Residential Fuel Oil Tank Questionnaire

/
Broker: / Policy No.:
Insured: / Phone No.:
Street Address: / City: / Province: / Postal Code:

PLEASE ATTACH 4 PHOTOS:

1.Front of Oil Tank 2.Side of Tank3.Oil Tank Valve Connector4.Certification Label

Page 1 of 2

7672 (06/13)

Tank (One questionnaire must be completed for each tank on the premises)

Page 1 of 2

7672 (06/13)

  1. What is the construction type of your home?
/ Detached Semi Detached Townhouse
Row HouseDuplexTriplex
  1. How many tanks are on the premises?

  1. How many of those are not in use or abandoned?

  1. Professionally installed?
/ YesNo
  1. Is your heating system on an annual service contract?
/ YesNo
  1. Tank Manufacturer?
/ RothGranby
Vilco ZCL Other:
  1. What type of tank do you have?
/ Steel Fibreglass
Steel with Interior Liner (Double Wall)
Reconditioned Other:
  1. What year was the tank manufactured?

  1. Where is the tank located?
/ Outside InsideUnderground
  1. Is the oil tank located adjacent to a water well or body of water?
/ YesNo
  1. What is the thickness of the tank (only applies to steel tanks)?
/ 10 Gauge (3.5 mm)12 Gauge (2.5 mm)
14 Gauge (2.0 mm) Other – specify:
  1. Does your tank have a certification label showing ULC on it?
/ YesNo
  1. Type of Spill Protections?
/ Concrete DamLeak Detection Alarm
Tank Tub Other Containment Device
No Spill Containment
  1. Is the tank supported in a stable manner?
/ YesNo
  1. Is the tank 4 inches above the ground and clear of debris and growth?
/ Yes No
  1. Is the tank at least 2 inches from any wall or contents allowing for airflow?
/ Yes No
  1. Any discolouration (weeping) along the bottom of the tank?
/ Yes No
  1. Any rust, corrosion, dents on the tank?
/ Yes No
  1. Sign of leaks or oil spills, current or past?
/ Yes No
  1. Has the tank been painted (for corrosion protection)?
/ Yes No
Fuel Line – Outdoor Tank
  1. Is the tank safe from physical impact or damage such as foot traffic, vehicle impact, falling ice or snow from the roof in the winter?
/ Yes No
  1. Location of the fuel filter:
/ InsideOutside
  1. Is there a loop in the fuel line at the tank connection?
/ Yes No
Fuel Line – Indoor Tank
  1. Is the fuel line buried in concrete or run underground?
/ Yes No
  1. Is the fuel line protected from physical damage such as foot traffic?
/ Yes No
Fill & Vent Pipes
  1. Is the fill pipe made of steel?
/ Yes No
  1. Does the vent pipe terminate at least 6 inches higher than the fill pipe?
/ Yes No

Page 1 of 2

7672 (06/13)

If you are unable to complete this questionnaire for any reason or wish to provide additional information, please do so here:

Spills from domestic fuel oil tanks are highly toxic and dangerous to the environment.
Together we can do our part for the environment and minimize the likelihood of an oil spill.
We remind you that your oil tank should be accessible at all times for inspections, for proper air circulation
and leak detection.

Page 1 of 2

7672 (06/13)