Checklist template

Emergency response readiness for convenience stores

A ready-to-use checklist with 120 items in 6 sections, covering Fire equipment, Fuel emergencies, First aid, Contacts, Training, Drills. Use it as-is in Bindy, or adapt it to your own standards in minutes.

  • 6 Sections
  • 120 Items
  • 101 Yes / No checks
  • 6 Scored ratings
  • 131 Points

Use this template How audits work

1. Fire equipment 23 items

  1. A portable fire extinguisher is mounted at the sales counter Yes / No 1 pt
  2. A portable fire extinguisher is mounted in the back room or stockroom Yes / No 1 pt
  3. A fire extinguisher is mounted at the fuel islands or on the storefront facing them, as required by the fire authority Yes / No 1 pt
  4. A class K extinguisher is mounted near the fryer, where the store fries food Yes / No 1 pt
  5. Each extinguisher has a pressure gauge in the green zone Yes / No 1 pt
  6. Each extinguisher carries an inspection tag dated within the last 12 months Yes / No 1 pt
  7. Each extinguisher tag is initialed for the monthly visual check Yes / No 1 pt
  8. No extinguisher is blocked by merchandise, cartons or equipment Yes / No 1 pt
  9. Each extinguisher location is marked by a sign visible above shelf height Yes / No 1 pt
  10. The hood suppression system over the fryer carries a service tag that is in date for the interval required by the fire authority Yes / No 1 pt
  11. Emergency lights come on when their test button is pressed Yes / No 1 pt
  12. Exit signs are lit over every exit door Yes / No 1 pt
  13. The rear exit door opens from the inside without a key Yes / No 1 pt
  14. The rear exit path is clear of stock, totes and trash for its full width Yes / No 1 pt
  15. Nothing is stored within 18 in (45 cm) below the sprinkler heads, where the store has sprinklers Yes / No 1 pt
  16. The electrical panel has 3 ft (1 m) of clear space in front of it Yes / No 1 pt
  17. The fire alarm panel, where installed, shows no trouble signal Yes / No 1 pt
  18. Smoke detectors in the back room and office were tested within the period set by company policy, per the record Yes / No 1 pt
  19. Lighter fluid, charcoal and propane accessories on the sales floor are displayed away from heat sources Yes / No 1 pt
  20. A flashlight with working batteries is kept at the counter Yes / No 1 pt
  21. Extinguishers found with an expired tag or low pressure Number
  22. Date of the last annual fire extinguisher service Date
  23. Condition of fire equipment Rating
    • In date, charged and reachable 5 pts
    • One or two defects 3 pts
    • Several defects or equipment missing 1 pt

2. Fuel emergencies 24 items

  1. The emergency fuel shutoff switch is marked by a sign that can be read from the forecourt Yes / No 1 pt
  2. A second emergency shutoff is at the cashier's position, within reach Yes / No 1 pt
  3. The employee on duty can point to each emergency shutoff without searching Yes / No 1 pt
  4. The emergency shutoff was tested within the period set by company policy, per the record Yes / No 1 pt
  5. Nothing blocks access to the emergency shutoff switches Yes / No 1 pt
  6. The pump controller's "all stop" key is known to the employee on duty Yes / No 1 pt
  7. A fuel spill kit (absorbent, pads, drain cover, disposal bags) is kept within reach of the forecourt Yes / No 1 pt
  8. The spill kit is complete against the contents list inside the lid Yes / No 1 pt
  9. A filled bucket or bag of absorbent is at each fuel island Yes / No 1 pt
  10. The employee can state the size of spill above which the fire department is called, per company policy Yes / No 1 pt
  11. The employee can describe the steps for a fuel spill: stop the pumps, keep people and vehicles away, contain, call Yes / No 1 pt
  12. Storm drains near the fuel islands can be covered with the drain cover or boom in the kit Yes / No 1 pt
  13. Used absorbent is placed in the marked, lidded metal container, not in the regular trash Yes / No 1 pt
  14. Breakaway couplings are fitted on each fuel hose Yes / No 1 pt
  15. Collision posts protect each dispenser, with none bent or missing Yes / No 1 pt
  16. The procedure for a vehicle striking a dispenser is posted or in the emergency binder Yes / No 1 pt
  17. The procedure for a vehicle fire at the pumps tells the employee to stop the pumps and stay clear Yes / No 1 pt
  18. The tank monitor alarm is audible in the store Yes / No 1 pt
  19. The employee knows whom to call when the tank monitor alarms Yes / No 1 pt
  20. "No smoking, stop engine" signs are on every dispenser Yes / No 1 pt
  21. The propane exchange cage is locked Yes / No 1 pt
  22. The propane exchange cage stands clear of the entrance door and of ignition sources Yes / No 1 pt
  23. Fuel spills recorded in the last 12 months Number
  24. Readiness of the store for a fuel spill or pump fire Rating
    • Shutoffs known, kit complete 5 pts
    • Kit incomplete or shutoff location unsure 3 pts
    • No kit, or shutoff unknown to the employee 1 pt

