Oil Tank Questionnaire Insured’s Name: Risk Address:
Policy Number:
1.
Age of Oil Tank:
2.
Location of tank:
3.
Tank type:
year(s) Inside
Make/Model:
Outside
Serial No:
Underground
14 gauge (2 mm) end/top outlet 14 gauge (2 mm) bottom outlet
Please note: we are not a market for underground tanks.
12 gauge (2.5 mm) end/top outlet 12 gauge (2.5 mm) bottom outlet
Other 4.
Is the tank double walled, double bottomed or does it include a secondary containment tank?
5.
Does the tank have a construction/approval label?
6.
Was the tank professionally installed?
7.
Is the tank inspected/serviced annually by a certified or licensed contractor?
Yes
CSA No
ULC
Yes
No
Not Approved
By whom? Yes
No
Name of contractor: 8.
Are there any signs of rust, dents or corrosion?
Yes
No
9.
Are there any signs of leakage, stains, sweating or spills?
Yes
No
10.
Are there any noticeable fumes or odours?
Yes
No
11.
Is the tank located on a non-combustible pad? Is the tank fastened with a bracket for stability? Is the tank level, plumb or properly sloped? Is the vent stack located higher than fill pipe by a minimum of 6 inches? If inside, is the tank filled and vented outside? If inside, is the tank located at least 5 feet from an ignition source?
Yes Yes Yes Yes Yes Yes
No No No No No No
12.
Is there a clear air space around the tank of at least 24 inches?
Yes
No
13.
Is the tank protected from physical damage (e.g. vehicle impact)?
Yes
No
14.
Is there a loop in the fuel supply line? Is the fuel supply line installed under the foundation? Is the fuel supply line protected from physical damage (e.g. falling ice)? If yes, how?
Yes Yes Yes
No No No
14.
Is a clear, current photo of the oil tank attached?
Yes
No
15.
Has there been any previous oil spillages involving your property or neighbouring properties that you are aware of? If yes, when?
Yes
No
16.
Are there any underground tanks not in use on your property?
Yes
No
Insured(s) Signature:
Date (MM/DD/YY):
Note: If there is more than one tank on the premises, a separate Oil Tank Questionnaire must be completed. We are not a market for any tank that is not labelled and professionally installed.
7572 (08/2017)
The Dominion of Canada General Insurance Company, St. Paul Fire and Marine Insurance Company (Canada Branch), and Travelers Insurance Company of Canada are the Canadian licensed insurers known as Travelers Canada