Retail Application
Oregon Tilth Certified Organic
2525 SE 3rd Street · Corvallis OR 97333 · Phone (503) 378-0690 Fax (541) 753-4924
Email: Web Site: www.tilth.org
Organic System Plan – Class OR (Retail)
Organic Retail Application – New Applicant
ü As you fill out this form, keep in mind you are creating a legal document. No information will be supplied to any third party without prior permission of the operator, with the exception of accreditation agents or government authorities. Compiled data for statistical summaries may be distributed.
ü Please submit a check for all applicable certification fees with this application. Please refer to the OTCO Fee Schedule to determine the certification fee due for your operation. Applications will not be processed without payment or an approved financial agreement. Applications must be completed in full, returned to Oregon Tilth, and reviewed before an inspection can be scheduled. An additional fee of $25 will be charged for any application that must be returned for completion.
ü OTCO can only process completed applications. OTCO recommends beginning the application process with sufficient time before certification is required to allow for the necessary inspection and review process. While in some cases certification can be provided in a very short time frame, providing up to twelve weeks is recommended.
FOR OFFICE USE ONLY:Received: / Cleared Accounting: / Fee Estimate:
SECTION 1: General Information
[NOP 205.201, 205.2 and 205.401] The National Organic Program (NOP) requires all operations seeking certification to develop an organic system plan that is agreed to by the certified producer or handler and an accredited certifying agent. A certified operation must update this system plan on an annual basis in order to verify continued compliance. A Person is defined as: An individual, partnership, corporation, association, cooperative, or other entity.
Rev. 5/1/14 Page 1 of 1
Retail Application
Primary Contact InformationName of person applying for certification:
Please select the appropriate legal description of the applicant and provide the corresponding information as requested.
¨ Sole Proprietor
¨ Partnership
Business Name (DBA):
Address:
(Street, City, State or
Province and zip code)
Website:
Proprietor / Partner Name:
Phone Number(s): / Primary:
Mobile:
Office:
Fax:
Email Address:
Partner Name (if necessary):
Phone Number(s): / Primary:
Mobile:
Office:
Fax:
Email Address:
¨ Limited Liability Corporation (LLC)
¨ Corporation
¨ Trust / Other Organization
Legal Address:
(Street, City, State or
Province and zip code)
Website:
Executive Director, Managing Director,
or Registered Agent:
Phone Number(s): / Primary:
Mobile:
Office:
Fax:
Email Address:
Organic Compliance Manager:
(if applicable)
Phone Number(s): / Primary:
Mobile:
Office:
Fax:
Email Address:
Please attach a listing of all officers/shareholders, office/shareholder contact information, and/or articles of incorporation
Other Contacts (if applicable)These people have knowledge of organic operations and by being listed here will have access to any information contained in the Organic Management Plan or OTCO files. These people may also be consultants, processing entities, managers, etc.
1 / Name:
Company:
Title:
Phone Number(s): / Primary:
Mobile:
Office:
Fax:
Email Address:
2 / Name:
Company:
Title:
Phone Number(s): / Primary:
Mobile:
Office:
Fax:
Email Address:
3 / Name:
Company:
Title:
Phone Number(s): / Primary:
Mobile:
Office:
Fax:
Email Address:
Production Partnership (if applicable)
A production partnership involves a collaborative effort among two or more independent companies marketing their products in common. An operation may also have farm production partners that are contracted to provide crop or livestock products, predominately to the primary operation, which contribute to a finished organic product sold by the primary operation. This production partnership arrangement allows the primary operation (Production Partner) to cover the farm production partner’s certification expenses.
Company:
Contact Person:
Title:
Phone Number(s): / Primary:
Mobile:
Office:
Fax:
Email Address:
AUTHORIZATION REQUIRED: I, the legally authorized representative, authorize the above listed person(s) to act on behalf of my company in establishing or maintaining organic certification.
Name: / Date:
Signature:
Certification History
1. Has this operation ever:
a) Been successful at achieving organic certification? / Yes No
If yes:
Please include a copy of the most recent certificate
Which agency/agencies were you certified with?
What were the dates of maintaining certification?
