FLUE CURED RECORDS - GAP Connections

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FLUE CURED RECORDS - GAP Connections
FLUE CURED
 RECORDS
Operation &
                                                                                          Management
                                                                                          Nutrient
                                                                                  TAB 1
                                       Operation and Nutrient Management

                                        Included Records:
                                       •   Operation Records
                                       •   Field/Tract ID Records
                                       •   Greenhouse Fertilization Records
                                       •   Field/Tract ID Fertilization Records
                                       •   Animal Manure or Litter Application Records

Additional documents may be requested. See GAPC Certification Compliance Guide.
Operation
                       2019OperationRecords
                            OperationRecords
                                      Records

Contact Information

Farm Address:

City:                     State:                      Zip:

County:

Phone:

Email Address:

Primary Grower Name:

Grower ID:                         Grower Date of Birth:          /      /

Training Date:

Associated Grower Name:

Grower ID:                         Grower Date of Birth:          /      /

Training Date:

Associated Grower Name:

Grower ID:                         Grower Date of Birth:          /      /

Training Date:

Associated Grower Name:

Grower ID:                          Grower Date of Birth:        /       /

Training Date:

Associated Grower Name:

Grower ID:                         Grower Date of Birth:          /      /

Training Date:

                                                             1 | Operation & Nutrient Management
Operation Records
Total Tobacco Acres: _____________________

   Tobacco Type              Total Acres               Tobacco Type              Total Acres
 Flue-cured                                    Maryland

 Organic Flue-cured                            Wisconsin

 Burley                                        Cigar

 Organic Burley                                Louisiana Perique

 Dark Air                                      Other: ______________

 Dark Fired                                    Other: ______________

            Farm Infrastructure                      Type                Total Number
                                                Box Barns
  Flue-cured Curing Barns
                                                Rack Barns
  Dark-fired Curing Barns

  Air-cured Curing Barns

  Outdoor Air-cured Curing Structures*

                                                Open
  Storage Facilities
                                                Enclosed

  Stripping Facilities
  (Air and Fire Only)
  Sand Reels/Tumblers
  (Flue Only)
  Leaf Loaders
  (Flue Only)
  Mechanical Tobacco Harvesters
* For outdoor curing structures, give total stick capacity for Total Number

 Curing Information for Flue-Cured Tobacco

 Type of Curing Fuel Used:

 Pounds of Tobacco Cured per Gallon of Fuel:

 Curing Information for Dark-Fired Tobacco

 Type of Wood Source for Curing Fuel:

                                                                          2 | Operation & Nutrient Management
Field/Tract ID Records

                                      Field / Tract ID   Farm Name or    County      FSA Number   Tobacco    Latest Soil   Date of Last     Rate of Lime
                                                           Location			                             Acres    Testing Date Lime Application    (tons/acre)

3 | Operation & Nutrient Management
Greenhouse Fertilization Records

                                      Greenhouse ID    Transplant       Date   Types of Fertilizer           Rate
                                         Number       Batch Number			                                (per 1,000/gallons)

4 | Operation & Nutrient Management
Field/Tract Fertilization Records

                                                                                                                                              Rate of
                                      Field/Tract ID*           Date               Application Timing                    Analysis (N-P-K)   Application    K20 from Muriate, if applied   Muriate of Potash
                                                                                                                                            (lbs./acre)   after December 31 (lbs./acre)   Date of Application
                                                                                 Pre-plant          Transplanting
                                                                                 Side-dressing      Foliar Application

                                                                                 Pre-plant          Transplanting
                                                                                 Side-dressing      Foliar Application

                                                                                 Pre-plant          Transplanting
                                                                                 Side-dressing      Foliar Application

                                                                                 Pre-plant          Transplanting
                                                                                 Side-dressing      Foliar Application

                                                                                 Pre-plant          Transplanting
                                                                                 Side-dressing      Foliar Application

                                                                                 Pre-plant          Transplanting
                                                                                 Side-dressing      Foliar Application

                                                                                 Pre-plant          Transplanting
                                                                                 Side-dressing      Foliar Application

                                                                                 Pre-plant          Transplanting
                                                                                 Side-dressing      Foliar Application

                                                                                 Pre-plant          Transplanting
                                                                                 Side-dressing      Foliar Application

                                                                                 Pre-plant          Transplanting
                                                                                 Side-dressing      Foliar Application

                                                                                 Pre-plant          Transplanting
                                                                                 Side-dressing      Foliar Application

