Safety Assurance Audit

• Site conducted

  Select

• Site Platform

  COCO TGPL

  DEALER TGPL

  COCO Other

• Site Manager Name

• Site Manager Signature

  Sign

• Prepared by

• AM Name

• Conducted on

  Date

• Month

  Select January 2021 February 2021 March 2021 April 2021 May 2021 June 2021 July 2021 August 2021 September 2021 October 2021 November 2021 December 2021 January 2022 February 2022 March 2022 April 2022 May 2022 June 2022 July 2022 August 2022 September 2022 October 2022 November 2022 December 2022

  • January 2021
  • February 2021
  • March 2021
  • April 2021
  • May 2021
  • June 2021
  • July 2021
  • August 2021
  • September 2021
  • October 2021
  • November 2021
  • December 2021
  • January 2022
  • February 2022
  • March 2022
  • April 2022
  • May 2022
  • June 2022
  • July 2022
  • August 2022
  • September 2022
  • October 2022
  • November 2022
  • December 2022
• Location
  Address

• Take a selfie with site in the background

  Media

Emergency Response Plan

• Safety Organization in Place & Displayed?

  Yes

  No

  N/A

• Picture of Safety Organization

  Media

• Safety Champion or Designated Staff in shift has Whistle (to alert staff in case of emergency)?

  Yes

  No

  N/A

• Take Picture of Staff with Whistle

  Media

• Emergency Contact Numbers Displayed & Visible?

  Yes

  No

  N/A

• Picture of Emergency Board with Numbers?

  Media

• First Aid Kit available?

  Yes

  No

  N/A

• Is the First Aid Kit properly Stocked?

  Yes

  No

  N/A

• Picture of First Aid Kit

  Media

• There are no expired items in First Aid Kit

  Yes

  No

  N/A

• ESD Button Working (One button to cut Electrical Supply of entire site)? (Check By Testing)

  Yes

  No

  N/A

• Picture of ESD Button

  Media

• Designated Assembly Point Known by Staff? (Check by asking service champions or if displayed)

  Yes

  No

  N/A

• Is staff trained on responding to a robbery? Ask staff about reaction in case of armed robbery from random staff/attendant including NFR services staff

  Yes

  No

  N/A

• Is record of incidents and Near Misses maintained?

  Yes

  No

  N/A

• Picture of incident / near miss record

  Media

Site Security

• CCTV Installed on Site?

  Yes

  No

  N/A

• CCTV Functional & Recording Video (7 Days record at least)

  Yes

  No

  N/A

• CCTV Picture Evidence (Camera & Screen)

  Media

• Process in place to ensure cash with Super cashier is less than Rs 15K through frequent drops of cash into the safe? Questions asked from Cashier/site manager regarding their practice, observe entries in the register that are made before each cash drop

  Yes

  No

  N/A

• Process in place to ensure cash with Diesel cashier is less than 100,000 through frequent drops of cash into the safe? Observe cash with diesel cashier.

  Yes

  No

  N/A

• Underground Cash Safe Available on Site?

  Safe Available

  Safe Not Available

• Safe in Use?

  Yes

  No

  N/A

• Safe Drop Chute available in Cash Counting Room to Underground Safe?

  Yes

  No

  N/A

• Cash in Safe Insured?

  Yes

  No

  N/A

• Cash in Transit Insured?

  Yes

  No

  N/A

• Is cash deposited to the bank at least once a day? Show few last recepits of past 3 days

  Yes

  No

  N/A

• Picture of deposit slip

  Media

• In case Cash Van is not available, are 500,000 limit per transfer followed?

  Yes

  No

  N/A

• Picture of transfer slip

  Media

Safety Equipment

• Sufficient Fire Extinguishers Available on site? (2 per tank, 1 per dispenser, 1 near DB Room)

  Yes

  No

  N/A

• No. of Fire Extinguishers Available on Site?

• Any Fire Extinguisher Expired?

  Select No Fire Extinguisher Expired 1 or more fire extinguisher expired

  • No Fire Extinguisher Expired
  • 1 or more fire extinguisher expired

• No. of Fire Extinguishers Expired

• Picture of Fire Extinguishers

  Media

Spill Kit

• Sand Buckets available?

