TM
CSI Organic Wild Crop Questionnaire
Please attach a current map(s) of the harvest area showing the buffer zones and adjoining land use, and the completed Land
History Affidavit (ORG_FAR_01).
SECTION 1: GENERAL INFORMATION
Applicant (Name/Company)
Primary Contact Person
Address:
City:
Province:
Postal Code:
Telephone:
Fax:
E-mail:
Seeking certification to the following rules:
CDN
NOP – EQ
Do you have the current version of the standards?
Yes
Do you understand the requirements for the certification you are seeking?
Yes
Are you keeping your records a minimum of five years?
Yes
Do you document and resolve any complaints received?
Yes
Wild crop harvest:
Harvest area acreage:
SECTION 2: WILD CROP INFORMATION AND HARVEST AREA
Please complete and sign the land history affidavit (ORG_FAR_01_Land History Affidavit), either yourself or signed by a person legally
responsible for the wild crop production area.
Please provide a detailed description of the harvested areas and the history of compliance with the standard over the past three years.
ORG_FAR_18_Wild Crops Revision 3.0
Version Date: February 16, 2015
Page 1 of 3
Print Date: 2/7/2016
©2015 Centre for Systems Integration
TM
Please describe your buffer zones surrounding the harvest area.
SECTION 3: BIODIVERSITY
Please describe the measures taken to protect the wild species in the harvest area and minimize the disturbance of the environment.
SECTION 4: HARVEST METHODS and RECORDS
Please describe your harvest methods.
Please describe how you ensure that you harvest the wild crop in such a way that promotes its growth and production, and does not
destroy the surrounding environment.
Please describe how you deliver or sell your harvested crop (packaged prior to sale, sold in bulk, etc.).
Please describe the types of records you maintain.
ORG_FAR_18_Wild Crops Revision 3.0
Version Date: February 16, 2015
Page 2 of 3
Print Date: 2/7/2016
©2015 Centre for Systems Integration
TM
SECTION 5: AFFIRMATION
I affirm that all statements made in this application are true and correct. No prohibited products have been applied to the defined wild
crop harvest area during the three-year period prior to projected harvest. I understand that the operation may be subject to
unannounced inspection and/or sampling for residues at any time. I agree to follow the relevant scheme.
Signature of Operator
Date
_____________
I have attached the following additional documents (please check off):
Map(s) of all wild crop harvest areas (showing buffer zones and adjoining land use)
Organic product labels (when packaging organic product)
Please submit a copy of your completed system plan and all attachments to:
Centre for Systems Integration
240 Catherine Street, Suite 200
Ottawa, Ontario
K2P 2G8
1-800-516-3300
FAX: 613-236-7000
Email: info@csi-ics.com
ORG_FAR_18_Wild Crops Revision 3.0
Version Date: February 16, 2015
Page 3 of 3
Print Date: 2/7/2016
©2015 Centre for Systems Integration