Farm Name:
Contact Person:
Audit Site(s):
Main Address:
State:
ZIP:
Telephone Number:
FAX:
E-mail:
1

Questions
Did the auditee participate in
GAP & GHP training?
Response
NAME has participated in a GAP/GHP workshop.
Is there a map that accurately represents the farm operations?
Farm maps are included in this document that accurately represent this farm's operations. [You can get maps from NRCS or hand draw them]
Legal Description/GPS/Lat.-
Longitude of Location
[Optional]
A map of the main farm and/or packing house is located by GPS and included in this document.
GPS coordinates are as follows: Latitude:
_________________, Longitude:
________________[This is optional. You can get lat and long from Google Earth]
Action to Take
Optional
Are all crop production areas located on this audit site?
Total acres farmed (Owned, leased/rented, contracted, consigned):
All crop production areas are located on this farm's managed premises-either owned or rented-- as described on the maps or photos above.
FARM NAME owns and rents approximately __ acres of farm and orchard. __ acres are presently in production and __ acres are not in production at this time.
Does the company have more than one packing facility?
FARM NAME owns and operates only one packing facility.
Is there a floor plan of the packing house facility(s) indicating flow of product, storage areas, cull areas, employee break rooms, restrooms, offices?
Is any product comingled prior to packing?
A floor plan of the FARM NAME is available in this document
packing facility
All produce is grown and packed on the premises managed by this grower. No produce is comingled from other farms under different management.
Optional, but a good idea. Can hand-draw
2

Questions
P-1
A documented food safety program that incorporates
GAP/GHP has been implemented.
Response DOC
Action to Take
At Farm Name, food safety is an integral part of our entire operation and taken very seriously. Our food safety program of standard operating procedures addresses several areas of an agricultural operation, including: land, irrigation water, manure practices, fertilizer applications, pesticides, equipment and worker health and hygiene. This program will include a Good Agriculture Practices Manual that outlines specific steps taken to abide by USDA guidelines. The Manual will be reviewed on a yearly basis and updated as needed.
The facility will be self audited by an approved GAPs self audit checklist each year.
D
P-2
Name has been designated to implement and oversee an established food safety program
Name is the designated person to oversee the Food
Safety Program. He / she will attend workshops/ continuing education regularly to assure he / she is up to date on GAP/GHP standards. All trainings will be documented. He / she is responsible for making sure that all safety procedures are being followed. In the absence of the primary designated person,
_______ will serve as the designated person for this farm.
D
G-1
A documented traceability program has been established.
Describe how your traceability program works
G-2
The operation has performed a
"mock recall" that was proven to be effective.
D
R
3

Questions
G-3
Potable water is available to all workers.
Response
Potable water is available to all employees. If necessary, a sign is posted to designate the potable water source.
G-4
All employees and all visitors to the location are required to follow proper sanitation and hygiene practices.
Farm food safety policies should be followed by everybody, including visitors. [WRITE WHAT YOU
DO HERE IF THIS DOES NOT APPLY TO YOUR
FARM] With the exception of agriculture service providers and USDA Auditors, visitors are not allowed into the wholesale production fields or growing areas. A log of visitors will be maintained in a document/ guest book found in the retail sales area of the packing facility.
DOC
R
P
G-5
G-6
G-7
G-8
Training on proper sanitation and hygiene practices is provided to all staff.
All employees are trained in and must follow good hygiene practices. [DESRIBE WHAT YOU DO FOR
TRAINING] This training takes place during orientation of new employees and before harvest season for all returning employees. All training will be documented in a worker training log found in the
GAP Manual.
Employees and visitors are following good hygiene/sanitatio n practices
Signage has been posted where needed - e.g. at all sinks and toilet locations
Employees are washing their hands before beginning or returning to work.
Signs are posted to instruct employees to wash their hands before beginning or returning to work.
Hands must be washed before beginning or returning to work, and after the following activities:
Using the restrooms, smoking or tobacco use, eating, handling trash containers or disposing of trash. Proper Hand washing signage and procedures are posted.
Signage has been posted instructing employees to wash their hands before beginning or returning to work.
Action to
Take
D
Employee
Training
Verification Form
Post signage
Post signage
Post signage
4

