i s t i c s S a f e t y E n v i ro n m e n t C o n s u l t i n g Insurance Support

Page 5 of 11
Chola MS Risk Services Ltd.  Parry House, 4 th Floor, No. 2, NSC Bose Road, Chennai 600 001  Toll Free: 1-800-200-1991  www.cholarisk.com
 Data Request
LIGHTNING RISK ASSESSMENT
Sheet

Information Required for Thermography Study

Sl. No. Details Description

4. Total Built up area and names of important block

Electrical Safety Construction Safety Pro c e s s S a f e t y Lo g i s t i c s S a f e t y E n v i ro n m e n t C o n s u l t i n g Insurance Support

Page 6 of 11
Chola MS Risk Services Ltd.  Parry House, 4 th Floor, No. 2, NSC Bose Road, Chennai 600 001  Toll Free: 1-800-200-1991  www.cholarisk.com
 Data Request
LIGHTNING RISK ASSESSMENT
Sheet

Information Required for Thermography Study

Sl. No. Details Description

5. Details of Hazardous Chemicals Stored (including fuels) -
Name and Quantity

Electrical Safety Construction Safety Pro c e s s S a f e t y Lo g i s t i c s S a f e t y E n v i ro n m e n t C o n s u l t i n g Insurance Support

Page 7 of 11
Chola MS Risk Services Ltd.  Parry House, 4 th Floor, No. 2, NSC Bose Road, Chennai 600 001  Toll Free: 1-800-200-1991  www.cholarisk.com
 Data Request
LIGHTNING RISK ASSESSMENT
Sheet

Information Required for Thermography Study

Sl. No. Details Description

6. No of buildings / blocks / storage tanks present?

7. Details of electronic equipments installed like UPS, VFD,

Telephone exchange, Networks etc.,

Electrical Safety Construction Safety Pro c e s s S a f e t y Lo g i s t i c s S a f e t y E n v i ro n m e n t C o n s u l t i n g Insurance Support

Page 8 of 11
Chola MS Risk Services Ltd.  Parry House, 4 th Floor, No. 2, NSC Bose Road, Chennai 600 001  Toll Free: 1-800-200-1991  www.cholarisk.com
 Data Request
LIGHTNING RISK ASSESSMENT
Sheet

8. Details of Surge protection devices provided for

electrical / electronic equipments (if any)

9. Details of lightning protection provided for building (if any)

Electrical Safety Construction Safety Pro c e s s S a f e t y Lo g i s t i c s S a f e t y E n v i ro n m e n t C o n s u l t i n g Insurance Support

Page 9 of 11
Chola MS Risk Services Ltd.  Parry House, 4 th Floor, No. 2, NSC Bose Road, Chennai 600 001  Toll Free: 1-800-200-1991  www.cholarisk.com
 Data Request
LIGHTNING RISK ASSESSMENT
Sheet

10. Special electrical/electronic equipments (if any) installed

Note:
Please attach the site layout along with this data request form

Electrical Safety Construction Safety Pro c e s s S a f e t y Lo g i s t i c s S a f e t y E n v i ro n m e n t C o n s u l t i n g Insurance Support

Page 10 of 11
Chola MS Risk Services Ltd.  Parry House, 4 th Floor, No. 2, NSC Bose Road, Chennai 600 001  Toll Free: 1-800-200-1991  www.cholarisk.com
 Data Request
LIGHTNING RISK ASSESSMENT
Sheet

Electrical Safety Construction Safety Pro c e s s S a f e t y Lo g i s t i c s S a f e t y E n v i ro n m e n t C o n s u l t i n g Insurance Support

Page 11 of 11
Chola MS Risk Services Ltd.  Parry House, 4 th Floor, No. 2, NSC Bose Road, Chennai 600 001  Toll Free: 1-800-200-1991  www.cholarisk.com