Title Page

  • Conducted on

  • Prepared by

  • Site Name

  • Site Manager Name

  • Site Manager Contact Number

  • Site Manager Signature

  • Location
  • Upload the complete picture of site

HSE

Forecourt

  • Security & Safety signage is present & visible for customers (stickers)

  • Pictures of Safety signages

  • Fire extinguishers placed near dispenser

  • Picture of Fire extinguishers near dispenser

  • There are no electrical connection near dispenser & fueling area

  • Picture of electrical connection near dispenser & fueling area

  • Staff prompt customers to turn engine off before fueling?

  • There is no visible leakage of fuels from dispensers

  • There is no any issue in canopy water leakage?

  • There is no any any unsafe hanging items from the canopy?

  • Complete forecourt picture

Emergency Response

  • Is the Safety Organization chart available and displayed visibly?

  • Picture of safety organization chart

  • Does the staff know their responsibilities for the day?

  • ESD Button Working (One or two buttons to cut Electrical Supply of entire site)?

  • Does the staff know designated Assembly Point?

  • Does the Site staff conduct ERP drill? Check written record

  • Emergency Contact Numbers Displayed & Visible?

  • Picture of Emergency contact numbers

  • 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)

  • Picture of FEs

  • Are all FE Valid? (not expired)

  • Picture of expired FEs

  • Are FE accessible that is not on high or rusted hooks?

  • Is the First Kit Aid available and accessible i.e. it is not in a locked space; not fixed to the wall.

  • Picture of First aid kit

Decantation

  • No Electrical Connection within 10ft of Decantation Area?

  • Dip Caps are available for all tanks? Mark "No" even if one dip cap is missing.

  • Dip Caps are secured and fit completely? Mark "No" even if one dip cap is loose.

  • Picture of Dip caps

  • Is Earthing Point Present and tested? Check testing tag.

  • Is Earthing Point Clean & not painted on?

  • Picture of earthing point

  • Decantation Area Clean?

  • Decantation Area Tanks Labelled with Fuel Grade & Capacity?

  • Spill Containment Area Present at decantation point?

  • Picture of decantation area

  • All necessary signage in place? ( Precautionary Measures, No Smoking, Switch off Mobile)

  • Earth Bonding Cable Available on site?

  • Is 50 kg foam trolley available near decantation area?

  • Is 50 kg trolley is Valid not Expired

  • Sufficient and valid fire extinguishers/sand buckets present on the site?

  • Picture of FEs and sand buckets

  • Staff is wearing all PPE?

  • Decantation Area is safe ( no naked wiring, electric connect nearby)

  • Area around the decantation point is well-lit.

Electric Safety

  • There is no naked wiring on the entire site? Check DB room, decantation area, NFR facilities

  • There is no flammable substances near an electrical connection for example spilled oil or clothes/mattresses in DB room

  • Rubber Pad Placed in DB Room?

  • Picture of DB room

Cash Safety

  • What kind of Safe does the site have?

  • Is the cash room locked while counting?

  • Does the cashier adhere to 25K cash limit? Check on-ground with the cashier.

  • Follow the bank deposit SOPs?

Site Security

  • Are CCTV cameras available and functional?

  • At least 7 days backup available?

  • Picture of CCTV camera with 7 days backup

  • Do the CCTV cameras sufficiently cover the site particularly the decantation and fuelling area? Mention in notes areas not covered.

  • Security guard deployed on site ?

  • How many guards are deployed

  • Picture of guard

Tuck Shop

  • Tuck shop available at site?

  • Was the Shop premises free from any observable naked wiring?

  • Fire extinguishers available in Shop?

  • Fire extinguisher is valid?

  • Does the Shop store not have any stacking above 6 ft?

  • Picture of Tuck shop

Site Manager/Staff Feedback

  • Feedback by staff

  • Observations by trainer

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.