Title Page
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Document Number
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Site Name
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Site Name
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Caltex Site ID
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Conducted on
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Prepared by
Internal
Operations Register/Contractor paper work
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Is the "Milemaker Operations register" available on site? (Version 4)
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Does the site have a folder with all contractors work sheet, JSA, work permit, or WPCG permit attached?
Licences and certificates
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Does site have a Milemaker emergency contact list at the console?
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Is the current and valid dangerous good licence on display?
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Is the emergency flip chat (June 2013) up to date with current telephone numbers available at the console?
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Is the site currently registered as a food selling business?<br>View and note licence number.
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Is the a map outlining the site evacuation procedure including an evacuation point and escape route on display?
Communications
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Does the site have a diary or a communications book for recording customer concerns and or communicating to staff?
Site Self Audit
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Are the Milemaker Monthly store hazard/risk audit sheets being completed?
PA System
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Is there a public address system, and is it operational? (Test)
Emergency Stop
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Are all "emergency stop" switches readily accessible, with no items blocking access and operational?
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Does the site perform an emergency evacuation drill regularly, is this documented? Record last date?
Electrical Equipments
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Is all portable electrical equipment tested and tagging in date?
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Are all red power points free of any foreign appliances? <br>(Kettles, toasters, phone chargers, etc)
Training records
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Does the site have a current employee list which records staff training completed in any/all of the following
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Fire training
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Spill kit training
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Emergency response training
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First aid training
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Food safety training
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LPG training
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BBQ gas bottle training
LPG Gas- Auto gas and decanting
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Does site have a "Caltex LPG operations manual"? (Version June 2012)
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Is the "Caltex site occupier LPG daily & weekly inspection record" being completed?
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Has each pump dispenser breakaway coupling been tested and recorded? Note the last test date.
Food hygiene
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Does the site possess a Caltex HACCP food safety plan?
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Does the site have a qualified food safety supervisor? View certificate, noting name and date.
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Is all food currently with their expiry date? <br>Spot check.
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Does the site have a working thermometer?
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Has the thermometer been calibrated? (Probe- Water and ice. Laser- calibration kit) and is it bring recorded monthly?
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Is the daily monitoring schedule being completed daily?
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Is food preparation sink clean, sanitising soap and paper towel available?
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Is all PPE in good conditions? (Gloves, bakery trays, tongs)
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Is all food prep and display areas clean and free of spill and crumbs?
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Is there a system in place for the "in and out" times for the food with in the HAC units?
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Can the site provide a copy of a pest control service report including sighting register, bait station map, MSDS and current contractor licence?
Incident reporting
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Is the operator able to describe the correct procedures to follow in the event of an incident?
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Does site have blank incident reports available?
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Does the site have current incident reports completed and filed correctly?
Fire Equipment Interior
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Does site have at least 1 fire extinguisher in the sales showroom and or behind the console?
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Does the site have a fire extinguisher in the vicinity of the electrical switchboards?
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Does all interior fire extinguishers poses a metallic tag with dates of previous service not more then 6 months previous?
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Do all interior fire extinguisher locations have current signage in place?
Exit Lighting
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Are all exit signs and emergency lighting been maintained in an operable conditions?
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Is the view or identification of exit signs obstructed?
Door Signage
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Does the entranceway posses height stickers on the door frame to assist in height estimates?
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Is there decal asking customers to 'remove helmets' prior to entering the store?
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Can the console operator clearly see all areas of the forecourt with out having to look around obstructions?
General Fire Safety
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Are paths ways and isles clear?
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Are rubbish and combustible materials disposed of appropriately on a regular basis?
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Is there a sharps container and handling procedure?
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Is the correct ladder/safety steps being used? (No milk creates)
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Are all items in the store room stored safely not stacked above shoulder height?
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Is the store room clean and tidy, no obstacles or trip hazards?
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Is the store room & console are free of any LPG cylinders stored inside?
Site Emergency Equipment
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Is the touch available to employees intrinsically safe?
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Are thermally insulated gloves for emergency use (LPG) readily assessable?
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Does the site possess protective eye ware for LPG decanting?
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Are 2 spare LPG metal fill valve caps readily accessible for emergency use?
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Are at least 2 reflective vests readily available?
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Is there at least 3x 700mm high reflective safety cones available for forecourt work and traffic management?
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Does the site have adequate wet floor/hazard warning signs?
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Is all safety equipment together and located in an accessible location behind the console?
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Is all safety equipment/PPE in good conditions?
First Aid Kit
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Does the site posses a first aid kit?
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Is the first aid kit placed in a position where the console operator can readily access it at all times?
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Is the first aid kit free of all out of date stock?
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Is the first aid kit free of paracetamol and aspirin based medication?
Cash Handling Security
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Does the cash draw contain less then $300?
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Is the console area free any unsecured cash, change or spare float?
Security System CCTV
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Is there a camera pointed in the direction of the point of sale counter?
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Is there a camera on site that covers the main public entrence to store?
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Can the customer see the CCTV image on the monitor as the perform their transactions?
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Is the console camera focused at the customer at the console? (Rather than the stock or cash draw)
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Does the console camera clearly show the the customer features so that they can be recongnized?
Panic Duress Alarm
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Is there a duress/panic alarm at the console?
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Is the duress alarm immediately accessible? (Not blocked by stock)
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Are there records of monthly testing of the duress alarm switches?
Fuel Water Testing
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Does the site have suffice to water paste on site?
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Does the site conduct weekly water paste tests?
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Does the site keep a record of water paste tests?
External
Dip and fill points
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Are the fill and dip points securely marked with circular discs and numbers of durable materials?
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Are fill and dip caps present on site and have the ability to be secured?
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Do all fill and dip points possess a rubber or leather seal to prevent water entering the tank?
