Title Page

  • Farm name

  • Conducted by

  • Conducted on

  • Location

Production Practices

  • What water sources are used for irrigation? (select all that apply)

  • Please specify

  • What water sources are used for washing products? (select all that apply)

  • Please specify

  • Are wells protected from contamination? (e.g., wells are sealed, covered, secured, etc).

  • Date of recent well water test

  • Are farm livestock and other wild animals restricted from growing areas?

  • Are portable toilets and/ or restrooms available to staff on the farm?

  • Is the field currently exposed to runoff from animal confinement or grazing areas?

  • Is raw manure incorporated at least 2 weeks prior to planting and/or at least 120 days prior to harvest?<br>

  • Is manure application schedule documented?

  • What types of manure are used?

Product Handling

  • Are storage and packaging facilities separated from growing areas?

  • Is there a risk of contamination with manure after harvest?

  • 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?

  • Is harvesting equipment/machinery that comes in contact with products kept as clean as possible?

  • Is potable water used to wash products?

  • Is product protected as it travels from field to packing facility?

  • Are new packaging crates, totes, boxes used each time?

  • Are packaging materials stored in areas protected from pets, livestock, wild animals or other contaminants?

  • Are temperature logs for coolers and refrigerators maintained?

Animal Handling

  • Are animals provided with clean water daily?

  • Are living areas for farm animals kept clean?

  • Are livestock slaughtering procedures executed hygienically?

  • Are meat products handled and stored according to food safety standards?

Transportation

  • Is product carefully loaded and stored to minimize physical damage and risk of contamination?

  • Is transport vehicle well-maintained and clean?

  • Is the vehicle properly cleaned prior to the loading of food products?

  • Are products kept at the appropriate temperatures during transport? (e.g. cold produce must be held at < 41ยบ Fahrenheit)

Conditions of Places of Employment

  • Are tools, equipment, and machinery safe to use?

  • Are workers trained to do their jobs?

  • Are bridges and culverts under roadways on the farm or ranch strong enough to support the heaviest load that will cross them?

  • Is there enough clean drinking water for workers?

  • Are workplaces being maintained to avoid slipping hazards?

  • 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

  • Are substances that might harm workers marked with signs or symbols?

  • Have workers been told what to do if a harmful substance spills?

  • Does everyone working around anhydrous ammonia wear hand and eye protection?

  • Are showers or hoses available so workers can wash immediately if they are exposed to chemicals that might hurt their eyes or skin?

  • Have workers been told about any infectious organisms they might contact?

Pesticides

  • Are pesticides used according to the instructions on the label?

  • Are pesticides used according to good application practice?

  • Are all workers who mix, load, or apply moderately or very toxic pesticides over the age of 16?

  • Are all workers who clean or repair the equipment used for pesticides over the age of 16?

  • Do they wear the right protective clothing and equipment?

  • Are washing facilities available for workers who mix, load, and apply pesticides?

  • 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

  • Is the right personal protective clothing and equipment provided to workers?

  • Do workers wear leg protection while using a chainsaw?

  • Do workers wear hand and arm protection if materials are likely to cut or scratch?

  • Is the respirator in good working order?

  • Have workers been told how to use and maintain the respirator?

  • When a worker uses a respirator that seals with the face, is that seal effective?

  • Has the employer used engineering controls to keep noise below the permitted level?

Tools, Machinery, and Equipment

  • Are the seatbelts used whenever the tractor is moving or equipment is unstable?

  • Are workers operating mobile equipment properly instructed and capable?

  • Are brakes on mobile equipment working well?

  • Do workers using orchard ladders receive instruction first?

  • Are ladders inspected before each use and replaced or repaired immediately if found to be faulty?

  • Do the auger conveyors have guards wherever moving parts might touch workers?

Worker Health and Hygiene

  • Are workers trained about hygiene practices and sanitation?

  • Are signs posted to reinforce hygiene practices?

  • Are smoking and eating confined to designated areas separate from product handling?

  • Are workers instructed not to work if they exhibit signs of infection (e.g. fever, diarrhea, etc.)?

  • Do workers practice good hygiene by wearing clean clothing and shoes as appropriate for conditions?

  • Do workers practice good hygiene by changing aprons and gloves as needed?

  • Do workers practice good hygiene by covering open wounds with clean bandages?

  • Do workers practice good hygiene by limited bare hand contact with fresh produce?

Completion

  • Other notes/comments/explanations:

  • I confirm that the information provided above is accurate to the best of my knowledge:

  • Name & Signature of Assigned Agriculture Inspector

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