Title Page
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Farm name
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Conducted by
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Conducted on
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Location
Production Practices
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What water sources are used for irrigation? (select all that apply)
- Well
- Municipal
- Stream
- Pond
- Other
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Please specify
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What water sources are used for washing products? (select all that apply)
- Well
- Municipal
- Stream
- Pond
- Other
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Please specify
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Are wells protected from contamination? (e.g., wells are sealed, covered, secured, etc).
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Date of recent well water test
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Are farm livestock and other wild animals restricted from growing areas?
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Are portable toilets and/ or restrooms available to staff on the farm?
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Is the field currently exposed to runoff from animal confinement or grazing areas?
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Is raw manure incorporated at least 2 weeks prior to planting and/or at least 120 days prior to harvest?<br>
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Is manure application schedule documented?
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What types of manure are used?
Product Handling
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Are storage and packaging facilities separated from growing areas?
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Is there a risk of contamination with manure after harvest?
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Are harvesting baskets, totes or other containers kept covered and cleaned/ sanitized before (and in between harvest) use and stored in areas protected from pets, livestock, wild animals and other contaminants?
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Is harvesting equipment/machinery that comes in contact with products kept as clean as possible?
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Is potable water used to wash products?
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Is product protected as it travels from field to packing facility?
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Are new packaging crates, totes, boxes used each time?
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Are packaging materials stored in areas protected from pets, livestock, wild animals or other contaminants?
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Are temperature logs for coolers and refrigerators maintained?
Animal Handling
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Are animals provided with clean water daily?
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Are living areas for farm animals kept clean?
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Are livestock slaughtering procedures executed hygienically?
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Are meat products handled and stored according to food safety standards?
Transportation
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Is product carefully loaded and stored to minimize physical damage and risk of contamination?
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Is transport vehicle well-maintained and clean?
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Is the vehicle properly cleaned prior to the loading of food products?
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Are products kept at the appropriate temperatures during transport? (e.g. cold produce must be held at < 41ยบ Fahrenheit)
Conditions of Places of Employment
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Are tools, equipment, and machinery safe to use?
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Are workers trained to do their jobs?
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Are bridges and culverts under roadways on the farm or ranch strong enough to support the heaviest load that will cross them?
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Is there enough clean drinking water for workers?
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Are workplaces being maintained to avoid slipping hazards?
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Is there a method to protect workers from falling when they are working at heights, and have they been trained to use it?
Hazardous Substances
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Are substances that might harm workers marked with signs or symbols?
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Have workers been told what to do if a harmful substance spills?
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Does everyone working around anhydrous ammonia wear hand and eye protection?
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Are showers or hoses available so workers can wash immediately if they are exposed to chemicals that might hurt their eyes or skin?
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Have workers been told about any infectious organisms they might contact?
Pesticides
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Are pesticides used according to the instructions on the label?
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Are pesticides used according to good application practice?
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Are all workers who mix, load, or apply moderately or very toxic pesticides over the age of 16?
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Are all workers who clean or repair the equipment used for pesticides over the age of 16?
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Do they wear the right protective clothing and equipment?
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Are washing facilities available for workers who mix, load, and apply pesticides?
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Before any fumigants or other moderately or very toxic pesticides are applied, are warning signs posted where workers enter the area?
Personal Protective Clothing & Equipment
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Is the right personal protective clothing and equipment provided to workers?
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Do workers wear leg protection while using a chainsaw?
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Do workers wear hand and arm protection if materials are likely to cut or scratch?
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Is the respirator in good working order?
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Have workers been told how to use and maintain the respirator?
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When a worker uses a respirator that seals with the face, is that seal effective?
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Has the employer used engineering controls to keep noise below the permitted level?
Tools, Machinery, and Equipment
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Are the seatbelts used whenever the tractor is moving or equipment is unstable?
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Are workers operating mobile equipment properly instructed and capable?
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Are brakes on mobile equipment working well?
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Do workers using orchard ladders receive instruction first?
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Are ladders inspected before each use and replaced or repaired immediately if found to be faulty?
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Do the auger conveyors have guards wherever moving parts might touch workers?
Worker Health and Hygiene
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Are workers trained about hygiene practices and sanitation?
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Are signs posted to reinforce hygiene practices?
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Are smoking and eating confined to designated areas separate from product handling?
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Are workers instructed not to work if they exhibit signs of infection (e.g. fever, diarrhea, etc.)?
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Do workers practice good hygiene by wearing clean clothing and shoes as appropriate for conditions?
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Do workers practice good hygiene by changing aprons and gloves as needed?
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Do workers practice good hygiene by covering open wounds with clean bandages?
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Do workers practice good hygiene by limited bare hand contact with fresh produce?
Completion
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Other notes/comments/explanations:
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I confirm that the information provided above is accurate to the best of my knowledge:
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Name & Signature of Assigned Agriculture Inspector
