ATA 103 Checklist Template

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ATA 103 Checklist Template

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Audit

Introduction

Auditing tool used to inspect fueling equipment. This inspection is based off of ATA 103 and includes further details to help monitor overall safety of the user and their equipment.

GENERAL ITEMS

Station

Inspection Date

Select date

Equipment Inspected By:

Signature

INSPECTIONS

Fueling Equipment Inspection

Fueling Equipment Type

Select Hydrant Cart Solar Cart Hydrant Truck Tanker

Equipment Number

GENERAL INSPECTION

Damages

SAT N/A UNSAT

Tow Bar

SAT N/A UNSAT

Tire Condition

SAT N/A UNSAT

Brakes

SAT N/A UNSAT

Equipment Movable

SAT N/A UNSAT

SAFETY INTERLOCKS

Tow Bar Interlocks

Yes No N/A

Nozzle Coupler Interlock

SAT N/A UNSAT

Pit Coupler Interlock

SAT N/A UNSAT

Lift Deck Nozzle Coupler Interlocks

SAT N/A UNSAT

Lift Deck Interlock

SAT N/A UNSAT

Interlock Override

Yes No N/A

DECALS

Equipment #

SAT N/A UNSAT

Jet A

SAT N/A UNSAT

Flammable

SAT N/A UNSAT

No Smoking

SAT N/A UNSAT

Swissport Identification

SAT N/A UNSAT

GAUGES

Gauge Conditions

SAT N/A UNSAT

Max PSI Labeled

SAT N/A UNSAT

Accumulator PSI Correct

SAT N/A UNSAT

Surge PSI Correct

SAT N/A UNSAT

EMERGENCY FUEL SHUT-OFFS

Main panel EFSO Function

SAT N/A UNSAT

Secondary EFSO Function

SAT N/A UNSAT

Rear EFSO Function

SAT N/A UNSAT

Lift Deck EFSO Function

SAT N/A UNSAT

All EFSO Properly Label

SAT N/A UNSAT

FIRE AND SAFETY

Meter Sealed

Yes No N/A

Deadman Function

SAT N/A UNSAT

Bonding Cable and Clamp Condition

SAT N/A UNSAT

Product Recovery Tank Condition

SAT N/A UNSAT

PRT Lid Seal

Yes No N/A

Fire Extinguisher Condition

SAT N/A UNSAT

Extinguisher Sealed

SAT N/A UNSAT

Annual Extinguisher Inspection Current

SAT N/A UNSAT

Extinguisher Bracket Condition

SAT N/A UNSAT

LIFT DECK

Lift Platform Condition

SAT N/A UNSAT

Lift Function Operational

SAT N/A UNSAT

Emergency Lift Release Function

SAT N/A UNSAT

Wing Protectors

SAT N/A UNSAT

NOZZLES

Condition

SAT N/A UNSAT

Safety seal

Yes No N/A

Dust Covers

Yes No N/A

Nose Seal

Yes No N/A

Lift Deck Nozzle Couplers Condition

SAT N/A UNSAT

PIT COUPLER

Condition

SAT N/A UNSAT

Safety seal

Yes No N/A

Dust Covers

Yes No N/A

Nose Seal

Yes No N/A

HOSES

Nozzle Hose Condition

SAT N/A UNSAT

Pit Coupler Hose Condition

Yes No N/A

Lift Deck Nozzle Hose Conditions

SAT N/A UNSAT

Jack Risers Hose Condition

SAT N/A UNSAT

ELECTRIC

Solar Panel

SAT N/A UNSAT

Batteries Cleaned and Protected

Yes No N/A

Fuse panel Covered

Yes No N/A

TANKERS ONLY

Tanker Lid Condition

SAT N/A UNSAT

Tanker Lid properly install to close in forward motion

SAT N/A UNSAT

Tanker Trough Drains

SAT N/A UNSAT

Tanker Bottom Load Pre-Check

SAT N/A UNSAT

CONCLUSIONS

Does the Fueling Equipment Pass Inspection

Passed Failed

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Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.