                                                                                 Pre-plant          Transplanting
                                                                                 Side-dressing      Foliar Application

                                                                                 Pre-plant          Transplanting
                                                                                 Side-dressing      Foliar Application

                                                                                 Pre-plant          Transplanting
                                                                                 Side-dressing      Foliar Application

                                      *Field/Tract ID from Tab 1 Operation & Nutrient Management Records Page 1

5 | Operation & Nutrient Management
Animal Manure or Litter Application Records
                                     Date(s) Animal Manure Tested for Nutrient Content: _________________________________

                                           Field/Tract ID*                            Date                       Type of Manure   Rate

                                     *Field/Tract ID from Tab 1 Operation & Nutrient Management Records Page 1

6 | Operation &Nutrient Management
IPM &
                                                                                      CPA
                                                                          TAB 2
                                                                        IPM & CPA

                                        Included Records:
                                        • Scouting Records
                                        • CPA Applicator License Information
                                        • CPA Information Records
                                        • Greenhouse CPA Records
                                        • Field/Tract CPA & Sucker Control Records
                                        • Sprayer Calibration Records

Additional documents may be requested. See GAPC Certification Compliance Guide.
Scouting Records

                                                                                                                                                                     Follow-up on Pest
                        Field		                                                                                                                                     Control Practices to
                                                                      Pest Identified             Level of
                      Scouting            Field/Tract ID*                                                       Corrective Actions Taken (Include Date of Action)      Determine the
                                                                     During Scouting          Infestation of
                       Dates			                                                                                                                                       Effectiveness of
                                                                                              Pest Identified
                                                                                                                                                                       Actions Taken

                  *Field/Tract ID from Tab 1 Operation & Nutrient Management Records Page 1

1 | IPM and CPA
CPA Applicator License Information
List all the applicators and license numbers used on your farm operation below. If pesticide
applicator is not licensed, list the license number of the licensed supervisor.

    Reference
     Number                          Applicator Name                                License Number

        1.

        2.

        3.

        4.

        5.

        6.

        7.

        8.

        9.

       10.

                                                                                               2 | IPM and CPA
CPA Information Records
Save Time: The Federal record keeping regulations require the certified private applicator to record the
brand/product name and the U.S. Environmental Protection Agency (EPA) registration number of the federally
restricted-use pesticide (RUP) he/she applies. You will be able to save time by listing the brand/product name,
EPA registration number, and active ingredient(s) of the pesticides you apply on this page and then entering
the corresponding number(s) to complete your CPA records.

                                                                                            Label       SDS
 Reference         Brand         EPA Registration        Active Ingredient        REI        on          on
  Number           Name              Number		                                   (Hours)      File       File
                                                                                            “3”         “3”

      1.

      2.

      3.

      4.

      5.

      6.

      7.

      8.

      9.

     10.

     11.

     12.

     13.

     14.

     15.

                                                                                                3 | IPM and CPA
Greenhouse CPA Records

                                            Transplant                                                     Brand / Product
                   Greenhouse                 Batch                   Date                Applicator*     Name or Reference   Reason for Application   Rate / 1,000     Total         Start /
                   ID Number                 Number                                                           Number**                                  sq. ft.***    Application   Finish Time

                  *Applicator or reference number from Tab 2 IPM and CPA Page 2
                  **CPA Information Records from Tab 2 IPM and CPA Page 3
                  ***Total Amount of Product Used per 1000ft2 (indicate unit: oz., lb., pt., qt., gal.)

4 | IPM and CPA
Field/Tract CPA and Sucker Control Records

                    Field/				                                                                  Brand / Product			                         Size of   Start /
                    Tract				                                                                  Name or Reference Rate / Acre   Total        Area     Finish    Method of
                     ID*       Date       Applicator**         Reason for Application              Number           ****     Application   Treated    Time     Application
                                                                                                                                                                   Hand
                                                                                                                                                                   Sprayer
                                                                                                                                                                   Hand
                                                                                                                                                                   Sprayer
                                                                                                                                                                   Hand
                                                                                                                                                                   Sprayer
                                                                                                                                                                   Hand
                                                                                                                                                                   Sprayer
                                                                                                                                                                   Hand
                                                                                                                                                                   Sprayer
                                                                                                                                                                   Hand
                                                                                                                                                                   Sprayer
                                                                                                                                                                   Hand
                                                                                                                                                                   Sprayer
                                                                                                                                                                   Hand
                                                                                                                                                                   Sprayer
                                                                                                                                                                   Hand
                                                                                                                                                                   Sprayer
                                                                                                                                                                   Hand
                                                                                                                                                                   Sprayer
                                                                                                                                                                   Hand
                                                                                                                                                                   Sprayer
                                                                                                                                                                   Hand
                                                                                                                                                                   Sprayer
                                                                                                                                                                   Hand
                                                                                                                                                                   Sprayer
                                                                                                                                                                   Hand
                                                                                                                                                                   Sprayer
                                                                                                                                                                   Hand
                                                                                                                                                                   Sprayer
                                                                                                                                                                   Hand
                                                                                                                                                                   Sprayer
                                                                                                                                                                   Hand
                                                                                                                                                                   Sprayer
                                                                                                                                                                   Hand
                                                                                                                                                                   Sprayer

