Skip to main content

Toggle navigation

Divisions
License and Payments
News and Updates
Employment
About

Toggle search

Divisions
License and Payments
News and Updates
Employment
About

Toggle search

Home
Food Safety (FSMA), Hemp, & Hops
Produce Safety (FSMA)
Produce Safety Forms
Verification Form

WHAT CAN WE HELP YOU FIND?

Verification Form

Download PDF Version

Average Annual Produce Worksheet

FSMA Produce Safety Verification Form

*Qualified exempt farms must annually review farm sales records, complete this form, and submit to ISDA for renewal consideration.

Name of Farm:

Business Phone:

Farm Business Address:

City:

State:

Zip Code:

County:

Farm Mailing Address:

Same as Business Address

City:

State:

Zip Code:

County:

Website: (if applicable)

Business Email:

Primary Contact:

Phone:

Email:

Additional Contact:

Phone:

Email:

1. What does your farm grow, harvest, pack, or hold?

Please check all that apply.

Apples

Cantaloupe

Grapes

Alfalfa

Chard

Hay

Apricots

Cherries*

Herbs*

Beans*

Corn

Huckleberries

Blackberries

Cucumbers

Kale

Blueberries

Garlic

Leek

Cabbage

Grain*

Lettuce

Melons*

Peas*

Scallions

Microgreens*

Peppers*

Spinach

Mint*

Plums

Squash*

Mushrooms

Pluots

Strawberries

Onions

Potatoes

Sugar Beets

Peaches

Radish

Tomatoes

Pears

Raspberries

Other*

If not above or *, add crop or variety below:

2. Approximate total farm acreage:

0-10

11-100

101-500

501-1,000

1,001-2,500

2,501-5,000

5,000<

3. Are you:

Growing

Harvesting

Packing

Holding

Other

If other, please explain:

4. Approximate volume of commodities:

<5,001 lbs.

5,001-10,000 lbs.

10,001 – 50,000 lbs.

50,001 – 100,000 lbs.

100,001 – 150,000 lbs.

150,000< lbs.

5. What month do you start and end the following activities?

Planting Start Month

Planting End Month

Harvesting Start Month

Harvesting End Month

Packing Start Month

Packing End Month

6. To all that apply, fill in the percentage of your food (all food or drink for people or animals) that is sold to retail, farmers markets, food stands, distributors, or other (please specify).

Retail:

Farm Stand:

Farmers Market:

Distributor:

CSA:

Other:

7. Irrigation Water Source(s):

Ground (Well)

Surface (Canal, Pond, etc.)

Public (Municipal)

Other

If other, please explain:

8. Have you attended a Produce Safety Alliance Grower Training?

Yes

No

9. Irrigation Method:

Drip

Sprinkler

Furrow

10. Is 100% of the produce on your farm produced for personal consumption on your farm?

Yes

No

11. Does your produce receive commercial processing (kill step – pasteurization, dehydrating, etc.) that adequately reduces the presence of microorganisms of public health significance? *If yes, you must obtain written assurance from the processor as outlined in §112.2(b)(2)(3) and apply for an exemption with ISDA.

Yes

No

12. Do you receive any 3rd party audits? (Ex: GAP, Harmonized GAP, etc.)

Yes

No

If yes, which audit?

13. Do you have a Food Safety Plan?

Yes

No

For questions 14 & 15, please see the "Average Annual Sales Worksheet" to assist with calculations.

*Monetary value is strictly used to determine the size of your operation as defined by the Produce Safety Rule.

14. Size of your operation based on the previous 3-year average of all produce sales.

<$25,000

Very Small ($25,000 - $250,000)

Small ($250,000 - $500,000)

Large ($500,000<)

15. Previous 3-year average of all food sales. (Food as defined in §112.3(c)(1): all food or drink for people or animals)

<$25,000

Very Small ($25,000 - $250,000)

Small ($250,000 - $500,000)

Large ($500,000<)

Additional Comments:

Signature

Title

Date

Idaho State Department of Agriculture

2270 Old Penitentiary Road, Boise, ID 83712
Mailing Address: P.O. Box 7249, Boise, ID 83707
Phone: (208) 332-8500
M-F; 8 am - 5 pm

ISDA Divisions

Pesticides
Agricultural Inspections
Animal Industries
Laboratories
Market Development
Plant Industries
Food Safety (FSMA), Hemp, & Hops