Unoccupied Building Checklist

CONTACT DETAILS

Council Name*

Contact Name*

First Last

Position*

Email*

Phone*

UNOCCUPIED BUILDING DETAILS

Asset Type*

Office, Hall, Club etc

Please upload a current photograph of the unoccupied location

Max. file size: 600 MB.

Address of building

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Council’s intended use of the building

Declared replacement value - Building

Declared replacement value - Contents

Period of unoccupancy - FROM

Period of unoccupancy - TO

Level of cover requested

Indemnity
Removal of Debris Only
R & R

Ownership

Council
Council Controlled
Other

Historical significance

If yes, what kind?

National Trust
Heritage Listed
Other Historical

CONSTRUCTION DETAILS

Timber

Walls
Floor
Roof

Reinforced Concrete/Concrete

Walls
Floor
Roof

Fibrous Cement

Walls
Floor
Roof

Brick

Walls
Floor
Roof

Metal Deck

Walls
Floor
Roof

Galvanised Iron

Walls
Floor
Roof

Tile

Walls
Floor
Roof

Weatherboard

Walls
Floor
Roof

PVC

Walls
Floor
Roof

Please detail any other construction details not mentioned above

SECURITY DETAILS

Please select the security options applicable to this building

Please provide details

DESCRIPTION OF BUILDING

Please provide a description of the building

Is the building in a condition for immediate occupancy?

Are the premises in good condition?

If no, what pre-existing damage exists?

Does Council carry out any inspections?

If yes, by whom and how often?

Do these inspections include an internal check of the building?

Does Council maintain the surrounding grounds?

If yes, by whom and how often?

Are all utility services still connected to the building?

Collection Statement

Statewide Mutual is managed by JLT Risk Solutions Pty Ltd (ABN 69 009 098 864 AFSL 226827) and is a business of Marsh and McLennan Companies (MMC). For details on how we use this information please refer to our Collection Statement which can be found here

UNOCCUPIED BUILDING CHECKLIST