LOSS CONTROL ACADEMYINTERACTIVE FIELD MODULE · 2026 EDITION
Gas Station — Field Module
Fuel Dispensing & Convenience Store Field Worksheet
Observe fuel islands and stores separately. Describe emergency shutoffs and equipment visibly present; do not claim functionality or environmental compliance without supporting records.
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Risk / Building / Sales
Insured / DBA / contact
Location / website / phone
Survey date / inspector
Operating hours / staffing
Store SF / stories / construction
Canopy size / construction / condition
Recent upgrades / renovations
Gross sales / fuel vs store sales
Distinguish store sales, fuel sales, ancillary operations and operating entities.
Store / Cooking / Goods
Products or departments sold
FuelConvenience itemsBeer/wineTobaccoFood-to-goIceLotteryOther
Select applicable categories
Food preparation / cooking equipment
Hood / suppression / service if applicable
Alcohol licensing if applicable
Interior aisles / customer restroom / ATM
BPP / inventory / refrigerated stock
A separate cooking supplement is appropriate when commercial food preparation is present.
Fuel Dispensing Islands
Dispensers / nozzle count
Breakaway couplings / hose condition
Exterior/interior emergency shutoffs
No-smoking / engine-off / hazard signs
Bollards / dispenser crash protection
Canopy / paving / drains / spills
Fuel storage configuration / quantities
Count physical dispensing equipment and document visible impact/ignition controls.
Tank / Spill / Specialty Fuel Controls
Leak detection / tank monitoring
Spill kits / cleanup / incident response
Delivery fill ports / secondary containment
LPG sales / exchange / dispensing
LPG cage placement / locks / signage
Tank / fuel equipment inspection records
For underground or aboveground storage, record monitoring information as reported or documented—do not assess legal compliance.
Other Businesses / Premises
Automated carwash on site?Yes No Not observed Unable to confirm Not applicable
Choose Yes, No or Unable to confirm
Hand carwash or detail services?Yes No Not observed Unable to confirm Not applicable
Choose Yes, No or Unable to confirm
Carwash ownership / lease / COI
Tall roadside sign / supports
Lot lighting / trip/fall conditions
Ancillary services can create additional premises, auto and vendor exposures.
Fire / Security / Claims
Burglar alarm / cameras / cash control
Alarm / sprinklers / extinguishers
Exit signs / emergency lighting
Panel / wiring / pump area observation
Losses last three years
Records/areas not inspected
Check service labels and avoid treating alarm presence as proof of monitoring.
Photographs to Obtain
Check when obtained. Priority photographs are bold; required only where applicable, safe and permitted. Record restricted access or missing documentation.
☐Roadside sign, storefront and address
☐Fuel canopy, dispensers and nozzles
☐Hose breakaways and physical protection
☐Emergency shutoff locations and labeling
☐No-smoking / safety signage
☐Tank fill/monitor system (accessible view)
☐LPG cages or dispensing if present
☐Cooking appliances, hood and service tags if present
☐Fire extinguisher tag and electrical panel
☐Carwash and service vendor areas if present
☐Parking, walkways and pavement
☐Conditions supporting recommendations
Editable Narrative Insert
Replace bracketed cues with reported or verified facts; delete claims that do not apply. Save your draft and copy the finished narrative into the report.
The risk, [name/DBA], operates a fuel station and convenience store at [address] in a [stories/SF/construction] building, with a [SF/type] canopy. Hours are [times], with [staffing]. Retail merchandise includes [goods], and cooking or food service consists of [details]. Annual sales are estimated at [fuel value] for fuel and [store value] for merchandise (reported by [source]).
Fuel operations consist of [dispenser count] dispensers and [nozzle count] nozzles. Visible hose breakaways, emergency shutoffs, bollards and signage were [observations]. Tanks, fuel monitoring and service records were described/provided as [details]; their operation was not independently tested. Other operations consist of [LPG, carwash, outside vendors as applicable].
Fire and theft protection consists of [systems/service evidence]. Pavement, pedestrian areas and the premises were [observations]. Reported losses within the last three years include [details]. Items not independently verified were [limitations].
The risk, [name/DBA], operates a fuel station and convenience store at [address] in a [stories/SF/construction] building, with a [SF/type] canopy. Hours are [times], with [staffing]. Retail merchandise includes [goods], and cooking or food service consists of [details]. Annual sales are estimated at [fuel value] for fuel and [store value] for merchandise (reported by [source]).
Fuel operations consist of [dispenser count] dispensers and [nozzle count] nozzles. Visible hose breakaways, emergency shutoffs, bollards and signage were [observations]. Tanks, fuel monitoring and service records were described/provided as [details]; their operation was not independently tested. Other operations consist of [LPG, carwash, outside vendors as applicable].
Fire and theft protection consists of [systems/service evidence]. Pavement, pedestrian areas and the premises were [observations]. Reported losses within the last three years include [details]. Items not independently verified were [limitations].
Recommendations / Follow-Up
Document only visible or otherwise supported concerns. Cite the condition, location and action needed. Use “unable to confirm” where appropriate.