Are you still currently certified? / Yes No
If yes, with which agency are you still certified?
b) Been denied organic certification? / Yes No
c) Had your certification suspended or revoked? / Yes No
d) Withdrawn from certification with outstanding points of non-compliance or conditions? / Yes No
e) Withdrawn your application for certification with outstanding points of non-compliance or conditions? / Yes No
2. If yes was chosen on b, c, d, e above, please attach a copy of all relevant letter(s) and a description of any/all corrective actions:
3. Have you reviewed the NOP Standards? / Yes No
g) Have you reviewed the OTCO Program Manuals? / Yes No
h) Please check all certification services requested:
USDA NOP (Organic) Salmon Safe USDA-MAFF (Japan)
EU* Canada**(for operations located in Canada)
* EU evaluation requires submission of EU Application and appropriate fees
**Canadian evaluation requires submission of Canadian application and appropriate fees
i) Which, if any, other regulatory agencies inspect this facility?
ii) Do you plan on producing a multi-ingredient product, purchasing/selling/repackaging other’s products (i.e. cleaning, bagging, value-added, etc.)? / Yes No
If yes, please note that you must have an Organic Handling Management Plan submitted to OTCO.
iii) Have you ever failed any regulatory agency inspections or had a negatively scoring report, including, state health departments, FDA, OSHA, or any other agency? / Yes No
If so, describe and submit documentation regarding the issue.
iv) Please list any other certifications held by this company:
v) When do you anticipate the need for certification? / < 90 days < 6 months <1 year
Certification may take up to 90 days, please let us know if there is an emergency or extraordinary circumstance that would necessitate urgency.
Please note: all applications may be downloaded from OTCO website, www.tilth.org or one can be requested from the Oregon Tilth office.
SECTION 2: Retail Plan Information
NOP Rule 205.201(a) - Unless exempt or excluded, a producer or handler intending to sell, label, or represent agricultural products as organic must develop an Organic Handling Plan (OHP) that is agreed to by the producer or handler and Oregon Tilth. The OSP must be submitted with the application and reviewed by OTCO for compliance with organic regulations. An on-site inspection will verify that the information provided in the OHP accurately reflects the practices used or to be used. The OHP must be updated annually (at minimum) to include any deviations from, or changes to the previous year’s OHP, and any additions or deletions intended to be undertaken in the coming year.
Retail Plan InformationType of Retail Store: / Independent Supermarket
Independent Health Food Store
Natural Foods Supermarket
Natural Foods Cooperative
Regional/National chain, Number of stores: ______
Other (specify):
What % of Total Sales is Organic? / <5% 5-25% 25-50% 50-75% >75%
Number of Employees:
Total Square Footage:
Sq. Footage of Area Certified:
Government Permits/Inspections: (State Health Department, Weights and Measure, etc):
SECTION 3: Retail Organic Handling Plan
Please complete this section by each facility, or by each department in large facilities. List locations of all stores, commissary, food processing facilities, and central warehouse. Please list the name of the person at each location who is responsible for maintaining organic standards in that facility. Identify organic products produced off-premises in retailer’s own, or co-packers’ facilities, with the name of facility, manager, phone, location, and mail address and notation as to whether facility is applying for separate certification or as part of retailer’s own certification.
1. If you are seeking organic certification for more than 5 locations managed by a centralized office or corporate headquarters, please skip this section and move to SECTION 4: Centralized Operations.
A. Facility / Department InformationFacility / Department Name:
Address:
(Street, City, State or
Province and zip code)
Primary Manager Name:
Phone Number(s): / Primary:
Mobile:
Office:
Fax:
Email Address:
B. Facility Description
Please give a physical description of all areas where organic product is received, stored, prepared and handled, and displayed, including types of equipment used and specific handling protocols. Please attach diagrams or additional sheets if needed.
Receiving:
Storage:
Preparation and Handling:
Display:
Please attach a site map of each location / Attached
Please attach copies of any company policies regarding organic foods, and attach additional pages as necessary. / Attached
SECTION 4: Centralized office/Corporate Headquarters Retail Organic Handling Plan
Complete this section ONLY if your operation consists of more than 5 locations managed by a centralized office or corporate headquarters.
