Business Name
Contact Name
Business Address
Business Type
Number of Locations
Hours of Operation
Phone Number
Business
Headquarters
New or Existing Property
Number of Years In Business
Number of Employees
Number of Employees to Use System
The Business Threats
Value
High Risk Items
Causes for Business Interruption
Cost of Lost Business
Security Priorities
On a Scale of 1 to 10 (10 being the highest)
indicate level of risk
Robbery
Burglary
Vendor Theft
Fire
Slip and Fall Liabilities
Employee Theft
Limiting access, Sensitive
Areas
Internal Theft
Monitoring Employee activities
Other
Explain
Are you inquiring about a specific project
? or conducting
a general review
Describe the project of the reason for
your inquiry
Explain
Burglary and Fire
Yes
No
Current Security Provider
System(s) Information
Burglary
Fire (Current/Required Fire
Protection/Monitoring)
Water Sprinklers
Temperature
Smoke/Heat
CCTV
Access Control
Other
External Security Threats
Number
of Entries
Windows
Doors
Roof
Skylight
Building Lock/Unlock Process During Business
Hours
Building Lock/Unlock Process After Business
Hours
Number of Employees With Keys
Cost of Door Lock Changes and Key Replacements?
Limited or Restricted Access Areas
Theft Loss
Has Your Business Experienced Theft Related
Loss in the Past 12 Months?
Yes
No
Number of Incidences
Amount of Loss
Does Your Business Have a Loss Prevention/Security
Program?
Yes
No
Annual Budget
Productivity and Activity
Tracking
Do You
Track Ingress and Egress of Associates?
Yes
No
Do You Track Opening Times for Your Facility?
Yes
No
How do You Track Time and Attendance?
Do You See Value in Verifying that the Alarm is Set and at
what Time?
Yes
No
Do You Have Certain Areas
Where You Would Like to Prevent the Public or Unauthorized Employees From Entering?
Yes
No
Do You Notice "Wandering"
of Employees During Work Hours?
Yes
No
Average Hourly Salary
Hours/Week
Lost to Wandering
Liabilities
Has
Your Business Experienced a Liability Claim?
Yes
No
If Yes, What Type of Claim?
Slip and Fall
Yes
No
Harassment
Yes No
Workers Compensation
Yes
No
Have These Claims Affected
Your Insurance Premiums?
Yes
No
Approximately How Much More
Per Year are You now Paying?
How Much Time and Money was Spent on
Research, Court Appearances, and Attorney Fees?
Time
Money
Are You Concerned About Workplace Violence?
Yes
No
Have You Experienced Losses
as a Result?
Yes
No
Amount?
Property
Where are Your High Risk Slip and Fall
Areas?
Front
Entrances
Service Area
Aisles
Parking Lot
Delivery
Other
Are There Areas Outside Where
You Would Like to Monitor to Protect Your Employees From Theft or Violence?
Yes
No
Is your Parking Lot Secure?
Yes
No
If yes, How?
Are
All Areas Where There are Valuables Covered By Your Cameras or are There High
Theft Areas Where Cameras Could be a Deterrent?
Yes
No
If Your Business (s) Has
Video Cameras:
Do
You Actively Use Them or are They Mostly a Physical Deterrent?
Yes
No
We Actively Use Them
We Seldom Use Them Unless We Suspect Something Specific
We Use Them Less than Once a Month
We Use Them at Least Twice a Month
Back Door Receiving
How Many Times Per Month
do You Find Vendor Errors in the Cost of Goods or Counts?
Fewer Than 2 Times
2-6 Times
7-12 Times
More Than 12 Times
Is Your Receiving Area Accessible to
the Public or Employees?
Yes
No
Communication
Do You Ever Experience Interruption (Day/Evening) in Telephone
Service?
Yes
No
Does Anyone Other than
You or Your Senior Associates have Access to the Phone Lines/Room?
Yes
No
Where is Your Phone System?
Where do the Lines Enter the
Facility?
Maintenance
Do
You Budget Operational Expenses for Repairs of Key Equipment?
Yes
No
Do You Use a Cost Per Square
Foot Model?
Yes
No
Do You Accrue Monies for
Unexpected Repairs?
Yes
No
Is a predictable Standard
Fee in Lieu of Repair Bills of Value to You?
Yes
No
Thank you for taking the time to review your life safety, asset
protection and productivity needs. Please provide us with the following to receive,
at no obligation, the results of the Risk Assessment, along with our recommendations,
from one of our Security Consultants. We at PSI are confident that it is a document
that you will find valuable to have. If you have questions on a specific product or service ,
please complete our
Sales Information Request form.
Company Name:
Phone #
Contact Name:
Address:
Address2:
City:
State
Select State
------
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
Zip
Code
Fax #
E-Mail