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Petrol licence insp form

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					                                     PETROL FILLING STATION AUDIT AND INSPECTION
1.      General Information

Date:

Inspecting Officer:

Site Name & Address                         Company Owned                                       Type of Operation

                                            Dealer Operated                                     Attended Self Service

Contact Name:                               Independent                                         Attended Service

                                                                                                Unattended Service

Post Code                                   Retail Petrol Filling Station/Workplace/Farm

Tel No.                                     No of Staff Employed

E-mail:                                     No of Competent Persons (For Assisted Deliveries)

                                            Driver Controlled Delivery


Total Quantity Stored on Site:

No of Petrol Tanks and capacity of tanks:

No of Diesel Tanks:

No of Other Fuel Tanks:
    2.      Administrative Records & Procedures
Audit Item                           Statutory Reason                   Satisfactory & Comments
Current Petroleum Licence &          PCA Section 1                      Yes
Conditions available?                                                   No

Are there Special or Additional           PCA Section 2                 Yes
Conditions of Licence?                                                  No

Are staff aware of Conditions of          DSEAR Regulation 11           Yes
Licence?                                                                No

Are there any current Site Plans          DSEAR ACoP L136               Yes
available?                                Control & Mitigation          No

Is there a current tank to pump                                         Yes
diagram?                                                                No

Is there an Electrical Test Certificate   DSEAR Regulation 6;           Yes
that covers the hazardous areas?          Electricity at Work Regs NI   No
                                          1991
Are there current Hazardous Waste         Licence Conditions 4.2;       Yes
Transfer Notes or Certificate             DSEAR Reg 6 ACoP L137         No
available?                                Safe Maintenance              N/A

Does the Operator maintain a Site         Best Practice                 Yes
Register?                                                               No

Are Wet Stock Records/delivery            Licensing Conditions 4.1;     Yes
certificates maintained?                  DSEAR Reg 6 L136              No
                                          Controls
From the records is there any evidence   Licensing Conditions 4.1;   Yes
of significant gains or losses?          DSEAR Reg 6 ACoP L136       No
                                         Controls
Does the Site Operate Statistical        Licensing Conditions 4.1;   Yes
Inventory Reconciliation? (SIR)          DSEAR Reg 6 ACoP 136        No
                                         Controls
Is there a Site Operating Manual kept?   DSEAR Regulation 9          Yes
                                                                     No

Is there a risk assessment in            DSEAR Reg 5 ACoP L138       Yes
accordance with DSEAR?                   General Requirements        No
                                                                     N/A

Does the DSEAR Risk Assessment           DSEAR Reg 5 ACoP L133       Yes
include Tanker Deliveries?               Tanker Deliveries           No
                                                                     N/A

Is there a Competent Person in charge    Licensing Conditions 1.4;   Yes
of the Site?                             DSEAR Regulations 6 & 9     No

Are there any Staff Training Records?    DSEAR Regulation 9          Yes
                                                                     No

Does the site have an Emergency          DSEAR Regulation 8          Yes
Action/Response Plan?                                                No

Are there safety procedures in place to DSEAR Regulation 8           Yes
protect employees against a                                          No
Dangerous Substance? Eg SDS & PPE
Is there a First Aid Kit on site?       DSEAR Regulation 8           Yes
                                                                     No
Are there records of maintenance of    Licensing Condition 4.2   Yes
fire fighting equipment?               DSEAR reg 8               No

Is there an Accident/Incident Book     DSEAR Reg 8               Yes
held on site?                                                    No

Is there a Pollution Response or       DSEAR Reg 8               Yes
Restoration Plan in place?                                       No


    3.     Storage Tanks, Vents & Vapour Recovery
Inspection Item                       Statutory Reason           Satisfactory & Comments
Types of Tanks known?                 Best Practice              Yes
Single Skin Steel;/Double Skin                                   No
Steel/GRP/Composite
Are there discontinued Tanks on site? DSEAR Regulation 6         Yes
                                                                 No

Have they been made either             DSEAR Regulation 6        Yes
permanently or temporary safe                                    No

Are there any Above Ground Tanks?      DSEAR Regulation 6 ACoP   Yes
If so are they Bunded and free from    L135 Storage              No
debris?
Are there any LPG Storage Vessels      DSEAR Regulation 6        Yes
on site?(Autogas or Bulk Storage)                                No
See footnote 1
Do LPG Storage Vessels appear in       DSEAR Regulation 6        Yes
good condition, free from corrosion?                             No
                                                                 N/A
Are LPG Storage Vessels in a secure     DSEAR Regulation 6           Yes
Compound and protected against                                       No
impact collision?                                                    N/A

Method of Tank Filling satisfactory?    DSEAR Regulation 6 ACoP      Yes
(Off Set Fills or Direct)               L133 Tanker Deliveries       No

Are Tanks tagged and labelled           DSEAR Regulation 10;         Yes
                                        ACoP L135 Storage            No