                  *Field/Tract ID from Tab 1 Operation & Nutrient Management Page 1
                  **Applicator or reference number from Tab 2 IPM and CPA Page2 ***CPA
                  Information Records from Tab 2 IPM and CPA Page 3
                  ****Total Amount of Product Used (indicate unit: oz., lb., pt., qt., gal.)

5 | IPM and CPA
Sprayer Calibration Records
The effectiveness of any pesticide depends upon the proper application and placement of the
chemical. The purpose of calibration is to ensure that your chemical application machinery is
uniformly applying the correct amount of material over a given area. Although you may have the
right chemical mixture, it is still possible to apply the wrong amount.

                    Date            Date           Date            Date           Date
                  Calibrated      Calibrated     Calibrated      Calibrated     Calibrated
 Sprayer
 Brand and
 Model

 Sprayer
 Type

 Nozzle Type
 and Size

 Pressure

 Speed (mph)

 Throttle
 (rpm)

 Tractor
 Model

 Tractor Gear

 Spray
 Volume
 (gal/ac)

                                                                                       6 | IPM and CPA
Management
                                                                                    Crop
                                                                          TAB 3

                                                               Crop Management

                                        Included Records:
                                        • Seed Selection Records
                                        • Transplanting and Topping Records
                                        • Weed Prevention Program

Additional documents may be requested. See GAPC Certification Compliance Guide.
Seed Selection Records
                                                                                        Seed
                                                                                *Required       Selection
                                                                                          for Plants ProducedRecords
                                                                                                              and Purchased
                                                                                *Required for Plants Produced and Purchased
                      Variety Selection: Please list the resources or sources of information used to make variety selection decisions: ______________________________
                          Variety Selection: Please list the resources or sources of information used to make variety selection decisions:
                      _______________________________________________________________________________________________________________________
                      _______________________________________________________________________________________________________________________

                                                                                       Batch 2: Variety, Date Seeded:

                                                                    Batch 1: Variety, Date Seeded:                                    Batch 3: Variety, Date Seeded:

             Transplant
      Transplant         Batch
                 Batch No.:     No.:
                              The    The transplant
                                  transplant         batch number
                                             batch number             is created
                                                             is created           by you
                                                                         by you and        and is
                                                                                       is used to used   to identify
                                                                                                  identify            each separate
                                                                                                            each separate   batch ofbatch  of transplants
                                                                                                                                     transplants  used in your   in your operation. A
                                                                                                                                                           used operation.
             separate
      A separate      number
                 number shouldshould  be given
                                be given to each  each batch
                                               to batch         of transplants
                                                        of transplants    of the of
                                                                                 same   same source,
                                                                                    the source,  variety,variety, lot number,
                                                                                                          lot number,         and seeded
                                                                                                                        and seeded  at the same   same
                                                                                                                                           at thetime in time
                                                                                                                                                          the same    same
                                                                                                                                                               in thegreenhouse.
             greenhouse.
      See diagram  above ofSee diagram below
                            greenhouse  bed. of greenhouse bed.
                              Greenhouse        Transplant                                                                                                                    LC Variety
                                ID No.*          Batch No.                Seedling Source                    Variety Name                       Seed Lot #              (Burley & Dark ONLY)   Date of Seeding
                       Greenhouse            Transplant                  Seeding                                Variety                            Seed                      LC Variety          Date of
                          ID No*             Batch No.              □ Grown □ Purchased
                                                                          Source                                Name                               Lot #               (Burley
                                                                                                                                                                          □ Yes& Dark ONLY)
                                                                                                                                                                                    □ No         Seeding
                                                                    □ Grown □ Purchased                                                                                   □ Yes     □ No
                                                                    Grown          Purchased                                                                               Yes
                                                                                                                                                                           Y           No
                                                                    □ Grown □ Purchased                                                                                   □ Yes     □ No
                                                                      Grown □ Purchased
                                                                    □Grown     Purchased                                                                                    Yes
                                                                                                                                                                          □Yes      □ No
                                                                                                                                                                                       No
                                                                    □ Grown □ Purchased                                                                                   □ Yes     □ No
                                                                    Grown          Purchased                                                                               Yes         No
                                                                    □ Grown □ Purchased                                                                                   □ Yes     □ No
                                                                    □ Grown □ Purchased                                                                                     Yes     □ No
                                                                    Grown          Purchased                                                                              □Yes         No
                                                                    □ Grown □ Purchased                                                                                   □ Yes     □ No
                                                                    Grown      Purchased
                                                                    □ Grown □ Purchased
                                                                                                                                                                           Yes
                                                                                                                                                                          □ Yes
                                                                                                                                                                                       No
                                                                                                                                                                                    □ No