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Do dipsticks have safe fill levels marketed on them?
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Are dip sticks free of any bends breaks or worn areas?
Spill Box
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Is the spill boxer drain valve sealing correctly? (Test)
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Is the spill box cleaned and free of mud leaf litter and water?
Fuel Dispensers
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Are all pump/dispensers in good working order?
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Are all pump/dispensers hoses free from cracks or damage? (Detail those that are not)
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Are the pump/dispensers area free of any evidence of fuel spill?
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Are all your pump/dispensers cabinets free from any damage? (Please detail those which are not)
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Are all pumps/dispensers and columns numbered?
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No ignition sources located in hazardous area?
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Are all dispensers protected from impact by vehicles and trailers?
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Are all LPG hoses fitted with self sealing break coupling?
Signage
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Do all LPG pumps/dispensers have "Filling instructions" in place?
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Do all "Emergency Stop" bottoms both at the dispenser and other locations have Emergence Procedure decals and identified as stop buttons?
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Are the following decals in place and legible? "Stop engine" and "No Smoking"
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Is signage for filling advertised on columns
External Safety Markers
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Are there "HAZCHEM" signs at all entrance to site?
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Are all dangerous steps/concrete painted yellow?
LPG Gas Tank (above ground)
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Is LPG tank well protected? (Adequate railing/barriers)
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Is all Emergency signage and placarding in place at the LPG tank? (Including "Flammable Gas" Dimond, no smoking, 2YE, correct emergency number)
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Is the correct emergency contact phone number on LPG signage CALTEX 0448 830 445?
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Is the area around the LPG tank clear of obstructions?
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Is LPG tank in good conditions? (No evidence of damage or corrosion)
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Is the LPG pipe work in good condition? (No evidence of damage or corrosion)
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Is the lid/cover of the LPG tank locked?
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Does the LPG tank fill valve posses a cap?
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Does the pressure relief valve posses a cap?
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Is the tank test date with in the last ten (10) years? (Record date and serial number of test)
LPG Tank Below Ground
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Does the site have a Gatwick lifter for opening the turret lid?
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Is the tank turret free from any water or rubbish?
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Is the tank test date with in the last ten (10) years? (Record date of test and serial number)
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Is the LPG fill point marked?
Air Compressor
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Does the air compressor have proper belt guard?
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Is the compressor being emptied of water and oil checked weekly, are records being recorded to show?
Spill Kit
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Does the site posses a spill control kit?
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Does the spill kit contents meet stock requirement? (Check stock levels using the checklist provided)
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Is the spill kit located adjacent to the shop entrance on the forecourt?
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Is the spill kit adequately identified?
Fire Extinguisher External
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Are the fire extinguishers "dry chemical" marked with a white band?
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Does all fire extinguishers have appropriate signage?
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Are the extinguishers fully charged with a test date stamped on maintenance tag? (Not more then 6 months previous)
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Are all extinguishers mounted in red boxes?
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Does the site have a 003 key to open the fire extinguisher box?
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Are all fire extinguishers in an appropriate location that is easily accessible?
Fire Hose Reel
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Does the fire hose reel posses a metallic tag with dates of previous service, not more then 6 months previous?
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Is the fire hose reel stored neatly, not tangled, free of kinks and leaks?
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Are the operating instructions clear and legible?
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Is the fire hose reel accessible at all times?
Fire Hydrant
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Does the site have fire hydrant? (If no mark NA)
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Is the hydrant easily accessible and free from hazards?
Manifest Box
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Is the emergency information manifest box located in an easily accessible locations?
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Is the cabinet weather proof, clearly visible and correctly labeled?
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Is the cabinet lockable with 003 key, does the site have key on site?
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Is the folder located in the box, is it up to date and signed off by fire authorities with in the last 5 years? (site layout drawing, manifest drawings, on and off-site emergency contact list, evaluation points, emergency procedures and current MSDS)
Decanting Gas
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Does the site have decanting gas cylinders? (If no, please mark as NA and more to BBQ gas cylinders)
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Is LPG decanting cylinders locked?
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Are LPG decanting cylinders at least 5m from a source of ignition and combustible materials?
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Are LPG decanting cylinder at least 2m from doorway, vent, or open window?
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Are LPG decanting cylinders at least 5m from building on the neighbouring property?
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Are LPG decanting cylinders at least 3m from a drain or pit?
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Are LPG decanting cylinders free of any device to keep the dead mans handle open? Eg cable ties, hose clamp. REOMVE IMMEDIATELY.
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Is there a fire extinguisher located adjacent to the filling area?
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Are LPG Exchange cylinders at least 5m from above ground LPG tank?
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Are LPG exchange cylinders at least 1.5m(height) & 0.5m (width) from a source of ignition, drain pit, or site boundary?
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Are LPG exchange cylinders at least 1m from a door way, vent or open window?
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Are LPG exchange cylinders at least 0.5m from combustible materials?
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Are LPG exchange cylinders cage sturdy, stable and clear on at least two sides?
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Where there are two cages are they at least 3m apart?
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Is the dangerous goods class label (250mm square) and "flammable gas- No smoking" label on the front of the cage?
Car Wash
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Is the car wash plant room neat and tidy wth no spills or trip hazard?
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Is the daily/weekly car wash checklist being completed?
Tank Dipping Observations
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Did the operator use correct PPE and 3x safety cones whilst dipping fuel tanks?
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Did the operator use clean rag or paper towel to wipe the dip stick?
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Did the operator position themselves facing the traffic?
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Did the operator remove the dipstick hand over hand?
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Did the operator dip two or three times before recording the tank dip?
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Did the operator check if the leather seal was in place prior to replacing the dip cap?
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Did the operator lower the dip stick gently not letting it free fall?