Title Page
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Conducted on
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Prepared by
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Site Name
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Site Manager Name
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Site Manager Contact Number
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Site Manager Signature
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Location
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Upload the complete picture of site
HSE
Forecourt
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Security & Safety signage is present & visible for customers (stickers)
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Pictures of Safety signages
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Fire extinguishers placed near dispenser
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Picture of Fire extinguishers near dispenser
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There are no electrical connection near dispenser & fueling area
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Picture of electrical connection near dispenser & fueling area
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Staff prompt customers to turn engine off before fueling?
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There is no visible leakage of fuels from dispensers
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There is no any issue in canopy water leakage?
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There is no any any unsafe hanging items from the canopy?
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Complete forecourt picture
Emergency Response
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Is the Safety Organization chart available and displayed visibly?
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Picture of safety organization chart
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Does the staff know their responsibilities for the day?
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ESD Button Working (One or two buttons to cut Electrical Supply of entire site)?
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Does the staff know designated Assembly Point?
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Does the Site staff conduct ERP drill? Check written record
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Emergency Contact Numbers Displayed & Visible?
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Picture of Emergency contact numbers
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Are there sufficient number of FE present on site? (2 per tank, 1 per dispenser, 1 per DB (CO2), 1 per Generator, 1 per each NFR)
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Picture of FEs
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Are all FE Valid? (not expired)
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Picture of expired FEs
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Are FE accessible that is not on high or rusted hooks?
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Is the First Kit Aid available and accessible i.e. it is not in a locked space; not fixed to the wall.
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Picture of First aid kit
Decantation
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No Electrical Connection within 10ft of Decantation Area?
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Dip Caps are available for all tanks? Mark "No" even if one dip cap is missing.
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Dip Caps are secured and fit completely? Mark "No" even if one dip cap is loose.
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Picture of Dip caps
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Is Earthing Point Present and tested? Check testing tag.
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Is Earthing Point Clean & not painted on?
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Picture of earthing point
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Decantation Area Clean?
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Decantation Area Tanks Labelled with Fuel Grade & Capacity?
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Spill Containment Area Present at decantation point?
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Picture of decantation area
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All necessary signage in place? ( Precautionary Measures, No Smoking, Switch off Mobile)
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Earth Bonding Cable Available on site?
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Is 50 kg foam trolley available near decantation area?
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Is 50 kg trolley is Valid not Expired
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Sufficient and valid fire extinguishers/sand buckets present on the site?
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Picture of FEs and sand buckets
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Staff is wearing all PPE?
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Decantation Area is safe ( no naked wiring, electric connect nearby)
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Area around the decantation point is well-lit.
Electric Safety
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There is no naked wiring on the entire site? Check DB room, decantation area, NFR facilities
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There is no flammable substances near an electrical connection for example spilled oil or clothes/mattresses in DB room
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Rubber Pad Placed in DB Room?
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Picture of DB room
Cash Safety
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What kind of Safe does the site have?
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Is the cash room locked while counting?
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Does the cashier adhere to 25K cash limit? Check on-ground with the cashier.
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Follow the bank deposit SOPs?
Site Security
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Are CCTV cameras available and functional?
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At least 7 days backup available?
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Picture of CCTV camera with 7 days backup
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Do the CCTV cameras sufficiently cover the site particularly the decantation and fuelling area? Mention in notes areas not covered.
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Security guard deployed on site ?
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How many guards are deployed
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Picture of guard
Tuck Shop
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Tuck shop available at site?
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Was the Shop premises free from any observable naked wiring?
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Fire extinguishers available in Shop?
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Fire extinguisher is valid?
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Does the Shop store not have any stacking above 6 ft?
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Picture of Tuck shop
Site Manager/Staff Feedback
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Feedback by staff
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Observations by trainer