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Self-Service Motor Fuel Facility Inspection

This inspection checklist monitors the compliance activities at the facility. It also serves as a hazard assessment to current activities. The inspection shall be completed in all areas of the facility that are applicable.
MaintainX
07/22/2022

Self-Service Motor Fuel Facility Inspection

This inspection checklist monitors the compliance activities at the facility. It also serves as a hazard assessment to current activities. The inspection shall be completed in all areas of the facility that are applicable.
  • Facility

  • Address

  • Owner/Manager

  • Date of Inspection

  • City/Town

  • License (FP-002) to store flammable liquids posted

    • Pass
    • Flag
    • Fail
  • Certificate of Registration

    • Pass
    • Flag
    • Fail
  • Permit to store flammable and combustible liquids

    • Pass
    • Flag
    • Fail
  • Fire suppression system inspected semi-annually

    • Pass
    • Flag
    • Fail
  • Fuel nozzles shall not surpass outer PLB grooves

    • Pass
    • Flag
    • Fail
  • In no event fuel hose shall exceed 18ft

    • Pass
    • Flag
    • Fail
  • Automatic shutoff fuel dispensing nozzles installed with hold/latch open device (new and under maintenance facilities)

    • Pass
    • Flag
    • Fail
  • Portable fire extinguisher on island(s) minimum 80 BC rating inspected annually by a company with Certificate of Registration

    • Pass
    • Flag
    • Fail
  • Fire suppression system installed, according to State Fire Marshal

    • Pass
    • Flag
    • Fail
  • Console operator has been instructed and trained on operations of the service facility including the suppression system emergency controls

    • Pass
    • Flag
    • Fail
  • Positive Limiting Barrier (PLB) installed/maintained according to site plans. (Free of dirt and debris)

    • Pass
    • Flag
    • Fail
  • “Extinguish All Smoking Materials & Stop Engine While Refueling” sign posted on both ends of pump dispensing island. Shall consist of block letters no less than 2 inches in height and either be red letters on white background or white letters on red background

    • Pass
    • Flag
    • Fail
  • Controlling console in constant attendance by operator during pump operations

    • Pass
    • Flag
    • Fail
  • Intercom system maintained in proper operating conditions on each island

    • Pass
    • Flag
    • Fail
  • Convex mirrors or CCTV cameras & monitors are installed and maintained to provide visibility

    • Pass
    • Flag
    • Fail
  • Clear and unobstructed view to dispensing island from console operator

    • Pass
    • Flag
    • Fail
  • Controlling console includes an emergency shut off switch which instantly cuts all pumping power to all fuel pumps

    • Pass
    • Flag
    • Fail
  • Automatic credit card reading device installed and does not activate dispenser

    • Pass
    • Flag
    • Fail
  • Split island facility: Emergency switch installed and accessible on full service islands, which activate fire suppression system and deactivate power to self-service dispensers

    • Pass
    • Flag
    • Fail
  • Comments:

  • Inspected By:

  • Operator Name (print):

  • Date:

  • Operator Signature

    Click here to sign
Source: MaintainX (Community Member)

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