  Yes

  No

  N/A

• Sand Buckets filled with dry sand?

  Yes

  No

  N/A

• Picture of Sand Buckets

  Media

• 200 KG Sand Available on Site?

  Yes

  No

  N/A

• Picture of Sand (200KG)

  Media

• Broom available to collect sand?

  Yes

  No

  N/A

• Brush available to collect sand?

  Yes

  No

  N/A

• Plastic Dust Pan available to collect sand?

  Yes

  No

  N/A

• Picture of Broom, Brush & Plastic Dust Pan

  Media

• Jute Bag Available to put Sand & Fuel Mixture?

  Yes

  No

  N/A

• Picture of Jute Bag?

  Media

• Site staff knows the usage of Spill kit, its emergency response & consequences of not following the proper use of spill kit in case of oil spillage?

  Yes

  No

  N/A

• Drill conducted regarding oil spilling?

  Yes

  No

  N/A

PPEs

• Safety Helmet (Hard Hat) with chin trap?

  Yes

  No

  N/A

• High Visibility Safety Vest?

  Yes

  No

  N/A

• Safety Glasses?

  Yes

  No

  N/A

• Safety Boot with steel toe?

  Yes

  No

  N/A

• Safety Gloves (EN374 Gloves only)

  Yes

  No

  N/A

• 5 Safety Cones Available?

  Yes

  No

  N/A

• Picture of PPEs

  Media

• PPEs being regularly used by Site Staff for TL decantation & other activities (Check CCTV or assess usage from condition of PPEs)?

  PPEs Used Regularly

  PPEs Not Used

• Was the driver in PPEs? (Check CCTV)

  Yes

  No

  N/A

• Was the driver in PPEs?-comment

Decantation Equipment

• Intrinsically Safe Torch (Explosion Proof Torch)?

  Yes

  No

  N/A

• Earth Bonding Cable?

  Yes

  No

  N/A

• Aluminum Bucket?

  Yes

  No

  N/A

• Funnel?

  Yes

  No

  N/A

• Authorized Sampling Container?

  Yes

  No

  N/A

• Water Finding Paste?

  Yes

  No

  N/A

• Dip Paste?

  Yes

  No

  N/A

• Decantation Equipment being used regularly? (Check CCTV or assess usage through condition of equipment)

  Used Regularly

  Not Used

• Picture of all Decantation Equipment

  Media

• Armed guard present on duty on site?

  Yes

  No

  N/A

• Police verification of armed guard done?

  Yes

  No

  N/A

• Does the armed guard have licensed weapon?

  Yes

  No

  N/A

• Picture of Armed Guard (If Possible)

  Media

• Guard has a designated area assigned on site?

  Yes

  No

  N/A

• Is the armed guard in uniform?

  Yes

  No

  N/A

• Standards for maintaining Arms are followed?

  Yes

  No

  N/A

• If there a room for Service Champions to change and rest in?

  Available

  Not Available

• The rest area is neat & tidy?

  Yes

  No

  N/A

• Staff do not smoke inside the rest area? (check for evidence like cigarette buds)

  Yes

  No

  N/A

• No Naked wiring visible in the room?

  Yes

  No

  N/A

• ERP is available for the Rest Room

  Yes

  No

  N/A

• Break Times are assigned for staff to rest?

  Yes

  No

  N/A

• There is an available water facility for staff to drink clean water

  Yes

  No

  N/A

DB Room

• DB Room Not In Office?

  Not in Office

  In Office

• DB Room has No Flammable Materials Present?

  No Flammable Material Present

  Flammable Material Present

• Check for Flammable Materials like Clothes, boxes, lubricants other storage items that can be removed. Allow Generators or UPS batteries.

• Picture of DB Room

  Media

• Rubber Pad Placed in DB Room?

  Yes

  No

  N/A

• Picture of Rubber Pad in DB

  Media

• Fire Extinguisher available outside DB Room

  Yes

  No

  N/A

• Specifically Carbon Dioxide (CO2) Extinguishers i.e used for electrical fire

  Yes

  No

  N/A

• Is staff aware regarding its usage in case of incident?