Questions Response
G-9
All toilet/restroom/fie ld sanitation facilities are clean. They are properly supplied with single use towels, toilet paper, and hand soap or antibacterial soap and potable water for hand washing.
Commercial Service: Cleaning and supplies are furnished. Units are serviced as per contract.
Record initials and date of cleaning on “Service
Record” sheet when unit is serviced.
Restroom Facility on Farm: Wash contact areas weekly. Sanitize toilets, urinals, doorknobs, and any other surface inside unit weekly. Fill paper products and soap dispensers as needed. Remove trash to dumpster as needed. Record initials and date of cleaning on “Service Record” sheet when unit is serviced.
DOC
Action to
Take
If family members are working on the farm and touching produce but using the bathroom in the house, these standards should be followed for the bathroom in the house as well as the port-a-john.
Make sure sinks for washing hands are located close to the port-ajohns and break areas
G-10
All toilet/restroom/fie ld sanitation facilities are serviced and cleaned on a scheduled basis.
Commercial Service: Record initials and date of cleaning on "Service Record" sheet when unit is serviced. Restroom Facility on Farm: Standard procedure (SOP Document) is followed, record initials and date of cleaning on "Service Record" sheet when unit is serviced.
G-11
Smoking and eating are confined to designated areas separate from where product is handled.
Designated smoking and eating areas are located____________________
R
P
Post signage at designated smoking areas
– should also be close to handwashing facilities or hand sanitizer station
5

G-12
Workers with diarrheal disease or symptoms of other infectious disease are prohibited from handling fresh produce.
Any employee who is ill or appears to be ill with a possible communicative disease will be sent home or assigned work away from harvesting operation.
P
6

Questions Response
DOC
G-13
There is a policy describing procedures which specify handling/dispositi on of produce or food contact surfaces that have come into contact with blood or other body fluids.
A first aid kit is properly identified and located
[WHERE] . If you have an open wound or cut it must be bandaged. If you obtain a wound, cut or have a nosebleed while working, you need to stop working immediately, contact your supervisor, and have it attended to. Make sure the area you were working in gets cleaned and disinfected as soon as possible. Discard all product that has come into contact with any blood and if any came into contact with product containers or transport equipment, disinfect before continued use. All other possible accidents, such as leakage or damage to a restroom or sanitation facility will be attended to as soon as possible and contaminated soil around facility will be neutralized.
P
G-14
Workers are instructed to seek prompt treatment with clean first aid supplies for cuts, abrasions and other injuries.
All workers are aware of the location of first aid supplies [WHERE] and what steps they should take in case of a first aid emergency to stop work and avoid bodily fluid contact with others or product.
[WRITE STEPS TO TAKE IF SOMEONE GETS
HURT]
G-15
Workers that apply regulated pre-harvest and/or post harvest materials are licensed.
Company perosnnel or contracted personnel applying nonregulated materials have been trained on its proper use.
Only employees licensed by the State of Vermont
Department of Agriculture for pesticide application may apply restricted use chemicals. Only those chemicals that are lawfully registered under FIFRA and other applicable state laws are used on this operation and applied according to label. Records of pesticide applications are maintained and readily accessible.
P
R
Action to
Take
7