A. Site Information: Please complete the table below. Include site addresses, phone number, email and a main contact for each. Or attach a complete list of locations included under this application. / Attached
Store Name or Number / Contact Name / Phone / Address / Email address / City / State / Zip
SECTION 4 Continued - Centralized office/Corporate Headquarters Retail Organic Handling Plan
B. Organization Structure1. Please describe the organizational structure of your company (central headquarters, franchises, regional offices, company owned stores, independently managed stores, etc…):
2. Describe your personnel and management structure (teams, management, etc…):
3. Please indicate which functions or decisions are managed centrally, regionally, locally or all:
a) / Organic Compliance Systems / Centrally Regionally Locally All
b) / Organic Sourcing / Centrally Regionally Locally All
c) / Material Use / Centrally Regionally Locally All
d) / Pest Control and Pest Control Contractors / Centrally Regionally Locally All
e) / Sanitization and Cleaning / Centrally Regionally Locally All
f) / Signage / Display Areas / Centrally Regionally Locally All
g) / Organic Product Labeling / Centrally Regionally Locally All
h) / Operating Procedures / Centrally Regionally Locally All
i) / Staff Training / Centrally Regionally Locally All
j) / Other (specify): / Centrally Regionally Locally All
3. Where individual locations make independent decisions, please indicate the parameters for making those decisions (notification of regional management, internal audits where system are unique etc…).
SECTION 4 Continued - Centralized office/Corporate Headquarters Retail Organic Handling Plan
C. Organization Implementation Consistency1. Describe how and when you train individual locations on organic compliance procedures and policies.
2. Describe how you monitor whether procedures and policies have been successfully implemented at each location.
3. Describe how you ensure employees in all departments seeking certification are provided ongoing access to organic practices, procedures and updates.
4. Describe your plan to correct non-compliances with organic procedures and policies.
D. Display Areas
1. Describe how in-store labels are generated and your overall system for verifying the accuracy of organic claims and ingredient statements.
SECTION 5: Background Information
1. Please check below each department that is on your store premises and if you are requesting certification
Have department / Requesting Certification / Conduct Employee Training
Fresh Produce
Bulk food areas
Herbs & Spices
Meats
Grocery
Dairy
Health & Beauty
Prepared Foods – Bakery
Prepared Foods – Deli
Prepared Foods – Salad bar
Prepared Foods – Coffee bar
Prepared Foods – Juice bar
Other (specify):
Warehouse (separate facility)
2. Does your store have receiving protocols established to examine new incoming organic products prior to placing in store inventory? / Yes No
3. If yes, please describe:
4. Is there a quarantine protocol for organic products that arrive with improper labels, are damaged in some way, or have their organic integrity compromised? / Yes No
SECTION 6: Employee Training
1. Do you have an employee-training program? / Yes No
2. Is your training program written down? / Yes No
3. Does your training program document individual employees’ training? / Yes No
4. Does your training program include training on the proper handling of organic products? / Yes No
5. How often do you require refresher trainings?
6. Do your employees understand the USDA Final Organic Rule and Regulations for labeling products as organic? / Yes No
7. Do your employees understand the basic production methods associated with certified organic production? / Yes No
8. Are your employees empowered to re-label organic food as non-organic in the event that commingling or contamination has occurred? / Yes No
9. Do your employees sign an affidavit or other document, stating that they understand the responsibilities in maintaining the integrity of organic produce? / Yes No
10. Please attach copies of your training program protocols and forms used. / Attached
11. Be sure to indicate which departments train their own employees from the department list in Section 4 above.
SECTION 7: Water usage
1. Check the manner in which water is used in the retail store:
Misting organic product in display areas / Cleaning equipment
Cooling organic product in display areas / Cleaning facility
Cooling organic product in preparation / Other (specify):
Cooling organic product in storage / Other (specify):
Washing organic product / Other (specify):
Ingredient in prepared foods
Cooking organic products
2. A water test is recommended for all water that comes into direct contact with organic products (not water used for sanitation purposes). If you checked any boxes in the left column above, a water test is recommended. If you use municipal water, obtain a copy of a current water test and attach a copy with the Organic Handling System Plan in this section. Attach label information on any water additives the retail store uses.
3. What is your source of water? / Municipal system On-site well
Other (specify):
4. Is the water potable? / Yes No
5. Water tests are conducted by: / City In-house Third party
6. Are water additives used? / Yes No
7. If yes, please list:
8. Is water additionally treated or filtered at this facility? / Yes No
9. If yes, please describe what means of treatment are used (i.e. chlorination, filtration, softening, reverse osmosis, etc…):
10. How often are filters replaced or cleaned?
11. What is the residual chlorine level in water used in food preparation?
12. Does water comply with the Safe Drinking Water Act standards? / Yes No
13. List any known water contaminants in the water supply area:
SECTION 8: Pest Management