  Yes

  No

  N/A

• Picture of Fire Extinguisher outside DB Room

  Media

• Main Distribution Board Labelled?<br>

  Yes

  No

  N/A

• Picture of Distribution Board Labelling

  Media

• Main DB Kept Closed?

  Yes

  No

  N/A

• Picture of Closed DB

  Media

• DB has ELCB & earthing of DB has been checked?

  Yes

  No

  N/A

Generator

• Generator available at site?

  Available

  Not Available

• Generator looks clean and well maintained?

  Yes

  No

  N/A

• Rubber Pad placed in area from where generator contact is made?

  Yes

  No

  N/A

• Fire extinguisher available near generator?

  Yes

  No

  N/A

• There is no any visible oil or fuel spill on the floor near generator?

  Yes

  No

  N/A

• There is no naked wiring near the generator?

  Yes

  No

  N/A

• Picture of Generator

  Media

• Picture of Generator Maintenance Log

  Media

Air Compressor Room

• Is there an air compressor placed on site (in room or outside)?

  Available

  Not Available

• Picture of Air Compressor

  Media

• Air compressor looks clean & well maintained?

  Yes

  No

  N/A

• There is no any naked wiring or unsafe switches near air compressor?

  Yes

  No

  N/A

• The belt cover should be in place and facing towards the wall? (non-customer facing)

  Yes

  No

  N/A

• Traffic guide is present on site during rush hours to regulate traffic flow safely? (Check CCTV Camera to see in rush hours)

  Yes

  No

  N/A

• Pictures of Site Adjoining Areas (left & right)

  Media

• Comments on Fence Line Risk Assessment

• Steel gratings available on site to capture any fuel leakage from getting out of the site area

  Available

  Not Available

• Gratings are clean and not chocked?

  Yes

  No

  N/A

• Picture of Gratings

  Media

• Are the gratings connected to main water drain directly?

  Select Not Connected to Main drain (Connection through Oil Water Separator) Connected to main water drain

  • Not Connected to Main drain (Connection through Oil Water Separator)
  • Connected to main water drain

• There are no electrical connection near dispenser & fueling area

  Select No Electrical Connections Presents Electrical Connections are present

  • No Electrical Connections Presents
  • Electrical Connections are present

• Picture of any electrical connections near dispensers & fueling areas

  Media

• Security & Safety signage is present & visible for customers (stickers)

  Yes

  No

  N/A

• Attendants prompt customers to turn engine off before fueling?

  Yes

  No

  N/A

• Staff encourages bikers to get off their bikes before fueling? CCTV evidence of service champion, ask relevant question from site staff how they explained customer regarding this safety issue & how they explain consequences of not following this SOP

  Yes

  No

  N/A

• Before filling drums, staff use earthing cables to earth the drums using dispenser earthing connections?

  Yes

  No

  N/A

• There is no visible leakage of fuels from dispensers

  Select No visible leakage Leakage & spills present near dispenser

  • No visible leakage
  • Leakage & spills present near dispenser

• There is no leakage from any loose oil containers near the dispenser?

  Select No visible leakage Leakage & spills present near dispenser

  • No visible leakage
  • Leakage & spills present near dispenser

• Fuel not given in unauthorize container and attendants knows what is an unauthorize container? & what are the repercussion of using an unauthorize container?

  Yes

  No

  N/A

• Is there any issue in canopy water leakage? (ask site manager)

  Select No canopy issue identified There is water leakage from canopy

  • No canopy issue identified
  • There is water leakage from canopy

• Are there any unsafe hanging items from the canopy?

  No hangings

  Unsafe hangings present

• Generally, forecourt area clean and free of spillage (fuel or oil)?

  Yes

  No

  N/A

• Back alleys area clean?

  Yes

  No

  N/A

• Fire extinguishers are placed near dispensers for quick access?

  Yes

  No

  N/A

• All staff on forecourt are wearing closed shoes to protect their feet?

  Yes

  No

  N/A

• Bollards are present in front of all glass structures on the site?

  Yes

  No

  N/A

General Safety Items

• Moveable Ladder or Scaffolding Present on Site?

  Not Present

  Present

• Monkey ladder with covered backing for CNG is allowed, fixed ladder with handrails is also allowed as well.