1-1
Questions
What is the source of irrigation water?
(Pond, Stream, Well,
Municipal, Other)
Please Specify.
Response
[DESCRIBE AND ASSESS SOURCES OF
IRRIGATION AND SPRAY WATER]
1-2
1-3
1-4
How are crops irrigated? (Flood,
Drip, Sprinkler,
Other) Please
Specify.
Water quality is known to be adequate for the crop irrigation method and crop being irrigated.
Water quality is known to be adequate for chemical application or fertigation method.
[DO YOU KNOW WATER QUALITY AND pH IS
APPROPRIATE FOR INTENDED USES?]
DOC Actions to Take
D
D
Get irrigation water tested –
Include steps to mitigate any microbial risks in food safety plan
Test water quality for pathogens. Test water pH to make sure it is in appropriate range for product
1-5
1-6
If necessary, steps are taken to protect irrigation water from potential direct and non-point source contamination.
[IF NECESSARY, WHAT DO YOU DO?]
The farm sewage treatment system/septic system is functioning and there is no evidence of leaking or runoff.
The farm sewage treatment is known to be functioning properly and there is no evidence of leaking or runoff.
8

1-7
1-8
1-9
1-10
1-11
Questions Response
There is no municipal/commercial sewage treatment facility or waste material landfill adjacent to the farm.
Crop production areas are not located near or adjacent to dairy, livestock, or fowl production facilitiesl.
Additionally, there is no municipal/commercial sewage treatment facility adjacent to the farm.
All livestock grazing areas are located a safe distance and/or down slope from crop production areas. Fencing is in place and regularly maintained.
Manure lagoons located near or adjacent to crop production areas are maintained to prevent leaking or overflowing, or measures have been taken to stop runoff from contaminating the crop production areas.
Manure stored near or adjacent to crop production areas is contained to prevent contamination of crops.
[IF NECESSARY, WHAT DO YOU DO? COVER, BUFFER
STRIP, FENCE?]
Measures are taken to restrict access of livestock to the source or delivery system of crop irrigation water.
DOC
Actions to Take
If near a neighbor’s dairy farm, you will need to address their raw manure in your farm plan
9

1-12
Questions
Crop production areas are monitored for the presence or signs of wild or domestic animals entering the land.
All fields are routinely monitored for unauthorized entry of wildlife or domesticated animals to the fields.
Response
1-13
Measures are taken to reduce the opportunity for wild and/or domestic animals to enter crop production areas.
[WHAT DO YOU DO? TRAP, HUNT, FENCE,NETS
SCARE TACTICS???]
Please check ONLY one of the following options as it relates to the farm operation
Questions Response
Option A . Raw manure or a combination of raw and composed manure is used as a soil amendment.
Option B . Only composed manure/treated municipal biosolids are used as a soil amendment.
Option C . No manure or municipal biosolids of any kind are used as a soil amendment.
DOC
Actions to Take
R
Start keeping records of animal events in fields
R
You will need to talk about all the steps you take to restrict wildlife in your farm plan
–
DOC Actions to Take
10

Option A: Raw Manure
1-14
Questions
When raw manure is applied, it is incorporated at least
2 weeks prior to planting or a minimum of 120 days prior to harvest.
Response
[EXPLAIN YOUR PRACTICE AND HAVE RECORDS
TO BACK UP]
1-15
Raw manure is not used on commodities that are harvested within 120 days of planting.
[DITTO]
DOC
R
Actions to Take
Explain all handling procedures for all manure – even what is sprayed on hay fields
R
1-16
1-17
If a combination of raw and treated manure is used, the treated manure is properly treated, composted or exposed to reduce the expected levels of pathogens.
Manure is properly stored prior to use.
Option B: Composted
Manure
Questions
1-18
Only composted manure and/or treated biosolids are used as a soil amendment.
[DO YOU COVER MANURE OR COMPOST?]
Response
R
DOC Actions to Take
R
Have all your compost records
11

1-19
1-20
1-21
1-23
Questions
Composted manure and/or treated biosolids are properly treated, composted, or exposed to environmental conditions that would lower the expected level of pathogens.
Composted manure and/or treated biosolids are properly stored and are protected to minimize recontamination.
Analysis reports are available for composted manure/treated biosolids.
Option C: No
Manure/Biosolids Used
Questions
1-22
No animal manure or municipal biosolids are used.
A previous land use assessment has been performed.
Response
Response
Farm Name do not use animal manure or municipal biosolids on any production areas of this farm.
This farm has been in the possession of the
___________ family in excess of ___ years.
The fields have been in agricultural production since _____ [NOTE IF ANY
POTENTIAL SOURCES OF
CONTAMINATION]
DOC
D
R
Actions to Take
DOC Actions to Take
P
R
12

