Gas Station — LCA Field Module

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

Underwriting Focus — Risk / Building / Sales

Distinguish store sales, fuel sales, ancillary operations and operating entities.

Store / Cooking / Goods

Food preparation / cooking equipment

Hood / suppression / service if applicable

Alcohol licensing if applicable

Interior aisles / customer restroom / ATM

BPP / inventory / refrigerated stock

Underwriting Focus — Store / Cooking / Goods

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

Underwriting Focus — Fuel Dispensing Islands

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

Underwriting Focus — Tank / Spill / Specialty Fuel Controls

For underground or aboveground storage, record monitoring information as reported or documented—do not assess legal compliance.

Other Businesses / Premises

Automated carwash on site?

Choose Yes, No or Unable to confirm

Hand carwash or detail services?

Choose Yes, No or Unable to confirm

Carwash ownership / lease / COI

Tall roadside sign / supports

Lot lighting / trip/fall conditions

Underwriting Focus — Other Businesses / Premises

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

Underwriting Focus — Fire / Security / Claims

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.

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.