Cannabis Operations (Not Finished) - Drag N' Drop FormBuilder

Cannabis Operations (Not Finished)

Type of operation? (Please check all that apply): *
- Distributor
- Extraction
- Greenhouse grower
- Guided marijuana tours
- Indoor grower
- Lab/Testing
- Manufacturer
- Medical Dispensary
- Other (Please describe)
- Outdoor grower (No structure)
- Processor (Bud and more)
- Processor (Usable bud only)
- Recreational
- Retailer/Dispensary

Describe other type of operation: *

Any in-home cannabis operations? (Check all that apply): *
- Cultivation
- Dispensing
- None
- Other (Please describe)
- Processing

Describe other in-home operation: *

All required state and local license and permits maintained? *
- Yes
- No

How is insured licensed? (City permit # and/or state license #): *

Ever been denied or suspended licensing? *
- Yes
- No

Explain denial/suspension of license: *

In compliance with all local and state laws, regarding the cultivation, manufacturing, dispensary &/or control of marijuana or marijuana-containing products? *
- Yes
- No

Explain non-compliance: *

Is a member of any cannabis/marijuana trade associations? *
- Yes
- No

Describe members: *

Years of experience in the med/rec marijuana industry? *

Does insured own any other business? *
- Yes
- No

Is the location fully owned and operating? *
- Yes
- No

Year the business started? *

Hours of operation? *

Date of location opening and fully operational? *
- Month
- Day
- Year

Type of neighborhood? *
- Industrial
- Residential
- Rural

Is it a drug-free workplace? *
- Yes
- No

Number of employees at this location? *

Background check for employees? *
- Yes
- No

Does the business operate in shifts? *
- Yes
- No

Describe shifts (How many, night shifts, what kinds of job duties are performed at night?): *

Are volunteers or non-paid workers used? *
- Yes
- No

Are temporary staffing workers or leased employees used? *
- Yes
- No

Is insured a farm labor contractor providing employees to cannabis operations other than cultivation? *
- Yes
- No

Any claims or losses within the past 3 years? *
- Yes
- No

Description of losses and claims within the past 3 years: *

Building/Protection

Building square feet occupied by the insured: *

% of building occupied by the insured? *

Type of building construction: *
- Masonry/Non-combustible
- Joisted Masonry
- Frame

Year built: *

Is part of the building residential? *
- Yes
- No

Any known building updates? *
- Wiring
- Heating/HVAC
- Plumbing
- Roof
- None

Is the building sprinkled? *
- Yes
- No

Sprinkler coverage: *
- Full
- Partial

Does the building have an active Central Station Fire Alarm? *
- Yes
- No

Central Station Burglar Alarm? *
- Yes
- No

24/7 interior and exterior video surveillance (14 days of recording)? *
- Yes
- No

Motion detectors? *
- Yes
- No

All entryways, doors and windows are locked, secured and protected by alarm during non-business hours? *
- Yes
- No

Buzz-in system at entryway? *
- Yes
- No

Hold-up button/Panic button? *
- Yes
- No

Security guards on site? *
- Yes
- No

Are they contracted? *
- Yes
- No

Any armed guards? *
- Yes
- No

Are they bonded? *
- Yes
- No

Retail/Dispensary

EDIBLE - sell/dispense infused medical marijuana edible products containing THC or other active cannabinoids (CBD)? (e.g. Baked goods, candies, other food or drink items, tinctured, capsules, etc.)... *
- Yes
- No

If yes, fully describe: *

TOPICAL - sell/dispense topical medical marijuana products containing THC or other active cannabinoids? (e.g. Oils, creams lotions, etc.): *
- Yes
- No

If yes, fully describe: *

VAPORIZERS - sell/dispense medical marijuana oil cartridges or medical marijuana concentrates intended to be used with vaporizers or vapor pens: *
- Yes
- No

If yes, fully describe: *

FDA Violation - sell/distribute or otherwise market cannabis-related products that are in violation of FDA regulations prohibiting the marketing of CBA products claiming to prevent, diagnose, treat... *
- Yes
- No

If yes, fully describe: *

SIGNAGE - if operation is as a retail store or dispensary offering cannabis-related products, is there signage advertising the same? (If yes, provide a photo.): *
- Yes
- No

ANIMAL FOOD - Any sales of animal food or feed to which THC or CBD has been added? *
- Yes
- No

If yes, fully describe: *

DIETARY - Are any THC and CBD marketed, sold and/or distributed as DIETARY supplements? *
- Yes
- No

MMIC - Are MEDICINAL products only sold to patients having a current, qualified physician's script or valid medical marijuana identification card (MMIC)? *
- Yes
- No