                                                                      Grown □ Purchased
                                                                    □Grown     Purchased                                                                                    Yes
                                                                                                                                                                          □Yes      □ No
                                                                                                                                                                                       No
                                                         □ Grown □ Purchased                                                               □ Yes                                    □ No
                            *This Greenhouse ID number isGrown
                                                         created by Purchased                                                                Yes
                                                                    you and is used to identify each separate greenhouse used in your operation.                                       No

                                                                    Grown          Purchased                                                                               Yes         No

                                                                    Grown          Purchased                                                                               Yes         No

                                                                    Grown          Purchased                                                                               Yes         No

                                                                    Grown          Purchased                                                                               Yes         No

1 | Crop Management
                      *This Greenhouse ID number is created by you and is used to identify each separate greenhouse used in your operations.
Transplanting and Topping Records
                Plant Population (Plants/acre): ____________________                    Row Spacing: ______________________   Plant Spacing in Row: ___________________

                                                                                                                                                 Topping Height
                       Field/Tract ID*              Transplanting                       Transplant                      Date                 (approximate number of
                                                        Date                          Batch Number**                 of Topping                    leaves left)

                 * Field/Tract ID from Tab 1 Operation & Nutrient Management Page 1
                 ** Transplant Batch No. from Tab 3 Crop Management Page 1

                      Program for Preventing Weed Seed Contamination of Harvested Leaf (Palmer Amaranth, other Pigweed, Ragweed, Grasses)

                      Herbicides used __________________________________________________________________________

                      Number of Cultivations _____________________ Control of weeds in field borders _____________________

                      Preharvest scouting and cleanup practices _____________________________________________________

2 | Crop Management
                      Other (hand hoeing, etc.) ___________________________________________________________________
TAB 4

                                                                                   Management
                                                                                    and Barn
                                                                                    Curing
                                          Curing & Barn Management — Flue

                                        Included Records:
                                        • Flue Curing Facility Records
                                        • Flue Harvesting and Curing Records

Additional documents may be requested. See GAPC Certification Compliance Guide.
Flue Curing Facility Records
                        GAP Connections Certification -- Barn Testing Report

Farmer or Farm Name: ____________________________ Testing Entity: _____________________
Signature of Barn Tester: ___________________________ Date of Testing: ___________________
Barn Location: __________________________________      CO2 Meter Make: __________________
Probe Number: _______________________ Probe Calibration Date: _________________
Total Number of Barns Tested: _________
  Number of Barns Passing: _________
How is barn temperature and /or humidity in curing barns monitored? _________________________
                                                        CO2 Measurements

   Barn ID      Barn Make and     Heat Exchanger        Initial             Final        Barn Status
   Number           Model              Brand           Reading             Reading       Pass / Fail

                                                                              1 | Curing & Barn Mgmt.-Flue
Flue Curing Facility Records (Retest Report)
                       GAP Connections Certification -- Barn (RETEST) Report

Farmer or Farm Name: ____________________________ Testing Entity: _____________________
Signature of Barn Tester: ___________________________ Date of Testing: ___________________
Barn Location: __________________________________      CO2 Meter Make: __________________
Probe Number: _______________________ Probe calibration date: _________________
Total Number of Barns Tested: _________
  Number of Barns Passing: _________
How is barn temperature and /or humidity in curing barns monitored? _________________________
                                                        CO2 Measurements

   Barn ID      Barn Make and     Heat Exchanger        Initial             Final         Barn Status
   Number           Model              Brand           Reading             Reading        Pass / Fail