Are Fill Pipes securely locked?         DSEAR Regulation 6; ACoP     Yes
                                        L135 Storage                 No

Has the number of Drop Lines for        DSEAR Regulation 6 ACoP      Yes
deliveries been specified?              L133 Tanker Deliveries PPC   No
                                        Regulations (Permit
                                        Requirements)

Does the Driver check the Ullage        DSEAR Regulation 6 ACoP      Yes
Space before dropping?                  L133 Tanker Deliveries;      No
                                        PPC Regulations (Permit
                                        Requirements
Dedicated Tanker Stand                  DSEAR Regulation 6 ACoP      Yes
provided?                               L135 Storage                 No

Is the tanker stand satisfactory with   DSEAR Regulation 6 ACoP      Yes
dedicated drainage?                     L133                         No

Gauge Measurement System (or            Licensing Condition 4.1;     Yes
Dipsticks) working?                     DSEAR Regulation 6           No
Are Tank Chambers free from surplus DSEAR Regulation 6               Yes
water                               ACoP L135 Storage                No

Are all visible pipe/cable ducts sealed   DSEAR Regulation 6; ACoP   Yes
in manhole chambers?                      L136 Controls              No

Is all visible pipe work free from        DSEAR Regulation 6         Yes
excess corrosion and sound?                                          No

Are manhole Lifting Key (s)               DSEAR Regulation 6         Yes
available?                                                           No

Are Manhole Chambers and Covers           DSEAR Regulation 6         Yes
in good condition?                                                   No

Has a Vapour Recovery Permit been         PPC Regulations            Yes
issued                                    (Permit Requirements)      No

Is Vapour Recovery Warning and            DSEAR Regulation 10        Yes
Indication Tags provided?                                            No

Are Vents & Vapour Recovery Lines         DSEAR Regulation 6         Yes
secure and undamaged?                     PPC Regulations            No

Is there any opening within 1.5           DSEAR Regulation 6         Yes
metres with VR or within 3 metres         PPC Regulations            No
for natural venting?

Are all vent lines tagged and             DSEAR Regulation 10; PPC   Yes
labelled?                                 Regulations (Permit        No
                                          Requirements)
Is there evidence of any test on the    PPC Regulations (Permit    Yes
VR System?                              Requirements)              No

Has any maintenance taken place on      Licensing Condition 4.2    Yes
the VR installation?                    PPC Regulations            No
                                        permit
Has the site installed Stage 2 Vapour   PPC Regulations            Yes
Recovery?                               (Permit Requirements)      No

Is Stage 2 VR fitted and monitored      PPC Regulations (Permit    Yes
and working?                            Requirements)              No

Is any dedicated Tanker Stand           DSEAR Regulation 6         Yes
Lighting working?                       ACoPL133 Tanker            No
                                        Deliveries
Is there an Unassisted Delivery         DSEAR Regulation 6 ACoP    Yes
Cabinet provided for the Tanker         L133 Tanker Deliveries     No
Driver?
Emergency Switch provided in the        DSEAR Regulation 6 ACoP    Yes
Cabinet?                                L133 Tanker Deliveries     No


4. Pumps/Dispensers & Electrical Aspects
Inspection Item                     Statutory Reason               Satisfactory & Comments
Are all Pumps numbered clearly?     DSEAR Regulation 6             Yes
                                                                   No

Do all Automatic Nozzle Shut Offs       Licensing Condition 2.4;   Yes
operate?                                DSEAR Regulation 6         No

Are all Delivery Hoses in good          Licensing Condition 2.4;   Yes
condition free from leaks?              DSEAR Regulation 6         No
Are visible Joints /Couplings free        Licensing Condition 2.4;   Yes
from any signs of wear and leaks?         DSEAR Regulation 6         No

Have all Trigger Latches been             DSEAR Regulation 6         Yes
removed?                                                             No

Are dispenser Housings Ventilated         DSEAR Regulation 6 ACoP    Yes
properly?                                 L134 Design of Plant &     No
                                          Equipment
Are there any cavities at the base of     DSEAR Regulation 6 ACoP    Yes
the pumps (old types)?                    L134 Design of Plant &     No
                                          Equipment
Are Check Valves (Suction System)         DSEAR Regulation 6 ACoP    Yes
fitted?                                   L134 Design of Plant &     No
                                          Equipment
Is a sump (pressure system) fitted?       DSEAR Regulation 6 ACoP    Yes
(dispenser will be smaller, unlikely to   L134 Design of Plant &     No
find these)                               Equipment
Are Lead Seals in position on             DSEAR Regulation 6 ACoP    Yes
metering devices?                         L136 Controls              No

Are Pump Operating Instructions           DSEAR Regulation 6         Yes
clearly displayed?                                                   No

Are Fuel Grades marked clearly?           DSEAR Regulation 6         Yes
                                                                     No

Are there any obvious signs of            Licensing Condition 2.4;   Yes
leakage?                                  DSEAR reg 6                No

