ghana agricultural insurance pool
TRANSCRIPT
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GHANA AGRICULTURAL INSURANCE
POOL
Poultry Proposal Form
1 Insured
1.1 Name, address contact details of the insured?
Company address:
Person:
Legal address:
ZIP Code:
Country / Province:
Telephone
Fax
1.2 Please provide the exact location (or GPS co-ordinates) of the farm(s) and attach a map. (map of the area and a plan of the farm(s))
2 Farm management
2.1 Experience and qualification of owner, management and supervisory personnel
Name Role / title Qualifications Additional
training
No. of years on this farm
2.2 Workforce overview (summary)
Management Supervisory
Security General Worker
TOTAL
No. of people (permanent)
No. of people (temporary)
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3 The farm
3.1 When was the farm constructed/established?
3.2 When has the farm last been surveyed?
(if the farm was surveyed, please provide copy of survey)
3.3 Poultry type and breed?
(chickens, ducks, turkeys; broilers or layers)
3.4 Source of eggs and/or day old chicks?
3.5 Number of houses and respective floor space in m2?
(rearing, laying, broilers; packing houses etc.)
3.6 Number of animals kept per houses?
3.7 Total number of animals kept on farm?
3.8 Stocking densities for the different production types in kg/m2?
(chicken, layers, broilers etc.)
3.9 Age range and maximum age (in weeks) of animals kept?
3.10 Production system?
(caged, barn, free ranging; state equipment manufacturer)
3.11 Are layers kept beyond molting?
3.12 Construction of buildings (houses)?
(describe briefly floor-, wall-, roof-type incl. material used)
3.13 Any bird estuaries or natural reserves located within 20 km of the farm?
3.14 Markets served?
(state companies and countries)
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3.15 Welfare and husbandry-systems
type(s) manufacturer(s) age
Feeding
Drinking
Ventilation
Heating
Nest boxes
Egg collection
Alarm
type(s) & number manufacturer(s) power (HP or kW) age
Emergency power supply system(s) (generators)
NOTE: In the following, several questions will have to be answered with “yes” or “no”. At the end of this section, you will have the opportunity to give details for the questions you have answered with “no”!
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4.1 Biosecurity yes no
1. Do only essential visitors have access to the farm? ☐ ☐
2. Are records kept of arrival/departure/purpose of visit of all visitors? ☐ ☐
3. Does the management deny visitor entry should the health of the birds be affected? ☐ ☐
4. Is the poultry farm fully enclosed and fully fenced? ☐ ☐
5. Is the poultry farm manned during 24 hours/7days? ☐ ☐
6. Are individual buildings/houses looked when there is no personnel inside? ☐ ☐
7. Are foot dips/barrier systems provided at the entrance to the buildings? ☐ ☐
8. Are disinfectants approved, periodically replaced and is this recorded? ☐ ☐
9. Are hand washing and toilet facilities available on the farm? ☐ ☐
10. Is hand washing enforced at entry/exit to poultry after handling birds? ☐ ☐
11. Is separate clothing provided to the staff and washed/discarded between flocks? ☐ ☐
12. Do all houses operate on a “all in all out” basis? ☐ ☐
13. Are vehicle’s wheels washed and disinfected when entering the farm? ☐ ☐
14. Is poultry the only livestock species that enters any buildings of the farm? ☐ ☐
15. Are rodents, flies and parasites controlled adequately? ☐ ☐
16 Are wild birds prevented to enter any of the buildings/houses where poultry is kept? ☐ ☐
17 Are, at certain seasons, migratory birds observed within farm limits? ☐ ☐
18. Is pest control carried out by a licensed contractor and/or trained personnel? ☐ ☐
19. Are pest control measured recorded? ☐ ☐
20. Is smoking restricted to designated areas, away from birds, and enforced? ☐ ☐
4.2 Health and hygiene yes no
1. Do the birds have a health certificate when entering the farm? ☐ ☐
2. Has the farm the services of a veterinary surgeon trained in poultry husbandry? ☐ ☐
3. Are sick, injured, or dead birds removed daily? ☐ ☐
4. Is the daily mortality recorded? ☐ ☐
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5. Is the use and application of medicines and vaccines recorded? ☐ ☐