1-24
1-25
1-26
When previous land use history indicates a possibility of contamination, preventative measures have been taken to mitigate the known risks and soils have been tested for contaminants and the land use is commensurate with test results.
Crop production areas that have been subjected to flooding are tested for potential microbial hazards.
Each production area is identified or coded to enable traceability in the event of a recall.
[MAKE SURE TO PUT CODE OR NAMES ON MAPS]
R
R
R
Do any of your fields flood? If so, how do you handle that?
13

Questions Response
2-1
2-2
A documented preharvest assessment is made on the crop production areas.
Risks and possible sources of crop contamination are noted and assessed.
The number, condition, and placement of field sanitation units comply with applicable state and/or federal regulations.
2-3
When question 2-2 is answered "NA"
(sanitation units are not required), a toilet facility is readily available for all workers.
2-4
Field sanitation units are located in a location that minimizes the potential risk for product contamination and are directly accessible for servicing.
2-5
A response plan is in place for the event of a major spill or leak of field sanitation units or toilet facilities.
DOC Actions to take
D
Food Safety coordinator fill out before crop harvested
P
14

P
2-6
Questions
All harvesting containers and bulk hauling vehicles that come in direct contact with product are cleaned and/or sanitized prior to use and kept as clean as practicable.
Response
EXPLAIN HOW YOU CLEAN THE BINS AND
HARVEST TOTES
2-7
All hand harvesting implements (knives, pruners, machetes, etc.) are kept as clean as practical and are disinfected on a scheduled basis.
2-8
Damaged containers are properly repaired or disposed of.
2-9
Harvesting equipment and/or machinery which comes into contact with product is in good repair.
2-10
Light bulbs and glass on harvesting equipment are protected so as not to contaminate produce or fields in the case of breakage.
DOC Actions to Take
D
Clean and keep records.
Consider investing in power washer
D
Keep a container to dip hand tools in at end of day with
2% bleach solution. This will also reduce risk of spreading fungi and plant pathogens. Do not leave in bleach overnight
15

2-11
Questions
There is a standard operating procedure or instructions on what measures should be taken in the case of glass/plastic breakage and possible contamination during harvesting operations.
2-12
There is a standard operating procedure or instructions on what measures should be taken in the case of product contamination by chemicals, petroleum, pesticides or other contaminating factors.
2-13
2-14
For mechanically harvested crops, measures are taken during harvest to inspect for and remove foreign objects such as glass, metal, rocks, or other dengerous/toxic items.
Harvesting containers, totes, etc. are not used for carrying or storing non-produce items during the harvest season, and farm workers are instructed in this policy.
Response
DOC
Actions to Take
P
P
P
16

Questions
2-15
Water applied to harvested product is microbally safe.
2-16
Efforts have been made to remove excessive dirt and mud from product and/or containers during harvest.
2-17
2-18
Transportation equipment used to move product from field to storage areas or storage areas to processing plant which comes into contact with product is clean and in good repair.
There is a policy in place and has been implemented that harvested product being moved from field to storage areas or processing plants are covered during transportation.
Response
DOC
R
Actions to Take
Add disinfectant to dunk tanks when rinsing product. Switch to double or triple rinse system to decrease risk of food borne pathogens and increase shelflife of produce
– especially for leafy greens
P
17

2-19
In ranch or field pack operations, only new or sanitized containers are used for packing the product.
D
Have a standard operating procedure for cleaning plastic containers
18

Questions
2-20
Packaging materials used in ranch or field pack operations are properly stored and protected from contamination.
2-21
Product moving out of the field is uniquely identified to enable traceability.
Response DOC Actions to Take
Make sure that packing containers and waxed boxes are kept in a clean, dry area, up off of the floor, and protected from possible contamination from birds, rodents (can cover with tarp)
D
19