Are all Dispensers secure on their        DSEAR Regulation 6         Yes
mountings?                                                           No
Are spillage control facilities          Licensing Conditions 2.4;     Yes
provided for? (lids and scoops)          DSEAR Regulation 6            No

Are Diesel/LPG Dispensers in good        DSEAR Regulation 6            Yes
order?                                                                 No

Is visibility an issue over the          DSEAR Regulation 6 ACoP       Yes
Dispensing area?                         L134 Design of Plant &        No
                                         Equipment                     N/A

Are Vehicle Parking arrangements         DSEAR Regulation 6            Yes
satisfactory                                                           No
                                                                       N/a

Is all Electrical Switchgear labelled?   Electricity at Work           Yes
                                         Regulations NI 1991           No

Type of Earthing known?                  Electricity at Work           Yes
(See Electrical Certificate)             Regulations NI 1991           No

Are all Electrical Ducts sealed where    DSEAR Regulation 6            Yes
they enter the building?                                               No

Can any uncertified electrical           Licensing Condition 4.2;      Yes
equipment be brought into the            DSEAR Regulations 6 & 7;      No
Hazardous Area? Eg car vac               Schedule 3
If a CCTV is installed as part of the    Licensing Condition Section   Yes
safety arrangements for dispensing, is   2 Special Condition DSEAR     No
it working adequately?                   Regulation 6                  N/A

Is the Public Address System             DSEAR Regulations 6 & 9       Yes
working and sufficiently audible                                       No
Is there an Emergency Isolation        DSEAR Regulation 8         Yes
Switch under the Console?                                         No
                                                                  N/A
Is there an Emergency Isolation        DSEAR Regulation 8         Yes
Switch on the fascia of any building                              No
suitably marked?                                                  N/A
If fitted, are all Canopy Lights       DSEAR Regulation 6         Yes
working?                                                          No
                                                                  N/a
Are all lights and switchgear that are Licensing Condition 4.2;   Yes
not protected outside of the hazardous DSEAR Regulation 6         No
areas?                                                            N/A

Are signs provided for all emergency   DSEAR Regulations 6 &      Yes
switches?                              Schedule 3                 No



5. Fire Safety, Signage and Drainage

Inspection Item                        Statutory Reason           Satisfactory & Comments
Are all Promotional Signs sited so not DSEAR Regulation 6         Yes
causing an obstruction?                                           No
                                                                  N/A

Are Fire Safety & Warning Signs        DSEAR Regulation 8         Yes
provided and legible?                                             No
                                                                  N/A
Is there a written fire procedure      Licensing Condition 2.4;   Yes
displayed or known?                    DSEAR L136 Controls;       No
                                                                  N/A
Are Fire Exits clear from                 DSEAR Regulation 8         Yes
obstructions?                                                        No
                                                                     N/A
Are LPG Cylinders stored outside on       DSEAR Regulation 6         Yes
the Forecourt? If so are they secure?                                No
                                                                     N/A
Are all Fire extinguishers checked        Licensing Condition 2.4;   Yes
and serviced at least once per year?      DSEAR Regulation 8         No

Are the numbers & types of                Licensing Condition 2.4;   Yes
extinguishers appropriate to the risk?    DSEAR Regulation 8         No
                                                                     N/A
Have all Staff been trained in fire       DSEAR Regulations 8 & 9    Yes
procedures and evacuation?                                           No
                                                                     N/A
Is an Interceptor or Separator            DSEAR Regulation 6 ACoP    Yes
provided?                                 L136 Controls              No
                                                                     N/A
Is there evidence of routine checks of    Licensing Condition        Yes
Separator?                                4.2                        No

Are the existing arrangements             Licensing Condition 4.2;   Yes
capable of taking up to 9,000 litres of   DSEAR Regulation 6 ACoP    No
product?                                  L136 Controls              N/A

Is the drainage system in good order      Licensing Condition 2.4;   Yes
& clear of debris and surplus             DSEAR Regulation 6 ACoP    No
product?                                  L136 Controls              N/A

Are all Storm Drains clear of debris      DSEAR Regulation 6 ACoP    Yes
and fuel?                                 L136 Controls              No
                                                                     N/A
Is there drainage at the              DSEAR Regulation 6 ACoP         Yes
entrance/exit/tanker stand?           L136 Controls                   No

   6. Other Matters/Actions Required

Audit Item                            Statutory Reason                Satisfactory & Comments
Has there been any fire, explosion,   Licensing Condition             Yes
leak or spillage on the site?         2.4
                                                                      No



Actions to be Taken - Tick as appropriate

   1.      No Action – Site is Satisfactory
   2.      Recommendations to be made
   3.      Contraventions Found – Letter to be issued
   4.      Contraventions Found – Improvement Notice Required
   5.      Dangerous Conditions Found – Prohibition Notice Required
   6.      Referral to other statutory body




   Footnote 1 – For further details in relation to inspections – Autogas, see Blue Book

				
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