Ministry for Primary Industries - Dealer in Fish

• Document No.3D

• Dealer in Fish Inspection

• Name of DIF

• Date of Inspection

  Date

• Prepared by

• Location
  Address

• Personnel

Resources: Officer Details

• Name (OIC)

• Warrant No

Name

• Name

• Warrant Number

Inspection Summary

• Start Time

  Date

• Compliance District

  Upper North Island

  North West Island

• Compliance Team

  North Harbour

  Manukau
• Location
  Address

• Location Extra Description

• At Sea Inspection Latitude Longitude

Premise Details

• Photo of Premises

  Media

• Name of Premises

• Dwelling Attached

  Yes

  No

  N/A

• Premise Phone no

• Contact Family Name

• Contact Given Name(s)

• Contact Position Held

• Contact's Address

• Contact's Phone

• Type of Business

  Takeaways

  Restaurant

  Fish Retailer

  Hawker

  Other (specify)

• Comments

• Photo ID of Contact

  Media

Owner Details

• Organisation

• Family Name

• Given Name(s)

• Gender

  Male

  Female

• Date of Birth

• Address

• Phone Daytime

• Mobile

• Phone After Hours

• Observed Ethnicity

  Select European Maori Pacific Island Asian Indian Middle Eastern Latin American Native American Other (specify)

  • European
  • Maori
  • Pacific Island
  • Asian
  • Indian
  • Middle Eastern
  • Latin American
  • Native American
  • Other (specify)

• English Speaking

  Yes

  No

  Limited

  Don't Know

• Photo Of Owner and ID (DLIC, Passport)

  Media

Inspection Information

• Areas Inspected

• Annual Inventory

  Inspected

  Breach

• Chillers

  Inspected

  Breach

• Freezers

  Inspected

  Breach

• Held on Behalf Documents

  Inspected

  Breach

• Processing Areas

  Inspected

  Breach

• Purchase Invoices

  Inspected

  Breach

• Sales Documentation

  Inspected

  Breach

• Storage Documentation

  Inspected

  Breach

• Storage Offsite

  Inspected

  Breach

• Supporting Documentation

  Media

Storage Details

• Freezers

• Number inside Premises

• Number Outside Premises

• Chillers

• Number Indide Premises

• Number Outside Premises

Vehicle Notings

Registration

• Registration

• Make

• Model

• Colour

• Year

• Photo of Vehicle

  Media

Product Details

Species

• Species

• State

• Container Type

• Weight/Quantity

• Location Found

• Date Obtained

• Supplier Name/LFR number

• Invoice Docket Number

Inspection Supporting Information

• Was Non Compliance Detected

  Yes

  No

  N/A

• Number Of Breaches

• Risk

  Low

  Medium

  High

• Risk Reason (for Low, Med & High Assessment)

Level Of Co Operation

• Excellent

  Reasonable

  Poor

  Obstructive

• I acknowledge receipt of a letter outlining the Fisheries (Recordkeeping) Regulations 1990 and copies of Regulationd 6-10 of the Regulations

  Sign

Comments

• Finish Time

  Date