Gas Station Site Survey Form
Please complete this form to evaluate the essential aspects of the gas station site. Your feedback helps ensure quality and safety standards are met.
Overall Site Condition
*
1
2
3
4
5
Cleanliness of Forecourt and Pumps
*
1
2
3
4
5
Lighting Adequacy (Day & Night)
*
1
2
3
4
5
Signage Visibility
*
Highly visible from all approaches
Visible from main road only
Partially obstructed
Not visible
Pump Functionality Issues Observed
*
Out of order pumps
Slow dispensing
Leaking or spills
No issues observed
Safety Features Present
*
Fire extinguishers accessible
Emergency shut-off switch
First aid kit visible
Spill containment materials
Restroom Condition
*
Clean and well-stocked
Clean but lacking supplies
Dirty or poorly maintained
Restroom not available
Convenience Store Quality
*
1
2
3
4
5
Exterior Maintenance (Landscaping, Trash, Paint)
*
Excellent
Good
Fair
Poor
Staff Presence and Helpfulness
*
Staff present and helpful
Staff present but unhelpful
No staff present
Submit Survey
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