Service Station HSEQ Assessment - Rev 1.1

• Site conducted

  Select

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

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  Address

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Condition of pumping equipment & surrounding area

• Fuel hoses are clear of the ground and in good physical condition?

  Yes

  No

  N/A

• Breakaway couplings in good condition and free of corrosion?

  Yes

  No

  N/A

• All pumps within calibration certification period?

  Yes

  No

  N/A

• All pumps are clean and free from physical damage?

  Yes

  No

  N/A

• Bollards are in place and free from physical damage?

  Yes

  No

  N/A

• Hazardous warning/safety signage in place and clearly legible?

  Yes

  No

  N/A

Facility boundaries

• Security fences in good condition?

  Yes

  No

  N/A

• Site entrance(s) and exit(s) are free of visual obstructions?

  Yes

  No

  N/A

• Site perimeter free of obstructions/trip hazards?

  Yes

  No

  N/A

Forecourt surface

• Forecourt free of potholes and cracks?

  Yes

  No

  N/A

• Forecourt clear of fuel spills?

  Yes

  No

  N/A

• Site run-off will mean any spills will flow into site drainage?

  Yes

  No

  N/A

Forecourt canopy (or Gull wings)

• Canopy footings in good condition and free of corrosion?

  Yes

  No

  N/A

• Canopy lights in good condition?

  Yes

  No

  N/A

Vent pipes

• Vent pipes at least 1.5 metres (radius) clear of combustible items?

  Yes

  No

  N/A

• Hazardous warning signage in place on vent pipes?

  Yes

  No

  N/A

Underground fuel tanks

• Fill points correctly marked?

  Yes

  No

  N/A

• Dip points correctly marked?

  Yes

  No

  N/A

• Under the toby plate the fill points are in good condition?

  Yes

  No

  N/A

• All dip sticks present and useable?

  Yes

  No

  N/A

• Safe Fill Levels on dip sticks able to be checked?

  Yes

  No

• Enter SFL levels on dip sticks for each fuel tank on-site.

• Tank truck access to fill points assessed as adequate?

  Yes

  No

  N/A

• Wet stock reconciliation being done on daily basis?

  Yes

  No

  N/A

• Water level in tank monitored and below alarm level?

  Yes

  No

  N/A

• All dip sticks present and useable?

  Yes

  No

  N/A

Interceptor pits

• Interceptor pit located on-site?

  Yes

  No

  N/A

• Location of isolation valve clearly identified?

  Yes

  No

  N/A

• Does the interceptor handle turn?

  Yes

  No

  N/A

• Does the site undertake monthly checks of the interceptor?

  Yes

  No

  N/A

• Interceptor checked within last 12 months?

  Yes

  No

  N/A

Major ID Sign

• Major ID sign positioned away from overhead power cables?

  Yes

  No

  N/A

• Footing of major ID sign secure and free of corrosion?

  Yes

  No

  N/A

Emergency response

• Emergency contact numbers are clearly displayed and legible?

  Yes

  No

  N/A

• Fire extinguisher(s) available and within certification?

  Yes

  No

  N/A

• Suitable spill kit available, appropriately stocked and clearly visible?

  Yes

  No

  N/A

• Emergency plan tested with last 12 months and recorded?

  Yes

  No

  N/A

• Emergency stop button clearly visible or staff know of location?

  Yes

  No

  N/A

• Safety data sheets are available and less than five years old?

  Yes

  No

  N/A

Forecourt security cameras

• Security cameras operational and giving good quality images?

  Yes

  No

  N/A

Store and site buildings

• If present, store building is free from damage and in good physical condition?

  Yes

  No

  N/A

• Doors to office are shut and locked?

  Yes

  No

  N/A

• Restricted access to cashier?

  Yes

  No

  N/A

• CCTV capturing customer image on entry to store?

  Yes

  No

  N/A

• Height strips on door?

  Yes

  No

  N/A

• Instore lighting assessed as adequate?

  Yes

  No

  N/A

• For 24 hr sites, can they operate controlled door access and activate from the cashdesk?

  Yes

  No

  N/A

• For 24 hour sites, does the cash draw operate correctly?

  Yes

  No

  N/A

• IT door handle can be opened from the inside?

  Yes

  No

  N/A

Certification and compliance requirements

• Stationary container tank certificates available and current?

  Yes

  No

  N/A

• HSNO Location certificate available and current?

  Yes

  No

  N/A

• Approved handler's name + contact details known and cetrification current?

  Yes

  No

  N/A

• Electrical certificate of compliance (or revalidation) issued and current?

  Yes

  No

  N/A

• Building Warrant of Fitness current and on display?

  Yes

  No

  N/A