6. Are medicines and vaccines stored in a secure/locked store and according to label recommendations?
☐ ☐
7. Does only trained staff have access and administers medical products? ☐ ☐
8. Are copies of the vaccination requirements and sanitary legislation(s) of the respective country attached?
☐ ☐
9. Is a full vaccination plan/schedule of the farm attached? ☐ ☐
10. Are houses left empty for at least two weeks between two flocks? ☐ ☐
4.3 Salmonella testing yes no
1. Are all chicken flocks sampled, tested and monitored for Salmonella at the appropriate stages?
☐ ☐
2. Are tests carried out in authorized and accredited laboratories? ☐ ☐
3. Are results of Salmonella and/or pathogen tests retained and available? ☐ ☐
4. Is there a written cleaning and disinfection procedure to eliminate pathogens? ☐ ☐
5. Is the feed tested for Salmonella at the mill? ☐ ☐
6. Any Salmonella occurrences on the farm during the last 3 years? ☐ ☐
4.4 Lighting, temperature, ventilation and air quality yes no
1. Is there a lighting program, suitable for the poultry kept, produced and implemented? ☐ ☐
2. Are lighting patterns recorded? ☐ ☐
3. Do all houses have a controlled environment ? ☐ ☐
4. Are air quality parameters continuously measured (Ammonia, CO2, humidity)? ☐ ☐
5. Is a documented ventilation plan (air quality, flow speed, temperature) implemented? ☐ ☐
6. Are ventilation rates variable to allow for environmental changes? ☐ ☐
7. Are heaters and additional circulation fans available in times of low or high temperatures to ensure that ventilation is not compromised?
☐ ☐
8. Are max. and min. temperatures of each house measured and recorded daily? ☐ ☐
9. Is the heating system sufficient to stop chicks huddling? ☐ ☐
4.5 Water and feed yes no
1. State source of water: -- --
2. Is the water source mentioned under 1) analyzed regularly and results recorded? ☐ ☐
3. Is there sufficient water stored to supply birds for at least 24 h in an emergency? ☐ ☐
4. Can all birds reach water without traveling more than 3 m and feed within 4 m? ☐ ☐
5. Are drinker and feeder heights checked daily? ☐ ☐
6. Do all houses have water meters connected and measure consumption daily? ☐ ☐
7. Are feeders and drinkers evenly distributed within the houses and not contaminated? ☐ ☐
8. Are feed delivery systems checked on a daily basis? ☐ ☐
9. Are feed bins numbered and identifiable? ☐ ☐
10. Are records kept covering type, levels and withdrawal dates of medicated feeds or coccidiostata.
☐ ☐
11. Are feed samples kept for 3 months and delivery records kept for one year? ☐ ☐
4.6 Cleaning and chemicals yes no
1. Is there an implemented program for the cleaning and disinfection of houses and equipment of the farm?
☐ ☐
2. Are all houses and equipment thoroughly cleaned and disinfected (fumigated if necessary) after use resp. between flocks?
☐ ☐
3. Are cleaning procedures recorded and kept on the farm? ☐ ☐
4. Is potable water used for all cleaning procedures and pressure washers? ☐ ☐
5. Are storage tanks and drinker line physically cleaned and sanitized with food grade sanitizer where water is for consumption by animals or man?
☐ ☐
6. Are all chemicals and sanitizers licensed and approved for the intended use? ☐ ☐
7. Are all chemicals locked/stored separately together with their technical data sheets? ☐ ☐
8. Is all use of chemicals recorded and are records kept? ☐ ☐
4.7 Bird handling and inspection yes no
1. Are all birds checked at least twice/day and three times/day in periods under stress? ☐ ☐
2. Are inspection records kept and retained on the farm? ☐ ☐
3. When problems are identified, are they rectified and recorded? ☐ ☐
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4.8 Plans and safety procedures yes no
1. Are the following plans and policies available on request and implemented on the farm: ☐ ☐
- a veterinary flock health plan, updated and agreed annually upon with veterinary surgeon of the farm?
☐ ☐
- a pest control plan? ☐ ☐
- a detailed site plan showing houses, access points, telephone points, water sources and pest control bait points?
☐ ☐
- an emergency action plan covering procedures in case of fire, power failure, equipment failure and heat/cold stress situations?