• Picture of Scaffolding or Ladder if present

  Media

• Bollards Present in front of all Dispenser Islands?

  Yes

  No

  N/A

• Picture of Bollards

  Media

• Naked wiring Anywhere on site?

  No Naked Wiring

  Naked Wiring Present

• Refer to Naked Wiring guide to understand what is naked wiring on site that needs to be flagged.

• How many naked wiring issues are present on site?

  One

  Two

  Three

  Four

  More than Four

• Pictures of Naked Wiring (you can add multiple pictures)

  Media

TL Decantation Process

• Secure Dip Caps (dips caps closed and secured on all tanks)?

  Secured

  Not Secured

• Dip Caps Picture

  Media

• There is no any additional open spaces in the tank sump from where vapor can leak?

  Yes

  No

  N/A

• No Electrical Connection within 10ft of Decantation Area?

  No Electrical Connection

  Electrical Connect Present

• Picture of Any Electrical Connection near Decantation Area

  Media

• Is Earthing Point Present?

  Yes

  No

  N/A

• Is Earthing Point Clean & not painted on?

  Yes

  No

  N/A

• Picture of Earthing Point

  Media

• Earthing is done during sampling of the bucket being used as well. Check CCTV footage

  Yes

  No

  N/A

• Did “bucketing” happen during/at the end of decantation?

  Yes

  No

  N/A

• Decantation Area Clean?

  Yes

  No

  N/A

• Decantation Area Tanks Labelled with Fuel Grade & Capacity?

  Yes

  No

  N/A

• Picture of Decantation Area

  Media

• Spill Containment Area Present at decantation point?

  Yes

  No

  N/A

• Picture of Spill Containment Area

  Media

• Staff is aware about Fence Line Risk to care for during decanation?

  Yes

  No

  N/A

• Staff is competent in safe decantation procedure using PPEs? (check by asking designated staff questions on safe decantation procedures)

  Yes

  No

  N/A

• Is site staff aware, how & when water can enter the fuel tank sump?

  Yes

  No

  N/A

• If water found in the tank sump, Do they contact authorized contractors for water removal?

  Yes

  No

  N/A

• Is site manager aware of the protocols for working in confined space area?

  Yes

  No

  N/A

• Staff not physically entering the tank sump to remove water from it?

  Yes

  No

  N/A

• Is site staff aware, what kind of Hazards involved in entering the tank sump physically & what can be the possible consequences of physical intervention?

  Yes

  No

  N/A

• Buyer's Own Site?

  Yes

  No

  N/A

• Compliant Hosepipe Available on site? Both ends of the pipe secure properly?

  Yes

  No

  N/A

• Picture of Hosepipe

  Media

• Is CNG Operational on Site?

  Operational

  Not Operational

• Ear Muffs Available? (Ear Protector for CNG Compressor Room)

  Yes

  No

  N/A

• Picture of Ear Muffs

  Media

• Soap Testing being done & recorded to check for leaks?

  Yes

  No

  N/A

• Picture of soap testing record

  Media

• No leakage of gas (smell)?

  No smell

  Gas smell present

• Compressor room is clean & tidy?

  Yes

  No

  N/A

• No drums, bottles or any other item stored in compressor room?

  Yes

  No

  N/A

• All safety valves are working fine? Check with operator

  Yes

  No

  N/A

• Safe ladder available for cooling tower?

  Yes

  No

  N/A

• Compressors and cylinder are tagged after last test?

  Yes

  No

  N/A

• Storage Cylinders checked & look in good condition?

  Yes

  No

  N/A

• CNG Fillers hold nozzles while filling CNG? Trainer to observe, if possible see CCTV footage

  Yes

  No

  N/A

• Is the CNG staff changing nozzle O-Rings after at least 12 fills?