3. First aid 20 items

  1. A first aid kit is kept in a marked location known to the employee on duty Yes / No 1 pt
  2. The first aid kit is stocked against its contents list Yes / No 1 pt
  3. No item in the first aid kit is past its expiry date Yes / No 1 pt
  4. The first aid kit was checked in the last month, per its checklist Yes / No 1 pt
  5. Disposable gloves are in the first aid kit Yes / No 1 pt
  6. A body fluid cleanup kit is available in the store Yes / No 1 pt
  7. Burn dressings or burn gel are in the kit, where the store prepares hot food Yes / No 1 pt
  8. An eyewash bottle or station is available where chemicals or fuel can splash Yes / No 1 pt
  9. The eyewash solution is within its expiry date Yes / No 1 pt
  10. An automated external defibrillator is on site, where company policy provides one Yes / No 1 pt
  11. The defibrillator shows a ready status indicator Yes / No 1 pt
  12. The defibrillator pads are within their expiry date Yes / No 1 pt
  13. At least one employee per shift holds a current first aid certificate, where local regulation or company policy requires it Yes / No 1 pt
  14. The employee can describe what to do when a customer collapses: call the emergency number, stay with the person, send someone to meet the ambulance Yes / No 1 pt
  15. Employees do not give medication from the sales floor to an ill customer, per company policy Yes / No 1 pt
  16. Overdose response supplies are on site, where company policy provides them Yes / No 1 pt
  17. Safety data sheets for the chemicals and fuels on site are in a binder or on the store tablet Yes / No 1 pt
  18. Expired items found in the first aid kit Number
  19. Date of the last documented check of the first aid kit Date
  20. Condition of first aid supplies Rating
    • Complete and in date 5 pts
    • A few items missing or expired 3 pts
    • Kit missing or largely empty 1 pt

4. Contacts 20 items

  1. The emergency contact list is posted at the counter, out of customers' view Yes / No 1 pt
  2. The list was updated within the period set by company policy, per the date on it Yes / No 1 pt
  3. The list gives the store manager's cell phone number Yes / No 1 pt
  4. The list gives the district manager's phone number Yes / No 1 pt
  5. The list gives the fuel supplier's or fuel maintenance contractor's emergency number Yes / No 1 pt
  6. The list gives the environmental spill reporting number required for the area Yes / No 1 pt
  7. The list gives the alarm monitoring company's number and the store's account number Yes / No 1 pt
  8. The list gives the utility emergency numbers for gas and electricity Yes / No 1 pt
  9. The list gives the refrigeration contractor's after-hours number Yes / No 1 pt
  10. The list gives the company's incident or risk management hotline Yes / No 1 pt
  11. The store's street address and nearest cross street are written at the phone for emergency calls Yes / No 1 pt
  12. A call to one number picked from the list during the visit reached the right person or service Yes / No 1 pt
  13. The manager on call answered a test call within the time set by company policy Yes / No 1 pt
  14. The emergency binder is at the store, in the place named in company policy Yes / No 1 pt
  15. The location of the main electrical disconnect is marked on a site plan in the binder Yes / No 1 pt
  16. The location of the main gas shutoff valve is marked on the site plan Yes / No 1 pt
  17. The location of the main water shutoff valve is marked on the site plan Yes / No 1 pt
  18. The media and police inquiry instruction (refer to the head office) is in the binder Yes / No 1 pt
  19. Date printed on the emergency contact list Date
  20. Emergency contact information Rating
    • Complete, current and tested 5 pts
    • Posted but partly out of date 3 pts
    • Missing or unusable 1 pt

