FUEL AUDIT LUX FBO

• Station Code

• Conducted on

  Date

• Prepared by

• Location
  Address

• Verify employee identitand if got certification with him

  Pass

  Fail

  N/A

  N/O

• Does the fuel vehicle approach the aircraft in a safe manner ?

  Pass

  Fail

  N/A

  N/O

• Did the fueler make a connection to the aircraft with a bonding cable before<br>connecting the fuel hose?<br>NOTE: When a hydrant servicer or carts is used for fueling, the hydrant coupler<br>shall be connected to the hydrant system prior to bonding the fueling equipment<br>to the aircraft.

  Pass

  Fail

  N/A

  N/O

• Check nozzle pressure while the aircraft is being fueled.<br>Is the pressure below 50-PSI?

  Pass

  Fail

  N/A

  N/O

• If fueling from a hydrant system, does the pit appear to be clean, very little water,<br>no fuel or debris in it? (Ensure dust cover is replaced on pit valve after fueling)

  Pass

  Fail

  N/A

  N/O

• Is there a fire extinguisher in the gate area?<br>a. Verify immediate access to fire extinguisher. (Nothing blocking access)<br>b. Check the fire extinguisher to see that the safety seal is not broken or missing.<br>c. Is there an inspection tag that is intact and current?

  PASS, FAIL, N/A, N/O

  PASS, FAIL, N/A, N/O

  PASS, FAIL, N/A, N/O

• Did the fueler replace the fuel cap on the aircraft (if required) and was fuel panel<br>secured?

  Yes

  No

  N/A

Record the following for use when completing the Fuel Vehicle Review section of this checklist

• Record the tail number of aircraft that fueling was observed on:

• Record the name of the person who was fueling the aircraft

• Record the number that identifies the fuel vehicle:

b. Fuel Servicing Equipment Inspection

• Check the general condition of the fuel vehicle. Is the vehicle clean inside and<br>out, free of dirt, oily rags, paper cups, trash?

  Pass

  Fail

  N/A

  N/O

• Are the static reels, cables and clamps in good condition?

  Pass

  Fail

  N/A

  N/O

• Check to see that there is a functioning deadman control that is used to control<br>the flow of fuel.

  Pass

  Fail

  N/A

  N/O

• Is there an intact calibrator/adjuster cover seal?

  Pass

  Fail

  N/A

  N/O

• Check Fire Extinguishers.<br>a. Is there immediate access to the fire extinguisher? (nothing blocking the<br>way)<br>b. Do fire extinguishers have a safety seal? (Ensure the seal is not broken or<br>missing)<br>c. Does the fire extinguisher have a current inspection tag that is attached?

  PASS, FAIL, N/A, N/O

  PASS, FAIL, N/A, N/O

  PASS, FAIL, N/A, N/O

• Check condition of dust covers.<br> Are they intact and in good condition?

  Pass

  Fail

  N/A

  N/O

• Check condition of hoses.<br>Are they free from abrasions, cuts, blisters, and exposed reinforcement cords<br>cracks, twisted or sharp bends?

  Pass

  Fail

  N/A

  N/O

• Verify the operation of the Safety Interlock System works.<br>Does it operate satisfactorily?

  Pass

  Fail

  N/A

  N/O

• Are there any fuel leaks anywhere on the vehicle?

  Pass

  Fail

  N/A

  N/O

c. Personnel Qualifications Record Review

• Does the fueling vendor have a program in place to periodically verify employee<br>driver’s licenses?<br>Are these checks documented?

  Pass

  Fail

  N/A

  N/O

• Are fuel training designees qualified for all LUX fleets servicing the airport?

  Pass

  Fail

  N/A

  N/O

• Does each employee who fuels LUX Aircraft have a training record(s) on file?

  Pass

  Fail

  N/A

  N/O

• Does the vendor provide the GM a list of qualified fuelers?

  Pass

  Fail

  N/A

  N/O

• Annual Fueler Proficiency Review:<br>Each fueler servicing aircraft shall be given a verifiable (i.e. documented)<br>Proficiency Review annually. Select a representative cross section of personnel<br>from the GM/Contract Agent’s list.<br>Are Proficiency Reviews being performed and documented?