  Yes

  No

  N/A

• Fire extinguisher for CNG present (50 kg trolly mounted cylinder)

  Yes

  No

  N/A

• Picture of CNG Fire Extinguisher trolley

  Media

• All CNG safety signs in place (No open flame, restricted entry, machine may start automatically, ear protection)

  Yes

  No

  N/A

• Toilets are free from spillage (no slip/trip hazards)

  Yes

  No

  N/A

• Staff is aware of toilet usage by customers & ensures toilets are not used for drug usage or other wrong doings? Do (sweeper or other staff) regularly observe if toilets are used for drugs or smoking related activity and report to Site Manager

  Yes

  No

  N/A

• There is no smoking in the toilets? (Check for evidence of cigarette buds)

  Yes

  No

  N/A

• There is no naked wiring in the toilets?

  No Naked Wiring

  Naked Wiring Present

• Number of toilets on site?

• Number of customer toilets?

• Number of Staff Toilets?

• Store rooms available?

  Yes

  No

  N/A

• Store rooms are clean & organized?

  Yes

  No

  N/A

• There is no stacking of more 6 ft in the store room

  Yes

  No

  N/A

• There are no naked wires in the store rooms?

  Yes

  No

  N/A

• There is no smoking in the Store Room? (Check for evidence of cigarette buds)

  Yes

  No

  N/A

• Picture of store rooms

  Media

• Site has dedicated oil change facility available?

  Available

  Not Available

• No naked wiring present in area?

  No Naked Wiring

  Naked Wiring Present

• Black Oil Storage drums are marked clearly?

  Yes

  No

  N/A

• Area is clean & tidy?

  Yes

  No

  N/A

• Hard plastic sheet is placed below oil drums?

  Yes

  No

  N/A

• There is no smoking in this area? Look for evidence

  Yes

  No

  N/A

• Wheel Chocks are used to ensure cars don't move during oil change?

  Yes

  No

  N/A

• Pictures of wheel chocks

  Media

• PPEs are used by Oil Change staff? (Gloves, Goggles, Hard Hat, Safety Boots)

  Yes

  No

  N/A

• Picture of staff using PPEs

  Media

Car Wash Operation

• Car Wash available on Site?

  Available

  Not Available

• Capacity Plate Displayed?

  Yes

  No

  N/A

• Picture of Capacity Plate

  Media

• Bollard Present in Car Wash?

  Yes

  No

  N/A

• Picture of Bollard

  Media

• Steel Grating Present to Drain Water Around Car Wash?

  Yes

  No

  N/A

• Picture of Gratings

  Media

• Oil Water Separator Present for Car Wash Area?

  Yes

  No

  N/A

• Picture of Oil Water Separator

  Media

• Car wash staff is wearing PPEs? (Gloves, Anti-slip Boots)

• Picture of car wash staff

  Media

• Floor is not full of leak fuel and oil from cars

  Yes

  No

  N/A

• Lift has been tested for safety and records available of lift tests?

  Yes

  No

  N/A

• Staff knows the operating process of lift & emergency response in case of an incident?

  Yes

  No

  N/A

• Safety signage for car wash in place?

  Yes

  No

  N/A

• Compliant water proof switches are being used?

  Yes

  No

  N/A

• Picture of switches

  Media

• Water-Proof Lights are being used inside car wash? (to avoid any electrical damage)

  Yes

  No

  N/A

• There is no naked wiring in this area?

  No Naked Wiring

  Naked Wiring Present

• No Smoking in the car wash area?

  Yes

  No

  N/A

• Is there waiting room available for customers?

  Available

  Not Available

• There is no naked wiring in the area?

  No Naked Wiring

  Naked Wiring Present

• Customers & staff do not smoke in this area?

  Yes

  No

  N/A

• No Slip/Trip Hazard in this area

  Yes

  No

  N/A

• Is there a tyre shop available on site>

  Available

  Not Available

• There is no naked wiring in this area?

  No Naked Wiring

  Naked Wiring Present

• No Smoking in this area?

  Yes

  No

  N/A

• No items are hanging with dangers of falling?

  Yes

  No

  N/A

• No stacking greater than 6ft?

  Yes

  No

  N/A

• All equipment is grounded and grouted?

  Yes

  No

  N/A

• There is no grinder in the tyre shop?

  Yes

  No

  N/A

• No Electrical overload with multiple equipment working on same outlet?

  Yes

  No

  N/A

• Tyre Shop Staff wear PPEs required? (Gloves, safety boots)

  Yes

  No

  N/A

• Picture of tyre shop staff

  Media

• Water does not have any mosquitoes and water is changed regularly?

