01
Particulars of Distributor
Distributor Name & Address
Proprietor Name & Mobile No.
Manager Name & Mobile No.
Date & Time of Inspection
Godown Plot No.
Godown Khata No.
Mouza
Tahasil
Block Name
Police Station
Pin No.
Company's Base Depot
Distributor Code
Oil Marketing Company
Appointment No.
Appointment Date
02
Consumer Profile & Coverage
Domestic (Normal)
Active Domestic
Ujjwala
Active Ujjwala
Commercial Consumers
Active Commercial
03
Stock Position – Filled Cylinders
Physical Count
| Type | Opening | Receipt | Total | Issue | Balance | Physical | Difference |
|---|
| 14.2 Kg Domestic | | | | | | | |
| 5 Kg Domestic | | | | | | | |
| 19 Kg Commercial | | | | | | | |
| 05 Kg Commercial | | | | | | | |
04
Stock Position – Empty Cylinders
Physical Count
| Type | Opening | Receipt | Total | Issue | Balance | Physical | Difference |
|---|
| 14.2 Kg Domestic | | | | | | | |
| 5 Kg Domestic | | | | | | | |
| 19 Kg Commercial | | | | | | | |
| 05 Kg Commercial | | | | | | | |
05
Defective / Damaged Cylinders
| | Domestic | Commercial | Others |
|---|
| 14.2 Kg | 5 Kg | 02 Kg | 19 Kg | 05 Kg | 02 Kg | |
|---|
| No. of Cylinders | | | | | | | |
| Action Taken on it | | | | | | | |
06
Cylinder Lifting & Supply Pattern — Last 3 Months
| Month Name | Domestic | Commercial | Others |
|---|
| 14.2 Kg | 5 Kg | 02 Kg | 19 Kg | 05 Kg | 02 Kg | |
|---|
| Jan-26 | | | | | | | |
| Feb-26 | | | | | | | |
| Mar-26 | | | | | | | |
07
Statutory Licences & Certificates
🔥 Fire + Explosive
| Particulars | Certificate No. | Valid Up To |
|---|
| Fire Safety from Fire Officer | | |
| Explosive Certificate | | |
| Fire Extinguisher | | |
| Insurance Policy No. | | |
| Last Inspection by Company | | |
| Particulars | Details | Certificate No. | Valid Up To |
|---|
| Weighing Scale | | | |
| No. of Spring Balance | | | |
| No. of Certified Test Weights | | | |
09
Other Particulars at Office
11
Godown Infrastructure & Safety