  Yes

  No

  N/A

d. Fueling Equipment Record Review

• When following ATA-103 Guidelines, check for documentation of the following items. Place check mark in all boxes that are documented. Items not found must have an explanation why on a separate sheet:

DAILY

• General conditions

  Yes

  No

  N/A

• Filter sumps, Record ratings

  Yes

  No

  N/A

• Filter DPI pressures

  Yes

  No

  N/A

• Deadman Controls

  Yes

  No

  N/A

• Safety Interlocks

  Yes

  No

  N/A

• Nozzle Fueling Pressure

  Yes

  No

  N/A

• Hoses, Nozzles & Swivels

  Yes

  No

  N/A

• Static reels, cables & clamps

  Yes

  No

  N/A

• Lift Platforms

  Yes

  No

  N/A

• Surge/waste tanks

  Yes

  No

  N/A

• Air Tanks

  Yes

  No

  N/A

• Refueling Truck Troughs

  Yes

  No

  N/A

• Refueling Truck Sumps

  Yes

  No

  N/A

• Refueling Truck Bottom Loading Pre check

  Yes

  No

  N/A

MONTHLY

• Filtrattion and free water test

  Yes

  No

  N/A

• Static System Continuity Test

  Yes

  No

  N/A

• Nozzle Screens

  Yes

  No

  N/A

• Fuel Hoses

  Yes

  No

  N/A

• Sings, Labels and placard

  Yes

  No

  N/A

• Meter seals

  Yes

  No

  N/A

• Fire extinguishers

  Yes

  No

  N/A

• Emergency Shutdown System

  Yes

  No

  N/A

• Lift Platforms

  Yes

  No

  N/A

• Refueling Truck Interiors

  Yes

  No

  N/A

• Refueling Truck Vents & dome covers

  Yes

  No

  N/A

• Refueling Truck Trough Drains

  Yes

  No

  N/A

• Deadman Control System

  Yes

  No

  N/A

QUATERLY

• Vehicle Inspection

  Yes

  No

  N/A

• Pressure Controls

  Yes

  No

  N/A

• Primary Pressure

  Yes

  No

  N/A

• Water defense system-External check

  Yes

  No

  N/A

• Internal Valve check

  Yes

  No

  N/A

Annual

• Filter element change

  Yes

  No

  N/A

• fueling&differential pressure gauge

  Yes

  No

  N/A

• meter calibration

  Yes

  No

  N/A

• Water defense system inspection

  Yes

  No

  N/A

• Does the vendor keep their Quality Control Records up to date and are they<br>completed for all days used?

  Pass

  Fail

  N/A

  N/O

• Does the vendor retain their Quality Control Records for a minimum of one<br>year?<br>Note: If current vendor has not been providing services for the past year, ensure that these<br>records are current from date this vendor began providing service, and historical dates as well as<br>next due dates for filter changes, periodic checks, etc. have been established.

  Pass

  Fail

  N/A

  N/O

• Does the vendor have access to the LUXFueling and Servicing Procedures<br>Manual online?

  Pass

  Fail

  N/A

  N/O

e. Fuel Storage Facility Inspection

• General Appearance of the Yard Area:<br>Is the facility clean, free of weeds, and maintaining good housekeeping?

  Pass

  Fail

  N/A

  N/O

• Are there security gates, access doors? Are there any broken fences, holes<br>under the fences? (All broken fences and gates are to be repaired or replaced)

  Pass

  Fail

  N/A

  N/O

• Are “NO SMOKING”, “FLAMMABLE”, “EMERGENCY SHUT-OFF” and product<br>identification signs prominently displayed on the fuel facility?

  Pass

  Fail

  N/A

  N/O

• Are there any visible fuel leaks from the piping, valves, hoses and/or other fuel<br>handling equipment? (Leaks must be repaired when they are found)

  Pass

  Fail

  N/A

  N/O

• a. Are Fire Extinguishers easy to access? (nothing blocking access)<br>b. Is the safety seal installed – not broken or missing?<br>c. Is the inspection tag intact and current

  PASS, FAIL, N/A, N/O

  PASS, FAIL, N/A, N/O

  PASS, FAIL, N/A, N/O

• Do Storage Tank(s) have the following stencils:<br>1. Tank Number?<br>2. Date cleaned and inspected?<br>3. Type of fuel it contains?<br>4. Sump drain line volume?

  PASS, FAIL, N/A, N/O

  PASS, FAIL, N/A, N/O

  PASS, FAIL, N/A, N/O

• Do Filter Vessel(s) have the following stencils:<br>1. Date filters last changed?<br>2. Manufacture label?<br>3. Filter vessel number?