MINORS - Is access for minors controlled? *
- Yes
- No

If yes, fully describe: *

Room/Lounge - Are smoking/vape rooms offered? *
- Yes
- No

Does all advertising of cannabis-related products contain the required consumption warning? *
- Yes
- No

Are consumers of the insured's products made aware that edible cannabis can take significantly longer to affect them than other methods of consumption? *
- Yes
- No

Are warnings included stating the potential adverse health effects associated with use of cannabis products containing THC by pregnant or lactating women? *
- Yes
- No

Approximate annual receipts (In dollars): *

Medical marijuana sales/Total receipts %: *

Recreational marijuana/Total receipts %: *

Average amount of cash on premise at any given time (In dollars): *

Maximum amount of cash on premise at any given time (In dollars): *

Displayed inventory is stored in shatter-proof glass display cases during business hours? *
- Yes
- No

What percentage of your stock is kept out of the safe/vault and on display during business hours? *

Is the grow facility located in the same building as a dispensary? *
- Yes
- No

Describe grow facility location: *

Delivery/Distribution (Testing labs, Warehouse)

Is delivery service offered? *
- Yes
- No

Delivery Details

Is delivery done by employees or is this contracted? *
- Employees
- Contracted

Typically, how many deliveries per week? *

Average trip distance of delivery (In miles): *

Does insured own or lease vehicles? *
- Own
- Rent
- Lease
- Borrow
- Other

Describe other: *

Is there a warehouse for storage of products? *
- Yes
- No

Describe warehouse location: *

Guided Tour

If offering guided marijuana tours, describe the tours including number, type of vehicles and how many passengers: *

Are there separate A/C and air filtration systems for the driver and passenger cabins and with no air flow between the cabins? *
- Yes
- No

Is there parition/eisen-type glass (Strata glass) between the driver and passenger cabins? *
- Yes
- No

If any delivery of cannabis and/or guided marijuana tours, are drivers checked for not being impaired (Under the influence)? *
- Yes
- No

How is smoke prevented from leaking through to the driver? *

Cultivation

Growing hazards include: Egress(maze like grow areas), Lighting (UV and FL ), Plastic dividers/combustible interior finishes, High Electrical Loads, High humidity, Illegal locks/barriers, Carbon monoxide, Carbon dioxide (CO2) enrichment, Fumigation (Pesticides, fungicides).

Does insured use a separate entity to transport the plants? *
- Yes
- No

Describe transportation methods: *

Does insured process the plants to finished products? *
- Yes
- No

Type of lighting: *
- Fluorescent Grow Light
- High Intensity Discharge Grow Light (HID)
- LED Grow Light

Are any metal halide bulbs used in HPS ballast? *
- Yes
- No

Any use of metal halide and HPS bulbs interchangeably in light fixtures? *
- Yes
- No

Processing/Extraction

How are the buds trimmed? *
- Dry
- Wet
- Machine
- Hand

What is the extraction solvent used? *
- Acetone
- Alcohol (Ethanol)
- Butane
- C02
- Hexane
- Isopropyl Alcohol
- Methanol
- Other
- Propane
- Toulene
- Water

Describe other extraction solvent: *

Extraction system used: *
- Open-ended
- Closed loop

Do you have the material safety data sheets (MSDS) for the chemicals used? *
- Yes
- No

For other than approved, unattended processes, is the extraction process continually staffed? *
- Yes
- No

Is all monitoring of the extraction process by staff who are adequately trained in the extraction process and all emergency procedures? *
- Yes
- No

All extraction work carried out in a C1D1 room, if using volatile solvents? *
- Yes
- No

Is the extraction room free of not-in-use LPG containers? *
- Yes
- No

Are all flammables are stored in a UL listed cabinets? *
- Yes
- No

Fume hood present? *
- Yes
- No

Automatic exhaust ventilation system present? *
- Yes
- No

Explosion proof electrical equipment used? *
- Yes
- No

Automatic gas detection system in place? *
- Yes
- No

What type(s) of equipment are used for post-processing and winterization (i.e. the removal of fats) involving the heating or processing of the raw extract? *

Is all equipment used for the extraction of oils from plant material listed and approved for the specific use? *
- Yes
- No

List of manufacturers and models of extraction equipment: *

Are all utensils used in the extraction process non-sparking? *
- Yes
- No

Is testing performed on site? *
- Yes
- No

Describe the testing process (Specifically list any chemicals or solvents that may be used): *

Special Hazards and Controls

What is the quality of the Eisen glass? *

What is the strength of the Eisen glass? *

Do the cooling and heating power of the temperature control units (TCUs) meet the capacity requirements for the size of the application? *
- Yes
- No

Opinion

Opinion of risk: *