Questions
3-1
Product delivered from the field which is held in a staging area prior to packing or processing is protected from possible contamination.
3-2
3-3
Prior to packing, product is properly stored and/or handled in order to reduce possible contamination.
Source water used in the packing house is potable.
3-4
If applicable, the temperature of processing water used in dump tanks, flumes, etc., is monitored and is kept at temperatures appropriate for the commodity.
Response
3-5
Processing water is sufficiently treated to reduce microbial contamination.
DOC Actions to Take
Put up a canopy over wash station outside of packing shed.
Keep everything off the ground on pallets that are washed down regularly
See guidelines
R
D
The temperature of water used in dunk tanks should be monitored (you can use a pool thermometer)
The water should be no more than
10 ⁰ colder than the produce – especially for apples, potatoes peppers, tomatoes or melons if you dunk them.
D
Develop SOPS for washing/rinsing product in dunk tanks.
20

3-6
Water-contact surfaces, such as dump tanks, flumes, wash tanks, and hydro coolers, are cleaned and/or sanitized on a scheduled basis.
Disinfectant is used in dunk tank water and dunk tank water is changed frequently. Water is sampled as necessary for disinfectant used
D
Develop cleaning schedules and
SOPs for all water and food contact surfaces in packing shed
21

3-7
3-8
Questions
Water treatment
(strength levels and pH) and exposure time is monitored and the facility has demonstrated it is appropriate for the product.
Food contact surfaces are in good condition; cleaned and/or sanitized prior to use and cleaning logs are maintained.
3-9
Product flow zones are protected from sources of contamination.
3-10
The water used for cooling and/or to make ice is potable.
3-11
Any ice used for cooling produce is manufactured, transported and stored under sanitary conditions.
3-12
Employee facilities
(locker rooms, lunch and break areas, etc.) are clean and located away from packing area.
Response DOC
D
Actions to Take
See guidelines pH and Temp of water must be monitored to make sure is appropriate for disinfectant used-
D
R
See guidelines – should be able to clean walls and ceilings, make sure dust, cobwebs, loose insulation cannot fall into product
R
Develop SOPs and cleaning schedule for ice machine, bins and paddle.
Keep records of cleaning
D
22

3-13
Questions
When there is a written policy regarding the use of hair nets/ beard nets in the production area, it is being followed by all employees and visitors.
3-14
3-15
When there is a written policy regarding the wearing of jewelry in the production area, it is being followed by all employees and visitors.
Only food grade approved and labeled lubricants are used in the packing equipment/ machinery.
3-16
Chemicals not approved for use on product are stored and segregated away from packing area.
3-17
The plant grounds are reasonably free of litter and debris.
3-18
The plant grounds are reasonably free of standing water.
Response DOC
Actions to Take
P
P
R
Clean all grounds, remove trash, piles of wood, keep grass and other plants mowed to reduce hiding places for rodents
23

3-19
Questions
Outside garbage receptacles/ dumpsters are closed or are located away from packing facility entrances and the area around such sites is reasonably clean.
3-20
Packing facilities are enclosed.
3-21
The packing facility interior is clean and maintained in an orderly manner.
3-22
Floor drains appear to be free of obstructions.
3-23
Pipes, ducts, fans and ceilings which are over food handling operations are clean.
3-24
Glass materials above product flow zones are contained in case of breakage.
Response DOC
Actions to Take
Packing shed must be cleaned on a scheduled basis, and kept as clean and free of dust and other airborne contaminants as possible
Ceilings should be kept clean, no exposed or loose insulation materials
24

3-25
Possible wastewater spillage is prevented from contaminating any food handling area by barriers, drains or a sufficient distance.
25

