SWIMMING POOL QUESTIONNAIRE
Date (MM/DD/YY):
Insured Name: Agency Name:
Policy #: Agency #:
If applicable, location where swimming pool resides?
Dimensions of swimming pool:
Length:________________________
Width:_________________________
Maximum Depth: ________________
Minimum Depth:_________________
Type of liner:
Concrete □ Vinyl □ Other □
Are there any diving boards?
Yes □ No □
Construction of diving board:
Board height from water:
Are there any slides?
Yes □ No □
Is there life safety equipment?
Yes □ No □
Is the area around the pool fenced?
Yes □ No □
Fence type:
Fence Height:
Are unsupervised children allowed access or use of the pool?
Yes □ No □
Are guests allowed access or use the pool?
Yes □ No □
Number in the household under 18 years of age?
Distance to neighbor #1:
Number of children under 18:
Distance to neighbor #2:
Number of children under 18:
Comments:
Note: Photos are required of swimming pool
AQ 85 26 01 07