                                                                              2 | Curing & Barn Mgmt - Flue
Flue Harvesting and Curing Records

                                 Field/Tract   Harvest Date   Method of    Stalk Position   Barn ID         Fuel Source              Bale ID Number(s)
                                      ID**                    Harvesting
                                                                                                      LP            Fuel Oil
                                                                                                      Natural Gas   Other ________

                                                                                                      LP            Fuel Oil
                                                                                                      Natural Gas   Other ________

                                                                                                      LP            Fuel Oil
                                                                                                      Natural Gas   Other ________

                                                                                                      LP            Fuel Oil
                                                                                                      Natural Gas   Other ________

                                                                                                      LP            Fuel Oil
                                                                                                      Natural Gas   Other ________

                                                                                                      LP            Fuel Oil
                                                                                                      Natural Gas   Other ________

                                                                                                      LP            Fuel Oil
                                                                                                      Natural Gas   Other ________

                                                                                                      LP            Fuel Oil
                                                                                                      Natural Gas   Other ________

                                                                                                      LP            Fuel Oil
                                                                                                      Natural Gas   Other ________

                                                                                                      LP            Fuel Oil
                                                                                                      Natural Gas   Other ________

                                                                                                      LP            Fuel Oil
                                                                                                      Natural Gas   Other ________

                                                                                                      LP            Fuel Oil
                                                                                                      Natural Gas   Other ________

                                                                                                      LP            Fuel Oil
                                                                                                      Natural Gas   Other ________

                                                                                                      LP            Fuel Oil
                                                                                                      Natural Gas   Other ________

3 | Curing & Barn Mgmt - Flue.
TAB 5
                                               Non-Tobacco Related Materials

                                        Included Records:

                                                                                  Non-Tobacco
                                                                                   Materials
                                        • NTRM Inspection Information

                                                                                    Related
                                          (English & Spanish)
                                        • NTRM Inspection Log

Additional documents may be requested. See GAPC Certification Compliance Guide.
NTRM Inspection Information
                    NTRM Inspection Information

Non-tobacco related material (NTRM) or foreign matter is a broad term that refers to all materials
that are not tobacco lamina and stem. This includes, but is not limited to: soil particles, paper, string,
metal fragments, tobacco stalks and suckers, plastics, foam materials, wood, grasses, weeds, oils
and burlap fibers, as well as gloves and other personal protection equipment.
Providing a product that is free of all forms of NTRM is a critical aspect of GAP that begins at the
farm level with elimination of NTRM sources and physical removal of all NTRM materials during on-
farm tobacco handling, storage and transport.
Below is a NTRM inspection checklist. Inspections should be done routinely to ensure new sources
of NTRM are addressed as soon as possible.
   □   Clean all market prep facilities. Starting the season with a clean facility will make it easier to
       maintain throughout the entire season.
   □   Create designated break areas with space to store gloves, jackets, tools, drinks, or food.
       These areas should be the only space workers are allowed to eat, drink, and take breaks
       from market prep activities.
   □   Ensure trash cans are emptied regularly, secured to prevent tipping, and in areas easily
       accessible to employees when they are on breaks.
   □   Check facilities for bird’s nest or roosting birds to prevent feathers and bird waste from
       getting in tobacco.
   □   Ensure all the tools used in the market preparation area are in good condition and have
       handles made of wood or metal.
   □   Check and replace any materials used to cover tobacco if fraying or tears are present. When
       possible use a non-plastic tarp such as canvas or similar quality material.
   □   Check to make sure the wagon, trailer, or truck used to transport the tobacco is clean and
       free from any oil or chemical spills.

   Worker Training
   Worker  TrainingTips:
                      Tips:
   •   Remind your workers everyday verbally and with posted posters to think about NTRM
       prevention.
   •   In training, ask them to use only the designated break areas for eating, drinking, and storage
       of other personal items.
   •   Ask them to pick up and place in a trash can any trash or non-tobacco material when they
       see it on the market prep floor or near baling supplies.

