Premier Stop

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

Documentation

• 300 Logs retained for the previous 5 years

  Yes

  No

  N/A

• 12 Months of Safety Meetings retained

  Yes

  No

  N/A

• 12 Months of Inventory Data retained for Underground Storage Tanks (UST) per EPA requirements

  Yes

  No

  N/A

• 12 Months of Location Monthly Inspections, Housekeeping and Maintenance retained

  Yes

  No

  N/A

• Work Comp., Incident Investigation, and Near Miss Reporting trained on and readily available

  Yes

  No

  N/A

• Emergency Action Plan and Fire Extinguishers up to date and trained on

  Yes

  No

  N/A

• SDS's readily available and trained on

  Yes

  No

  N/A

• Fire Marshall Report retained with SCALD, Line Leak Test, and all related data.

  Yes

  No

  N/A

• Federal Labor Law Poster and Nebraska Labor Law Poster are posted and accessible to employees

  Pass

  Fail

  N/A

• Cathodic Testing documentation for the previous 4 tests on hand

  Pass

  Fail

  N/A

Daily Inspections

• Spill Buckets: Clean and Empty

  Yes

  No

  N/A

• Spill and Overfill Response Supplies: Stocked, properly function, in good working condition

  Yes

  No

  N/A

• Over Fill Alarm: Delivery person can see and hear alarm as needed

  Yes

  No

  N/A

• Fill and Monitoring Ports: All fill/monitor ports and other access points have covers and caps are tightly sealed and locked

  Yes

  No

  N/A

• Dispenser Hoses, Nozzles and Breakaways: Fittings are tight, no obvious sign of leakage and deterioration, functioning as intended

  Yes

  No

  N/A

• Piping Sumps: No water or product present, piping, fittings, and couplings are in working order and debris is not present at sump

  Yes

  No

  N/A

Inside of Store

• Aisles are free and clear of obstructions

  Yes

  No

  N/A

• Ladders/step stools free of defects and properly labeled with weight rating

  Yes

  No

  N/A

• Fire Extinguishers are charged, tagged, inspected

  Yes

  No

  N/A

• First Aid Kit present and properly maintained

  Yes

  No

  N/A

• Floor coverings are in good condition

  Yes

  No

  N/A

• Adequate lighting

  Yes

  No

  N/A

• Cords are anchored, covered, and properly routed

  Yes

  No

  N/A

• Extension cords are not in use in lieu of permanent wiring

  Yes

  No

  N/A

• Materials are properly stored

  Yes

  No

  N/A

• Storage racks and shelves are capable of supporting the intended load and load capacity is identified

  Yes

  No

  N/A

• Emergency exits are identified, clear of obstructions and unlocked (unlocked during business hours)

  Yes

  No

  N/A

• Electrical Panels are identified and clear within 36"

  Yes

  No

  N/A

• Light switches and outlets in working order and in good condition

  Yes

  No

  N/A

• Electrical equipment in safe working order: ground prongs present, no fraying or splitting or cords, etc.

  Yes

  No

  N/A

• Kitchen is clean organized and food is properly stored

  Yes

  No

  N/A

Safe Certification, Licensing, and Practices

• Underground Storage Tank Operating Permit

  Yes

  No

  N/A

• Proper bending, lifting, and twisting

  Yes

  No

  N/A

• NE Dept. of Ag Weights and Measures Certificate

  Yes

  No

  N/A

• PPE readily available and in good condition

  Yes

  No

  N/A

• NE Dept. of Ag Dairies and Foods Certificate

  Yes

  No

  N/A

• NE Dept. of Revenue (Sales Tax) Certificate

  Yes

  No

  N/A

• Alcohol License and required posters, (Underage and Pregnancy)

  Yes

  No

  N/A

• Tobacco License

  Yes

  No

  N/A

• Health Inspection Certificate

  Yes

  No

  N/A

Outside of Store

• Walking/working grounds are clean/clear

  Yes

  No

  N/A

• Lighting in working order

  Yes

  No

  N/A

• NFPA Signage properly displayed (at applicable locations)

  Yes

  No

  N/A

• Product(s) properly secured: propane, wood, ice, etc.

  Yes

  No

  N/A

• Anti-tampering seals recent and not tampered with

  Yes

  No

  N/A