Title Page
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Conducted on
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Prepared by
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RD Number
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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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Complete forecourt picture
Emergency Response
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Is the Emergency Response Plan available and displayed visibly?
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Picture of Emergency Response Plan
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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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Emergency Contact Numbers Displayed & Visible?
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Picture of Emergency contact numbers
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Is the First Kit Aid available and accessible
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Picture of First aid kit
Decantation
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Dip Caps are available for all tanks? Mark "No" even if one dip cap is missing.
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Picture of Dip caps
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Is Earthing Point Present?
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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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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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Sufficient and valid fire extinguishers/sand buckets present in Decantation area?
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Picture of FEs and sand buckets
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PPEs available at site?
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Staff is wearing all PPEs
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Decantation Area is safe ( no naked wiring, electric connect nearby)
Electric Safety
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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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Fire Extinguisher (CO2) available in DB Room?
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Picture of DB room
Cash Safety
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Is the cash room locked while counting?
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Does the cashier adhere to cash limit? Check on-ground with the cashier.
Site Security
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Are CCTV cameras available and functional?
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At least 30 days backup available?
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Picture of CCTV camera with backup
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All Cameras are working?
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Security guard deployed on site ?
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How many guards are deployed
Tuck Shop
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Tuck shop available at site?
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Fire extinguishers available in Shop?
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Fire extinguisher is valid?
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Picture of Tuck shop
Car Wash
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Car Wash available at site?
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Bollard Present in Car Wash?
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Picture of Car Wash
Oil Change
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Oil Change available at Site?
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Fire Extinguisher available in Oil Change
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Fire extinguisher is valid?
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Picture of Oil Change
Tyre Shop
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Tyre shop available at site?
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Fire Extinguisher available in tyre shop
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Fire extinguisher is valid?
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Is the water for tyres being changed regularly?
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Picture of Tyre shop
Customer Experience
Entrance & Exit
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Entrance & Exit Area is clean - free of litter & spills?
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Picture of Entrance-Exit and Surrounding Areas
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Landscaping area/green belt is clean, green and well maintained?
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Picture of Landscape area
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Pylon is clean
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Pylon is functional
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Picture of Pylon
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Site is looking clean and bright?
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All canopy branding is working & functional (Fascia and bar)?
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Picture of canopy branding
Forecourt
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Forecourt is generally clean & free of litter, spills or water collection?
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Forecourt Picture
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All lights work & are switched on when dark? (ask staff or check CCTV footage of night)
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Under Canopy Area is Clean and undamaged?
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Picture of under canopy area
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All Fuel Dispensers are clean?
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All Fuel Dispensers are functional?
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Pictures of all dispensers
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Nozzle jackets are in good condition & clean?
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Pictures of Nozzle jackets
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All forecourt staff are wearing complete uniforms?
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All forecourt staff are wearing the shoes?
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Picture of staff
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Staff greet the customer? Show zero and final meter?
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Wiper bucket & Wiper is available on site?
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Picture of Wiper bucket
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Is there enough staff working on the site?
NFR
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NFR Available at stie?
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Name of the available NFRs
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NFR area is clean
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NFR Staff are wearing the complete uniform?
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NFR staff are wearing shoes?
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NFR Staff Picture
Toilets
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Customer Toilets present on site?
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Toilets Area is clean & tidy?
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Toilets are clean from the inside?
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Toilets are stocked with soap & tissues/towel.
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All equipment inside toilets are functional (no water leaking & toilet is usable)?
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Toilet Pictures (inside and outside)
Documentation
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Green Book Available at site? (Daily/Weekly Checklist & Wet Stock)
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Is it in use?
Site Manager/Staff Feedback
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Feedback by staff
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Observations by trainer
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Any other pictures