Title Page

  • Conducted on

  • Prepared by

  • RD Number

  • 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

  • Complete forecourt picture

Emergency Response

  • Is the Emergency Response Plan available and displayed visibly?

  • Picture of Emergency Response Plan

  • Does the staff know their responsibilities for the day?

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

  • Emergency Contact Numbers Displayed & Visible?

  • Picture of Emergency contact numbers

  • Is the First Kit Aid available and accessible

  • Picture of First aid kit

Decantation

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

  • Picture of Dip caps

  • Is Earthing Point Present?

  • Is Earthing Point Clean & not painted on?

  • Picture of earthing point

  • Decantation Area Clean?

  • Decantation Area Tanks Labelled with Fuel Grade & Capacity?

  • Picture of decantation area

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

  • Earth Bonding Cable Available on site?

  • Sufficient and valid fire extinguishers/sand buckets present in Decantation area?

  • Picture of FEs and sand buckets

  • PPEs available at site?

  • Staff is wearing all PPEs

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

Electric Safety

  • 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?

  • Fire Extinguisher (CO2) available in DB Room?

  • Picture of DB room

Cash Safety

  • Is the cash room locked while counting?

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

Site Security

  • Are CCTV cameras available and functional?

  • At least 30 days backup available?

  • Picture of CCTV camera with backup

  • All Cameras are working?

  • Security guard deployed on site ?

  • How many guards are deployed

Tuck Shop

  • Tuck shop available at site?

  • Fire extinguishers available in Shop?

  • Fire extinguisher is valid?

  • Picture of Tuck shop

Car Wash

  • Car Wash available at site?

  • Bollard Present in Car Wash?

  • Picture of Car Wash

Oil Change

  • Oil Change available at Site?

  • Fire Extinguisher available in Oil Change

  • Fire extinguisher is valid?

  • Picture of Oil Change

Tyre Shop

  • Tyre shop available at site?

  • Fire Extinguisher available in tyre shop

  • Fire extinguisher is valid?

  • Is the water for tyres being changed regularly?

  • Picture of Tyre shop

Customer Experience

Entrance & Exit

  • Entrance & Exit Area is clean - free of litter & spills?

  • Picture of Entrance-Exit and Surrounding Areas

  • Landscaping area/green belt is clean, green and well maintained?

  • Picture of Landscape area

  • Pylon is clean

  • Pylon is functional

  • Picture of Pylon

  • Site is looking clean and bright?

  • All canopy branding is working & functional (Fascia and bar)?

  • Picture of canopy branding

Forecourt

  • Forecourt is generally clean & free of litter, spills or water collection?

  • Forecourt Picture

  • All lights work & are switched on when dark? (ask staff or check CCTV footage of night)

  • Under Canopy Area is Clean and undamaged?

  • Picture of under canopy area

  • All Fuel Dispensers are clean?

  • All Fuel Dispensers are functional?

  • Pictures of all dispensers

  • Nozzle jackets are in good condition & clean?

  • Pictures of Nozzle jackets

  • All forecourt staff are wearing complete uniforms?

  • All forecourt staff are wearing the shoes?

  • Picture of staff

  • Staff greet the customer? Show zero and final meter?

  • Wiper bucket & Wiper is available on site?

  • Picture of Wiper bucket

  • Is there enough staff working on the site?

NFR

  • NFR Available at stie?

  • Name of the available NFRs

  • NFR area is clean

  • NFR Staff are wearing the complete uniform?

  • NFR staff are wearing shoes?

  • NFR Staff Picture

Toilets

  • Customer Toilets present on site?

  • Toilets Area is clean & tidy?

  • Toilets are clean from the inside?

  • Toilets are stocked with soap & tissues/towel.

  • All equipment inside toilets are functional (no water leaking & toilet is usable)?

  • Toilet Pictures (inside and outside)

Documentation

  • Green Book Available at site? (Daily/Weekly Checklist & Wet Stock)

  • Is it in use?

Site Manager/Staff Feedback

  • Feedback by staff

  • Observations by trainer

  • Any other pictures

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.