                                                                               1 | Non-Tobacco Related Materials
Inspección NTRM
                               Inspección NTRM
Materiales no relacionados al Tabaco (NTRM) o material ajeno al mismo es un término amplio que
refiere a todos los materiales que no son el vástago o la lámina del tabaco. Esto incluye, pero no se
limita a: partículas del suelo, papel, tiras, fragmentos metálicos, tallos y retoños de tabaco, plásticos,
materiales de goma espuma, madera, pastos, hierba mala, aceites y fibras de jute, así como
guantes y otros equipos de protección personal.
Proveer un producto libre de todas las formas de NTRM es un aspecto critico de GAP que empieza
en la granja a nivel de eliminación de recursos NTRM y remoción física de todos los materiales
NTRM durante el manejo, almacenamiento y transporte en la granja.
Adjunta se encuentra una lista de control de inspección de NTRM. Las inspecciones de deben hacer
(al menos 1 o 2 veces por semana) para garantizar que las nuevas fuentes de NTRM se aborden lo
antes posible.
   □   Limpiar las instalaciones de preparación del mercado. Empezar la temporada con unas
       instalaciones limpias hará el proceso de mantenimiento más fácil durante toda la temporada.
   □   Crear áreas designadas para descansos con espacio para guardar guantes,
       chaquetas/chamarras, herramientas, bebidas, o comida. Estas áreas deben ser el único
       lugar donde los empleados puedan comer, beber, y tomar descansos fuera de las áreas de
       preparación del mercado.
   □   Asegurar que los botes de basura sean vaciados con regularidad, asegurados para evitar
       que se volteen, y estar en áreas accesibles para los trabajadores cuando están
       descansando.
   □   Verifique las instalaciones para observar si hay nidos de pájaros, para prevenir que las
       plumas y desechos de los mismos caigan sobre el tabaco.
   □   Asegúrese que todas las herramientas que se usan en el área de la preparación del
       mercado estén en buenas condiciones y tengan mangos hechos de madera o metal.
   □   Observe y reemplace cualquier material usado para cubrir el tabaco si esta deshilachado o
       rajado. Cuando sea posible use lonas que no sean plásticas, como telas o materiales
       similares de calidad.
   □   Verifique que el vagón, tráiler o camión usado para transportar el Tabaco está limpio y libre
       de cualquier derrame de aceite o productos químicos.

    Consejos dede
   Consejos        Capacitación
                        Capacitación  para el para
                                                Personal:
                                                       el Personal:
   • Recuérdele a los trabajadores cada día verbalmente y con carteles para pensar cómo
       prevenir NTRM.
   •   En los entrenamientos/capacitaciones, pídales que solo usen las áreas designadas para
       comer, beber, y guardar artículos personales.
   •   Pídales que recojan y pongan - basura o materiales no relacionados al tabaco en los
       receptáculos provistos cuando lo vean en el piso del área de preparación del mercado o
       cerca de los suministros de empacado.

                                                                               2 | Non-Tobacco Related Materials
NTRM Inspection Log
            Regisstro de Inspección NTRM

                                Areas Inspected
                                                                     Comments
                           (ex: market prep facilities,
                                                           (ex: No new sources of NTRM,
                         baling equipment, break areas)
        Who did the                                       added a trash can in break area)
        Inspection?         Areas Inspeccionadas
                                                                    Comentarios
                              (ej: instalaciones de
                                                           (ej: No hay nuevas fuentes de
                           preparación del Mercado,
 Date   Quién hizzo la                                      NTRM, se agregó un bote de
                             equipos de emaque,
Fecha   inspección?                                         basura al área de descanso)
                              áreas de descanso)

                                                            3 | Non-Tobacco Related Materials
TAB 6
                                   Agrochemical Storage and Soil & Water

                                     Included Records:
                                     •   CPA Inventory Records
                                     •   Rainfall Records
                                     •   Irrigation Records
                                     •   Crop Rotation Records

                                                                                  Agrochemical
                                                                                  Soil & Water
                                                                                  Storage and

Additional documents may be requested. See GAPC Certification Compliance Guide.
CPA Inventory Records

    Reference        Brand Name / Product / Common Name   Storage Area               Amount
    Number*

*CPA Information Records from Tab 2 IPM and CPA Page 3

                                                                  1 | Agrochemical Storage Soil & Water
Rainfall Records
Rainfall records can be kept daily, weekly or monthly.

        Field/Tract ID*                       Date                 Amount of            Crop Condition
                                                                  Precipitation

*Field/Tract ID from Tab 1 Operation & Nutrient Management Records Page 1

                                                                                  2 | Agrochemical Storage Soil & Water
Irrigation Records
Irrigation records can be kept daily, weekly or monthly.
  Field/         Date               Source of             Application       Amount      Crop Condition before Irrigating
  Tract		                       Irrigation Water            Type            Applied
   ID*

*Field/Tract ID from Tab 1 Operation & