Sample Forms
PLEASE NOTE:
These forms can be important tools to help minimize E&O claims, but the use of these forms does not guarantee E&O claims will not be incurred.
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Also, no form can cover every possible exposure and new exposures and coverages frequently arise, so a form should be reviewed and revised periodically.
These forms may assist in improving the quality of an agency's services. However, neither Chris Burand nor Burand & Associates, LLC guarantee that these forms will result in either improved operations or a loss free E&O experience.
Agencies may use the forms below as a basis for developing their own forms.
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Please remember: Every agency is unique. Therefore, these forms must be modified to fit your agency's needs. Where possible, we have identified the form's author, but in some instances, we were not able to determine from where the checklist originated.
Submission/Coverage Checklists
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Checklist (a) (Anonymous)
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Checklist (b) (Anonymous)
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Checklist (c) (Anonymous)
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Checklist 8 (Insurance Institute of America)
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Insured's Data Sheet (Independent Insurance Agents of America)
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Customer Profile Sheet (Independent Insurance Agents of America)
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Commercial Lines Policy Review (Independent Insurance Agents of America)
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Submission Checklist (Anonymous)
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What are your clients' insurance needs? (Burand & Associates, LLC)
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The International Risk Management Institute (an external website) offers an Exposure Survey Questionnaire and IRMI Insurance Checklists. Visit www.irmi.com to learn more.
Carrier Checklists
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Company Insolvency Checklist (Developed by Bill Wilson)
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Company Quality Checklist (Anonymous)
HR Forms
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Partnership Checklist (Burand & Associates, LLC)
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​Don Phin, a top consultant on workplace relations, provides a variety of free materials on his Web site. Visit www.DonPhin.com for a comprehensive list of Free Tools.