☐ ☐
2. Is the farm manned 24 h / 7 days a week? ☐ ☐
3. Are electric installations checked by a qualified electrician, at least quarterly? ☐ ☐
4. Is there a service contract with your electrician? ☐ ☐
5. Are electrical switchgear/controls housed in a service area? ☐ ☐
6. Are service areas entirely lined with non-combustible materials? ☐ ☐
7. Are heaters suspended on metal safety chains? ☐ ☐
8. Is the fuel storage tank more than 25 meters away from the houses? ☐ ☐
9. Are all exit doors fitted with aluminium standard dead lock and minimum standard of 3 lever mortise?
☐ ☐
4.9 Emergency equipment
yes no
1. Are all automatic environment control systems monitored by an audible/visual alarm signaling mains failure, min. and max. temperatures and humidity?
☐ ☐
2. Can the audible/visual alarm be heard and seen outside the buildings? ☐ ☐
3. Has it a link to any other supervisory person via pager or telephone? ☐ ☐
4. Is there a service contract for the alarm system? ☐ ☐
5. Are all feeder, drinker, ventilation, heating and lighting systems installed by competent persons?
☐ ☐
6. Are all feeder, drinker, ventilation, heating and lighting systems maintained by competent persons?
☐ ☐
7. Are all fire extinguishers, alarm systems, and other automated/mechanical equipment installed by competent persons?
☐ ☐
8. Are all fire extinguishers, alarm systems, and other automated/mechanical equipment maintained by competent persons?
☐ ☐
9. Is all automatic equipment inspected daily and if necessary repaired? ☐ ☐
10. Is (are) there a stand-by generator(s) on the farm? ☐ ☐
11. Is (are) the stand-by generator(s) automatic “cut-in” and “cut out”? ☐ ☐
12. Is (are) the stand-by generator(s) tested weekly and under full load and are records kept?
☐ ☐
13. Is (are) the stand-by generator(s) subject to a service contract? ☐ ☐
4.10 Bird removal and waste disposal? yes no
1. Are vehicles and crates cleaned and disinfected and in good condition prior to bird transport?
☐ ☐
2. Is there a level, well drained loading area for the loading / unloading of birds? ☐ ☐
3. After depopulation is each house thoroughly cleaned and disinfected before another flock is placed?
☐ ☐
4. Is all packaging and waste stored in sealed containers and removed from the site regularly?
☐ ☐
5. Do carcasses, not disposed of on site, get stored in vermin proofed containers and removed weekly?
☐ ☐
6. What is the normal time, houses are kept empty after the animals/the flock terminated their cycle until
new animals are put in?
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4.11 Details to questions answered with “no”:
No. of paragraph
No. of question
your answers/explanations
(please copy sheet should you require more space)
5 Insurance
5.1 Name and address of direct insurance company?
5.2 Name and address of broker (if)?
5.3 Required insurance period?
5.4 Total sum insured and its method of valuation? (supply valuation scale per age and per type of poultry -> chicks, egg layers)
5.5 List perils you wish to have covered.
- - - - - -
5.6 Have the animals been insured in the past? By whom and for how long?
5.7 Attach the loss history for the last 10 years indicating causes & the value of losses and (if) describe improvements made.
year causes Value of loss
Improvements made
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6 Declaration
The above named/listed animals are owned by me and, to the best of my knowledge and belief, the information provided in connection with this proposal, whether in my hand or not, is true and I have not withheld any material facts. I understand that non-disclosure or misrepresentation of a material fact will entitle underwriters to void the insurance. I understand that that the signing of this proposal does not bind me to complete the insurance but agree that, should a contact of insurance be concluded, this proposal and the statements made therein will form the basis of the contract. Declaration of health: I hereby declare that all animals which have been kept at the location(s) proposed for insurance over the last 12 months were in sound health and have not suffered from any accident, sickness or disease unless otherwise stated. Date & Place: _________________________ ____________________________________ (Signature of Proposer(s)) List of required attachments (tick respective box):
- detailed map of area ☐
- detailed plan of farm ☐
- copy of farms survey ☐
- national vaccination requirements for poultry ☐
- national sanitary legislation for poultry ☐
- valuation scale per age and per type of poultry ☐
- loss history for the last 10 years ☐
- pictures of the farm ☐