Document No.

NAYA-MKT-HSEF-16-R1

Issue/Rev No. 1.0/1

Periodic Self Assessment of HSE controls at Retail Outlet

Name Of The RO:
RO Code:
Zone :
ROType (COCO/CODO/DODO/PCODO):
Assessment By:
Date:

Sl. No. Description Criticality Observation(Yes/No) Score Obtained

Safety Equipment
Are 9 Kg DCP type fire extinguishers provided?(2 Nos per DU and
1 High 5
one for sales building)
Are 4.5 Kg CO2 type fire extinguishers provided in electrical panel
2 High 5
room?

3 Are sand buckets with dry, free flow sand available at filling points ? High 5

4 Are sand buckets with dry, free flow sand available at tank farm? High 5
5 Is there a provision of at least 2 points for emergency shutdown? High 5
Is emergency stop system provided to cut off the power supply to all
6 metering pumps or dispensing equipment and associated High 5
equipment?
Is the push button for emergency stop of red colour, mushroom
7 Low 1
type, marked and has a key to open.
Tank Farm Operation & TT Unloading at RO
8 Is the vent pipe of tank located as per requirement? Medium 3
9 Is the wire gauge of the vent cap cleaned on regular basis? Medium 3
10 Is the tank manhole chamber free of rubbish & oil spillage? Low 1
11 Are tank curb walls / pipe railings in good condition? Low 1
12 Are TT discharge points distinctively painted / marked? Medium 3
Are sand buckets and fire extinguishers positioned near the TT
13 High 5
during TT unloading?
14 Is Earthing & bonding wire connected while decanting the TT? High 5
Are the fill points of tanks so located that the TT under decantation,
15 Low 1
is in drive out position?
16 Are the earthing wires at Tank Farm well-maintained? High 5
Forecourt Operation
17 Is illumination level adequate during night time? Medium 3
18 Is the illumination glare-free for customers driving in? Low 1
Are RO staff trained in fire extinguisher operation and operation of
19 High 5
emergency switches?
20 Are FSMs following rules related to 'No use of Mobile at Forecourt'? Low 1

21 Is 'Switching off engine before fuelling' followed? Medium 3

Electrical Safety
22 Is Earth Pit Testing record available at RO? Medium 3
23 Is result of Earth Pit Testing within Permissible limit? Medium 3
24 Is there any loose wiring in the pump? Medium 3
25 Is there any loose wiring in the switch board? Medium 3
26 Is Rubber Mat placed at every Panel? Medium 3
Is the shock treatment chart available in electrical room and all
27 Medium 3
concerned persons trained on the treatment procedures?
28 Are the light fixtures in good condition? Medium 3
Is electrical room used as store room - (Old tyres drums, hose
29 Low 1
pipes, unwanted materials, etc stored inside) ?
General Points
30 Is valid PESO License & Drawing available at site? High 5
Are suitable caution boards or signages displayed at areas where
31 Medium 3
required?
Are safety signages like emergency numbers Police, Fire Brigade,
32 Hospital; No Smoking, T/L under decantation and explosive licence Medium 3
no. displayed?
Is there any unauthorised facility inside and at the ingress / egress
33 Medium 3
of RO? Are vehicles parked at Ingress and Egress?
34 Is well equipped first-aid box kept inside sales building? Medium 3
35 Is any mock drill conducted at RO at least once a year? Medium 3
Is there any spillage observed in forecourt, Tank Farm or any other
36 Low 1
places inside the RO?
37 Is work permit system implemented at RO? Medium 3
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