SPROUTS Questionnaire
Please fill out this questionnaire if you are requesting organic certification for sprout production. Use additional sheets if necessary. Sign this form. Attach all other supporting documents as requested throughout this questionnaire. This form or a renewal form may be used for re-certification, according to PACS policies. Please fill out this form in its entirety.
SECTION 1: General Information / DATE OF APPLICATION:SPROUT OPERATION INFORMATION / APPLICANT'S CONTACT INFORMATION
Name: / Name:
Address: / Address (if different):
City: / Province: / City: / Province:
Postal Code: / Postal Code:
Tel: / Fax: / Tel: / Fax:
Email Address: / Email Address:
Web Site: / Web Site:
Alternate Contact’s Name: / Alternate Contact’s Phone Number:
If recertifying, Member Number:
Legal Status: Sole Proprietorship Trust or non-profit Legal Partnership Corporation Limited Liability
Please list previous organic certification applications to other agencies (name, year(s) of application, outcome of application). / Please list current organic certification by other agencies*.
*Please submit a copy of the certificate/certification letter and documentation indicating any issues that were noted as needing correction (requirements) from the agency(ies) other than PACS that you were certified by last year*
Have you ever been denied certification, received a Notice of Noncompliance, had your certification proposed for suspension or revocation, or had your certification suspended or revoked? Yes No
If yes, provide a copy of each notice of denial, Notice of Noncompliance, proposal for suspension or revocation, or suspension or revocation and attach documentation of the corrective actions taken in response.
If previously certified by PACS:
Year first certified: Year when complete PACS Organic Sprout Questionnaire was last submitted:
Check ALL the programs for which you are requesting certification.
COABC National Organic Program (NOP) Québec Standards (CAAQ) Japan Agricultural Standards (JAS)**
Verification/Equivalency Programs: EU 2092/91 Bio-Suisse** Swiss Ordinance JAS Equivalency
**Requires the submission of additional questionnaires**
Do you understand the current organic standards?
Yes No / Do you have a copy of all current standards applicable to your operation?
Yes No
Give directions to your sprout operation for the inspector.
When are you available to contact? Morning Afternoon Evening
When are you available for the inspection? Morning Afternoon Evening
SECTION 2: Description of Measures Taken to Meet Previous Year’s Requirements / NOT APPLICABLE
This is an important part of your application. Failure to address previous requirements could result in loss of certification. Please refer to the letter received with your certificate. This letter lists the requirements from last year’s certification.
Did you have any requirements from last year’s certification? Yes No
If yes, please complete the following table, listing each requirement, and the action you have taken.
Requirement / Action
SECTION 3: Product Lines
A. SPROUT PRODUCTS REQUESTED FOR CERTIFICATION (attach extra sheets if necessary)
PRODUCT NAME / SEED VARIETIES / Projected
Yields (Volume)
(LIST FOR EACH PRODUCT)
ORGANIC % / NON-ORGANIC %
B. NON-ORGANIC SPROUT PRODUCTS PRODUCED Not Applicable
PRODUCT NAME / SEED VARIETIES / Projected
Yields (Volume)
(LIST FOR EACH PRODUCT)
NON-ORGANIC % / ORGANIC %
SECTION 4: Handling
A. DESCRIBE PRODUCT FLOW FROM START (including seed washing) TO HARVEST. INCLUDE A FLOW DIAGRAM (ATTACH TO SUBMISSION).
B. MATERIALS USED - List all materials used in or on the sprouts requested for certification in the past 12 months.
ATTACH LABELS TO SUBMISSION.
PRODUCT / BRAND NAME OR SOURCE / ü if GMO / Ingredients / REASON FOR USE
C. MATERIALS USED List all materials used in or on your non-organic sprouts in the past 12 months. N/A
ATTACH LABELS TO SUBMISSION.
PRODUCT / BRAND NAME OR SOURCE / ü if GMO / Ingredients / REASON FOR USE
If non-organic sprouts products are produced, how are they visually distinguishable from the non-organic? N/A
SECTION 5: WATER USE AND QUALITY
Source(s) of water: municipal well pond spring other (specify):
Attach current water tests as required by all applicable Standards.
List known contaminants in water supplies. Attach residue analysis and/or salinity test results if available. None
What water contamination problems do you experience (why and where)? None
Describe your efforts to minimize water contamination problems listed above. N/A
Describe how you monitor the effectiveness of your water quality program.
How often do you conduct water quality monitoring? weekly monthly annually as needed
other (specify):
SECTION 6: POST-HARVEST HANDLING
A. INSPECTION
Is the facility inspected by food inspectors or other regulatory agencies? Yes No
If yes, provide the following information about the inspection agency.
Name:
Address:
Phone:
Date of last inspection:
B. COMMINGLING
Are all surfaces with which organic products have contact made of food-grade materials? Yes No Please describe what material(s) the extraction equipment is made from:
Is the equipment used dedicated to organic sprouts? Yes No
If no, describe measures taken to prevent commingling and contamination:
If equipment is cleaned-down, be sure to indicate this in the sanitation section.
C. PACKAGING
Type(s) of packaging material used: Are containers food grade? Yes No
Are any containers new or used? New Used
If any are used, what did they contain/for what were they used prior to organic use? N/A
If containers are cleaned prior to organic use, be sure to indicate this in the sanitation section
D. LABELLING
Describe the packaging (size, etc.) and labeling of sprout products:
Attach copies of all labels to submission
E. STORAGE
Describe where raw ingredients and packaged sprouts are stored and how this/these area/areas is/are identified (name, warehouse #, etc.).
How are organic storage areas indicated? signs labeling floor markings color coding
Do you use the same storage areas for organic and nonorganic products? Yes No
If yes, how do you segregate organic products from nonorganic products?
How long are sprouts stored?
If storage is cleaned prior to organic use, be sure to indicate this in the sanitation section
F. TRANSPORTATION
Who is responsible for arranging transportation? self buyer other (specify):
Describe how organic products are transported, including any packaging used other than that already described.
What potential contamination or commingling problems do you have with the transport of organic crops? None
What steps are taken to protect the integrity of organic products during transport? sealed packages/containers
dedicated organic only inspecting transport units prior to loading cleaning transport units prior to loading
use of Off-Farm Transportation Cleaning Affidavits letter / contract with transport company stating organic requirements other (specify):
SECTION 7: SANITATION
Do you test food contact surfaces or rinsate for cleaner/sanitizer residues? Yes No
Where are cleaning/sanitizing materials stored?
Check all cleaning methods used on equipment, facility, storage areas, and any other areas:
sweeping scraping vacuuming compressed air manual washing clean in place (CIP)
steam cleaning sanitizing other (specify):
Provide information on any sanitation used for harvest equipment, extraction equipment/facility, packaging materials, or storage areas, and list all cleaning products used:
Area/equipment/material / check (ü) if used for both organic and nonorganic products / Cleaning equipment used (broom, towel, etc.) / Products used (water, vinegar, etc.) / Frequency/
when? / Check (ü) if
cleaning is documented
Attach MSDS and/or label information for cleaning and sanitizing products, if applicable.
SECTION 8: STRUCTURAL PEST MANAGEMENT
A. STRUCTURAL PEST MANAGEMENT
Check all pest problems you generally have:
flying insects crawling insects rats mice spiders birds other (specify)
Describe or attach the structural pest management plan for the facility.
Are records kept of your pest monitoring activities? Yes No
List all structural pest management materials used in the extraction and storage facilities.
ATTACH LABELS TO SUBMISSION.
Substance / Target pest / Location where used / Method of application / Date of last application
SECTION 9: Record Keeping System
Records must disclose all activities and transactions of the operation, be maintained for 5 years, and demonstrate compliance with all standards applicable to your operation. All records must be accessible to the verification officer.
Which of the following records do you keep for organic production?
input records for materials used (including all labels and seed lots)
monitoring records/analyses (water tests, quality tests, observations)
equipment cleaning records
harvest records that show date of harvest and harvest amounts (tracking back to seed lot)
storage records that show storage location/identification, lot numbers, and amounts stored
cleaning/sanitation/clean-down logs
clean transport records
sales records (purchase order, contract, invoice, cash receipts, cash receipt journal, sales journal, etc.)
shipping records (scale ticket, dump station ticket, bill of lading)
Transaction Certificates
audit control summary
other (specify):
How long do you keep your records?
These records must also be available for the inspector.
Which of the following records do you keep for conventional production? Not applicable
input records storage records shipping records
sales records paid labour records harvest records
other (specify):
Type of Marketing:
farmers market direct to retail CSA/subscription service wholesale on-farm retail
bulk commodities to processor contract to buyer other (specify):
Which organic seal(s) do you use/plan to use on product labels or market information?
Attach copies of all organic product labels.
SECTION 10: Affirmation
I affirm that all statements made in this application are true, correct, and complete. No prohibited products have been applied to any of my organically managed fields 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 as deemed appropriate. I understand that acceptance of this questionnaire in no way implies granting of certification by the PACS. I agree to abide by the PACS Bylaws and the COABC certification standards and/or certification requirements applicable to my operation. I agree to notify THE PACS in writing of changes in any of the following: contact information, applicant contact information, legal status, ownership or control of the operation. I agree to pay all fees assessed by the PACS I further agree to abide by and fulfill duties and obligations to the PACS, as written in the Licensing Agreement.
Signature of Operator Date
I have attached the following documents:
Harvest record samples
Water test, if applicable
Monitoring records, if applicable
Residue analyses, if applicable
Input product labels (including non-GMO affidavits), if applicable
Organic product labels, if applicable*
Description of measures taken to meet requirements from previous certification year, if applicable*
Completed, signed, and dated Associate Licensing Agreement, if applicable*
Documents from previous or dual certification application, if other than the PACS
Audit trail documents
*Required documentation which must be submitted
Make copies of this questionnaire and all supporting documents submitted to the PACS for your records, in order to document your organic management plan as required by standards.
Submit completed form, fees and supporting documents to the PACS.
PACS Sproutt01 PACS Organic SPROUT Questionnaire Page 1 of 7
Effective Date: 15 Feb 005