  Yes

  No

  N/A

• No slip or trip hazards?

  Yes

  No

  N/A

• Safety signage in place?

  Yes

  No

  N/A

• Is there a Shop available on site>

  Available

  Not Available

• There is no naked wiring in this area?

  No Naked Wiring

  Naked Wiring Present

• No Smoking in this area?

  Yes

  No

  N/A

• Shop has multiple bollard installed outside

  Yes

  No

  N/A

• Picture of bollards

  Media

• Shop ERP in place?

  Yes

  No

  N/A

• Is the emergency exit marked and clear from blockage?

  Yes

  No

  N/A

• Does the select store have a cash safe available for its use?

  Yes

  No

  N/A

• Fire extinguishers are placed in the shop?

  Yes

  No

  N/A

• Shop Staff know COPS? Ask staff what to do in case of armed robbery?

  Yes

  No

  N/A

• Chillers are working fine maintaining temperature of 4C

  Yes

  No

  N/A

• No Stacking in storage area over 6 ft

  Yes

  No

  N/A

• Expiry date is mentioned on fresh food available on site?

  Yes

  No

  N/A

• No open flame inside or around shop area?

  Yes

  No

  N/A

• Lighters/Matches are not sold inside the store?

  Yes

  No

  N/A

• No Electrical overload with multiple items working on same electric outlet

  Yes

  No

  N/A

• CCTV available in side the shop?

  Yes

  No

  N/A

• Expired items are not sold, marked separately to avoid selling expired items.

  Yes

  No

  N/A

• Fumigation is done twice a year to ensure there are no pests in shop and in store rooms

  Yes

  No

  N/A

• Is there record available for the last fumigation on the site?

  Yes

  No

  N/A

• Picture of record

  Media

• Wasted items are marked separately in store and not mixed with regular stock

  Yes

  No

  N/A

• Chillers and freezers are clean

  Yes

  No

  N/A

• Stock room is clean and well organized

  Yes

  No

  N/A

• Proper dust bins with lids are available in the shop

  Yes

  No

  N/A

• There are no pests (rats, rodents) visible in the shop or stock room

  Yes

  No

  N/A

• Picture of stock room

  Media

• Picture of chillers & freezers

  Media

• Picture of store

  Media

• Is there ATM with dedicated room available on site?

  Available

  Not Available

• ATM Room can be monitoring using CCTV from the inside?

  Yes

  No

  N/A

• ATM Room has no naked wiring?

  No Naked Wiring

  Naked Wiring Present

• There is no smoking inside ATM Room

  Yes

  No

  N/A

• The ATM Room has a working lock for customers?

  Yes

  No

  N/A

• ATM Room has bollard placed in front of them?

  Yes

  No

  N/A

• Any other NFR available at Site?

  Yes

  No

  N/A

• Name of NFR

• Picture of NFR

  Media

• There is no naked wiring in this area?

  Yes

  No

  N/A

• Naked wiring picture

  Media

• No smoking in this area?

  Yes

  No

  N/A

• Fire extinguisher placed?

  Yes

  No

  N/A

• Staff knows COPS?

  Yes

  No

  N/A

• No Stacking in storage area over 6 ft?

  Yes

  No

  N/A

• No Electrical overload with multiple items working on same electric outlet?

  Yes

  No

  N/A

• CCTV available?

  Yes

  No

  N/A

• Notes on Site Manager Coaching Conversation

• Ease of Performing Audit & Coaching on Site (Openness to Learn)

• Comments On Any Unusual Safety Related Items/Activity on Site

• Picture of unusual safety related items/activity

  Media

• Site Customer Service Level Rating

• Any Other General Comments regarding Site or Staff

• Photo of inspection log filled by trainer

  Media

• Site Staff Wearing Masks?

  Yes

  No

  N/A

• Site Staff Wear Clean Gloves?

  Yes

  No

  N/A

• Regular Handwash for at least 20 secs for every service champion?

  Yes

  No

  N/A

• Sanitizer available on all dispenser and offered to all customers?

  Yes

  No

  N/A