Yes
No
Same as above
Yes
No
Yes No
Date: Time:
Date: Time
Mailing/Business Address
Beginning
Ending
United States Department of Agriculture
Agricultural Marketing Service
Specialty Crops Program
Specialty Crops Inspection Division
Distribute Audit Report to*(if known):
*Supplying names of retail and food service buyers is not mandatory, however it is useful to know in the event the buyer requires USDA-AMS to send a
copy of the audit report directly. No audit results are sent to a 3rd party without the written consent of the auditee.
Date & Time of Audit
Field Office:
Auditor Name(s):
Street:
Fax Number:
Commodities Covered by Audit:
Commodities Produced During Audit:
Total Acres Covered by Audit:
Is this company currently subject to the Produce Safety Rule (21 CFR Part 112)?
Company uses USDA GAP Logo on packaging or marketing materials?
Description of Operation:
Harvest Company Name (if applicable):
Other Contractors:
E-Mail Address:
Total Square Feet Covered by Audit:
Person(s) Interviewed:
Audit Requested by:
USDA Good Agricultural Practices
Audit Verification Checklist
This program is intended to assess a participant’s efforts to minimize the risk of contamination of fresh fruits, vegetables, nuts
and miscellaneous commodities by microbial pathogens based on the U.S. Food and Drug Administration’s “Guide to Minimize
Microbial Food Safety Hazards for Fresh Fruits and Vegetables,” and generally recognized good agricultural practices.
Phone Number:
Company Name:
Street: City, State, Zip:
Multiple sites covered by this audit? (If Yes, provide details in Additional Comments)
Audit Location Address
City, State, Zip:
Federal Account Number:
Contact Title: Company Contact:
For Official Government Use Only
USDA, AMS, SCP, Specialty Crop Inspection Division
August 1, 2022
Version 3.0