Title Page

  • Conducted on

  • Prepared by

  • Annual reminders:
    • Hold SPCC Briefing for all oil-handling personnel (and update briefing log in the Plan);
    • Check contact information for key employees and response/cleanup contractors and update
    them in the Plan as needed;

Annual Facility Inspection Checklist

  • This inspection record must be completed each year. If any response requires further elaboration, provide comments in Description & Comments space provided. Further description and comments, if necessary, must be provided on a separate sheet of paper and attached to this sheet. *Any item that receives “yes” as an answer must be described and addressed immediately.

Storage Tanks

Tank FO-1

  • Tank surface shows signs of leakage

  • Description & Comments

  • Tank is damaged, rusted, deteriorated or corroded

  • Description & Comments

  • Bolts, rivets, or seams are damaged

  • Description & Comments

  • Tank support is deteriorated or buckled

  • Description & Comments

  • Tank foundation has eroded or settled

  • Description & Comments

  • Level gauge or alarm is inoperative

  • Description & Comments

  • Vent is obstructed

  • Description & Comments

  • Interstitial space contains no liquid

  • Description & Comments

Tank FT-1

  • Tank surface shows signs of leakage

  • Description & Comments

  • Tank is damaged, rusted, deteriorated or corroded

  • Description & Comments

  • Bolts, rivets, or seams are damaged

  • Description & Comments

  • Tank support is deteriorated or buckled

  • Description & Comments

  • Tank foundation has eroded or settled

  • Description & Comments

  • Level gauge or alarm is inoperative

  • Description & Comments

  • Vent is obstructed

  • Description & Comments

  • Secondary containment is damaged or stained

  • Description & Comments

Piping

  • Valve seals, gaskets, or other appurtenances are leaking

  • Description & Comments

  • Pipelines or supports are damaged or deteriorated

  • Description & Comments

  • Joints, valves and other appurtenances are leaking

  • Description & Comments

  • Fill and discharge piping is not properly connected

  • Description & Comments

Loading/unloading and transfer equipment

  • Connections are not capped or blank-flanged

  • Description & Comments

  • Secondary containment is damaged or stained

  • Description & Comments

Security

  • Fencing, gates, or lighting is non-functional

  • Description & Comments

Response equipment

  • Response equipment inventory is incomplete

  • Description & Comments

  • Additional Remarks:

  • Print Name and Sign

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.