  PASS, FAIL, N/A, N/O

  PASS, FAIL, N/A, N/O

  PASS, FAIL, N/A, N/O

• Are fuel hoses free from the following: abrasions, cuts, blisters, exposed<br>reinforcement, cracks, twists and sharp bends?

  Pass

  Fail

  N/A

  N/O

• Do all the hoses and nozzles have dust covers on them?

  Pass

  Fail

  N/A

  N/O

• Is there a bonding cable on the fuel loading island? (Not required on a Scully<br>System)

  Pass

  Fail

  N/A

  N/O

• Is there a Deadman control in place and functioning at each Jet fuel loading<br>rack? (Does not apply to stations that only use a Hydrant System)

  Pass

  Fail

  N/A

  N/O

• If there are gauge sticks for the fuel tanks are they stored so they don’t get<br>dirty?

  Pass

  Fail

  N/A

  N/O

• Prior to Fuel delivery, vendor should receive a shipping document from fuel<br>supplier or shipping agent stating the type of Fuel being shipped, where it is<br>being shipped to, the quantity being shipped and API gravity – corrected to<br>60° F.<br>Does the vendor have this document?

  Pass

  Fail

  N/A

  N/O

• Does the vendor keep copies of shipping documents for one year for all<br>shipments received?<br>Note: If current vendor has not been providing services for the past year, ensure that these records<br>are current from date this vendor began providing service

  Pass

  Fail

  N/A

  N/O

F.Storage Facility Record Reviwe

• When following ATA-103 Guidelines, check for documentation of the following items. Place check mark in all boxes that are documented. Items not found must have an explanation why on a separate sheet:

• General condition of tank yard

  Yes

  No

  N/A

• security, Fire & Safety deficiencies

  Yes

  No

  N/A

• Hoses, Nozzles & Swivels

  Yes

  No

  N/A

• Static Reels, Cables & Clamp

  Yes

  No

  N/A

• Fire Extinguishers

  Yes

  No

  N/A

• Filter Differential Pressure

  Yes

  No

  N/A

• Storage Tank and product reclamation sump results

  Yes

  No

  N/A

• Filter Sump results

  Yes

  No

  N/A

Monthly

• Filtration and free water test

  Yes

  No

  N/A

• bonding cable continuity

  Yes

  No

  N/A

• nozzle screens

  Yes

  No

  N/A

• sings, labels and placards

  Yes

  No

  N/A

• floating suction

  Yes

  No

  N/A

• fire extinguishers

  Yes

  No

  N/A

Quaterly

• Emergency Shutoff System

  Yes

  No

  N/A

• Water Defense System

  Yes

  No

  N/A

• Tank High Level Controls

  Yes

  No

  N/A

• Reclaim tank Inspection

  Yes

  No

  N/A

Annual

• Storage tank interiors

  Yes

  No

  N/A

• Differential pressure gauges

  Yes

  No

  N/A

• filter elements

  Yes

  No

  N/A

• filter/separator heaters

  Yes

  No

  N/A

• Tank vent

  Yes

  No

  N/A

• Cathodic Protection

  Yes

  No

  N/A

• Line Strainers

  Yes

  No

  N/A

• Water defense System

  Yes

  No

  N/A

• Does the vendor keep their Quality Control Records up to date and are they<br>completed for all days used?

  Pass

  Fail

  N/A

  N/O

• Does the vendor retain their Quality Control Records for at least a year?<br>Note: If current vendor has not been providing services for the past year, ensure that these records<br>are current from date this vendor began providing service, and historical dates as well as next due<br>dates for filter changes, periodic checks, etc have been established

  Pass

  Fail

  N/A

  N/O

• Does the vendor have access to the LUX Fueling and Servicing Procedures<br>Manual online?

  Pass

  Fail

  N/A

  N/O

• Yes

  No

  N/A

LUX Fuel Self Audit Finding Discrepancy and Response Sheet

• Discrepancy:

• Root Cause Identified As: (Note: Answers to the following questions will help ensure the true root cause of the discrepancy was identified and properly addressed to help prevent a recurrence: (1) Who is responsible for the problem (2) When the problem occurred (3) Where the problem occurred (4) How the problem occurred and (5) Why the problem occurred.

• Short-Term Corrective Action: (Include immediate actions taken to resolve the discrepancy)

• Long-Term Corrective Action: (Include long term corrective actions needed to help prevent a recurrence)