Gas Station Inspection

Checklist
Inspect fueling and service stations for safety and proper waste management. Using the Fulcrum
app, you could customize this checklist to suit the needs of your facility. Find the digital version of
this form and more at https://www.fulcrumapp.com/apps/fuel-station-inspection.

Facility Information
Facility Name

Facility Address Street Address

City, State, Zip

Facility Contact Person

Phone Number

General Inspection
Number of Employees

Utilities Present ☐ City Sewer ☐ Septic

Choose all that apply.
☐ City Water ☐ Other (specify) __________________
☐ Well Water
Who services pumps? ☐ Full-time Employee ☐ Part-time Employee
Choose one.
☐ Contractor ☐ Other (specify) __________________
☐ Outside Company
Are spill kits on site?
☐ Yes ☐ No

Get the digital version of this checklist and more at fulcrumapp.com/checklists.

fulcrumapp.com/checklist. 1
 Retail store on site?
☐ Yes ☐ No
How are damaged/waste products handled?

Spill kits located in store?

☐ Yes ☐ No
Car wash on site? Is there a car wash facility on site?
☐ Yes ☐ No
Who services car wash?

How often is car wash serviced? Choose one.

☐ Daily ☐ Quarterly
☐ Weekly ☐ Annually
☐ Monthly

Who is contacted in the event of a spill?

Fire Department?
☐ Yes ☐ No
Police?
☐ Yes ☐ No
Corporate Contact Person?
☐ Yes ☐ No
Corporate Contact Name

Get the digital version of this checklist and more at fulcrumapp.com/checklists.

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 Environmental Company/Agency?
☐ Yes ☐ No
Environmental Contact Name

Site Photos

Attach Key Photos Here

With Fulcrum, photos

you take with your phone
automatically get included
with the rest of your data.

Get the digital version of this checklist and more at fulcrumapp.com/checklists.

fulcrumapp.com/checklist. 3
 Certification
Passed? ☐ Pass ☐ Fail
Name of [inspector/
operator/other]
Please print

Signature

Date / /

Time : AM / PM

Fulcrum is a mobile app creation platform that lets you digitize checklists like this
easily — and automate related workflows! — without writing any code.

Check us out at fulcrumapp.com/checklists

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