5. Training 16 items

  1. Each employee completed emergency procedure training during onboarding, per the training record Yes / No 1 pt
  2. Each employee has been shown how to operate a fire extinguisher (pull, aim, squeeze, sweep) Yes / No 1 pt
  3. Employees know they fight a fire only when it is small and their exit is behind them Yes / No 1 pt
  4. Each employee who works alone has operated the emergency fuel shutoff in training, or walked through it Yes / No 1 pt
  5. Each employee has been trained to use the fuel spill kit Yes / No 1 pt
  6. Employees can state the outdoor assembly point Yes / No 1 pt
  7. Employees know to keep customers from re-entering until the fire department allows it Yes / No 1 pt
  8. Employees can describe what to do in a power outage (pumps stop, doors, cash, refrigerated food) Yes / No 1 pt
  9. Employees can describe what to do when a customer smells gas or fuel vapor inside the store Yes / No 1 pt
  10. Employees can describe the severe weather shelter location for the store Yes / No 1 pt
  11. Employees know not to use the cooler or freezer as a shelter unless company policy names it Yes / No 1 pt
  12. Emergency training is refreshed at the interval set by company policy Yes / No 1 pt
  13. The employee on duty answered 3 scenario questions correctly during this visit Yes / No 1 pt
  14. Employees on the current schedule with no emergency training on record Number
  15. Name of the employee questioned during the visit Short text
  16. Knowledge of emergency procedures shown by the employee questioned Rating
    • Confident and correct 5 pts
    • Hesitant, or partly correct 3 pts
    • Does not know the procedures 1 pt

6. Drills 17 items

  1. An evacuation drill or walk-through was held within the period set by company policy Yes / No 1 pt
  2. The drill record lists the date and the employees who took part Yes / No 1 pt
  3. A fuel spill drill or tabletop exercise was held within the period set by company policy Yes / No 1 pt
  4. A drill of the emergency fuel shutoff was held with the night shift, not only the day shift Yes / No 1 pt
  5. A medical emergency scenario was practiced or discussed at a team meeting in the last 12 months Yes / No 1 pt
  6. Points to improve were written down after the last drill Yes / No 1 pt
  7. The points to improve from the last drill have been corrected Yes / No 1 pt
  8. Real emergencies in the last 12 months were reviewed afterward with the employees involved Yes / No 1 pt
  9. Each real emergency in the last 12 months has an incident report on file Yes / No 1 pt
  10. The fire department or fire marshal's last inspection report is on file Yes / No 1 pt
  11. Each item noted on the last fire inspection report has been corrected Yes / No 1 pt
  12. Date of the last evacuation drill Date
  13. Date of the last fuel spill drill Date
  14. Real emergencies (fire, fuel spill, medical) in the last 12 months Number
  15. Name of the person completing this inspection Short text
  16. Overall emergency readiness of the store Rating
    • Strong 5 pts
    • Partial 3 pts
    • Weak 1 pt
  17. Corrective actions required Comments

About this template

This checklist is part of the Bindy template library. Yes / No checks score 1 point when met; ratings score the points shown for each option. The overall score is the percentage of points earned, with N/A answers excluded. In Bindy you can add photos, assign corrective actions, require sign-off and compare results across sites.

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