3-26
Questions
There is a policy describing procedures which specify handling/ disposition of finished produce which is opened, spilled or comes into contact with the floor.
3-27
Only new or sanitized containers are used for packing the product.
3-28
Pallets and containers are clean and in good condition.
3-29
3-30
Packing containers are properly stored and protected from contamination (birds, rodents, and other pests.)
Measures are taken to exclude animals or pests from packing and storage facilities.
3-31
There is an established pest control program for the facility.
3-32
Service reports for the pest control program are available for review.
3-33
Interior walls, floors and ceilings are well maintained and are free of major cracks and crevices.
Response DOC Actions to Take
P
D
D
D
R
Interior walls and ceilings must be as clean as possible and free of places
26

Questions
3-34
Records are kept recording the source of incoming product and the destination of outgoing product which is uniquely identified to enable traceability.
Response where pests are nesting
DOC
Actions to Take
D
27

4-1
Questions
The storage facility is cleaned and maintained in an orderly manner.
4-2
4-3
4-4
Bulk storage facilities are inspected for foreign material prior to use and records are maintained.
Storage rooms, buildings, and/or facilities are maintained and sufficiently sealed or isolated to be protected from external contamination.
Storage grounds are reasonably free of litter and debris.
4-5
4-6
Floors in storage areas reasonably free of standing water.
Possible wastewater spillage is prevented from contaminationg any food handling area by barriers, drains, or a sufficient distance.
Response DOC Actions to Take
R
28

4-7
4-8
4-9
4-10
Questions
There is a policy describing prodecures which specify handling/disposition of finished product which is opened, spilled, or comes in contact with the floor.
Packing containers are properly stored and sufficiently sealed to be protected from contamination (birds, rodents, pests and other contaminants).
Pallets, pallet boxes, totes, bags, bins, cellars, storage rooms, etc. are clean, in good condition and do not contribute foreign material to the product.
Product stored outside in totes, trucks, bins, other containers or on the ground in bulk is covered and protected from contamination.
4-11
Non-food grade substances such as paints, pesticides, etc., are not stored in close proximity to the product.
Response DOC
Actions to Take
P
29

4-12
4-13
Questions
Mechanical equipment used during the storage process is clean and maintained to prevent contamination of the product.
Measures are taken to exclude animals or pests from storage facilities.
4-14
There is an established pest control program for the facility.
4-15
Service reports for the pest control program are available for review.
4-16
4-17
Interior walls, floors and ceilings are well maintained and are free of major cracks and crevices.
The water used for cooling/ ice is potable.
4-18
4-19
Manufacturing, storage and transportation facilities used in making and delivering ice used for cooling the product have been sanitized.
Climate controlled rooms are monitored for temperature and logs are maintained.
Response
DOC Actions to Take
R
D
D
R
D
D
R
30

4-20
4-21
4-22
4-23
4-24
4-25
4-26
Questions
Thermometer(s) are checked for accuracy and records are available for review.
Refrigeration system condensation does not come in contact with produce.
Refrigeration equipment
(condensers, fans, etc.) is cleaned on a scheduled basis.
Iced product does not drip on pallets of produce stored below.
Prior to the loading process, conveyances are required to be clean, in good physical condition, free from disagreeable odors, from obvious dirt/ debris.
Produce items are not loaded with potentially contaminating products.
Company has a written policy for transporters and conveyances to maintain a specified temperature(s) during transit.
Response
P
P
P
DOC Actions to Take
D
D
31

4-27
4-28
4-29
4-30
4-31
Questions
Conveyances are loaded to minimize damage to product.
Employee facilities
(locker rooms, lunch and break areas, etc.) are clean and located away from storage, shipping and receiving areas.
When there is a written policy regarding the use of hair/ beard nets in the storage and transportation areas, it is being followed by all employees and visitors.
When there is a written policy regarding the wearing of jewelry in the storage and transportation areas, it is being followed by all employees and visitors.
Records are kept recording the source of incoming product and the destination of outgoing product which is uniquely identified to enable traceability.
Response
P
P
DOC
P
Notes
D
32