Fuel Delivery Checklist and Submission

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Delivery Info

Driver Name*

Enter the driver's name.

Truck #*

Enter the truck number.

Date*

Enter the delivery date.

1

Before You Leave the Yard

Work order confirmed — customer, address, contact, product, quantity, tank ID

Pre-trip inspection complete — no unresolved safety-critical defects

Shipping documents, placards and SDS access on board

PPE on board: safety footwear, hi-vis, gloves, safety glasses

Fire extinguisher and spill kit on board and serviceable

Compartments loaded and verified against the work order

Route or permits confirmed if required

Notes

2

At the Site

Stop-Work Reminder You have the authority to stop or refuse a delivery any time a tank, product or safe capacity cannot be confirmed. No one will be disciplined for a good-faith stop-work decision.

Correct customer, site and tank confirmed

360° hazard check done — traffic, power lines, drains, ignition sources, footing

Truck parked, brake set, wheels chocked, exclusion zone set

Tank, product and available capacity independently verified (max 90%)

Hose connected securely; bonding/grounding applied if required

Meter zeroed and correct compartment selected

Delivery continuously attended, start to finish

Flow stopped at planned quantity / safe capacity

Valves, vents, hose and PTO shut down and secured

No leaks — site left clean and secure

Notes

3

Before Leaving the Site

Delivered litres, tank ID, meter reading and time recorded

Proof of delivery obtained

Photos taken if required by the customer or site profile

Deficiencies, near misses or issues reported to dispatch

Receipt and delivery slip photographed and attached below

Digital records sent — per current digital process

Notes

4

Proof of Delivery

Customer Preset

Pick a regular customer to fill in their name and all their units.

Customer Name*

Enter the customer name.

Address / Location*

Enter the delivery address or location.

Fill these in the order you fuel. Pick the product, then enter the meter reading after each fill — the litres work out automatically. When you switch product the meter goes back to 0, so a new receipt starts.

I confirm none of these were fuelled today

Tick to confirm these units weren't fuelled — or add a box for any you did fuel.

Time*

Enter the delivery time and choose AM or PM.

Meter Start Reading

Meter End Reading*

Enter the meter end reading.

Dipstick Before (cm)*

Enter the dipstick reading before delivery.

Dipstick After (cm)*

Enter the dipstick reading after delivery.

Received By (Print Name)

Deficiency / Near-Miss (if applicable) Leave blank if there was nothing to report.

Deficiency Observed

Classification

Reported to Dispatch (Name / Time)

5

Attachments & Sign-Off

Photo of Receipt*

Take / Choose Photo

Required — attach the delivery receipt.

Attach at least one photo of the receipt.

Attach Photos

Take / Choose Photos

Optional — dipstick before/after photos, site photos, deficiency photos, etc.

Attach Files

Choose Files

Optional — PDFs, other documents.

Attach up to 5 files.

Employee Signature*

Sign above

Employee signature is required.

Delivery Info

Before You Leave the Yard

At the Site

Before Leaving the Site

Proof of Delivery

Attachments & Sign-Off

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