Information
-
Document No.
-
Conducted on
-
Client / Site
-
Location
-
Prepared by
Ground history
-
1) Has the ground been used for intensive livestock production (feedlots, stables, poultry houses)
-
2) Has the ground been used as a landfill
-
3) Has the ground been used as a chemical dump
-
4) Has the ground been used for the production or storage of animal based agricultural products (compost, manure, blood/bone meal, etc.)
-
5) Has the ground been used as livestock pasture (grazing animals)
-
6) Has the ground been used for water treatment
-
7) Has the ground been used for agriculture
-
8) Is it virgin ground
-
9) Has the ground been flooded. If so, specify date and details.
Adjacent ground
-
10) Has been used or is being used for intensive livestock production (feedlots, stables, poultry houses)
-
11) Has been used or is being used as a landfill
-
12) Has been used or is being used as a chemical dump
-
13) Has been used or is being used for the production or storage of animal based agricultural products (compost, manure, blood/bone meal, fish emulsions)
-
14) Has been used or is being used as livestock pasture (grazing animals)
-
15) Are there any water treatment plants
-
16) Is there Housing/labor camps
-
17) Is there evidence of a large population of wildlife
-
18) Has it been used or is being used for agricultural use
Water source
-
19) Water source
- Well
- City water
- Recycled water
- Reservoir
- Spring water
- River/Canal
-
20) Irrigation method
- Drip irrigation
- Sprinkles/micro-sprinkles
- Furrow irrigation
-
21) Are there any pesticides or fertilizers stored nearby
-
Select date
-
22) Are there any animal based agricultural products nearby
-
23) Do domestic animals or wildlife have access
-
24) Is there a microbiological analysis available
Risk mitigation measures
-
Mitigation measure
Is the grown accepted?
-
YES
-
NO
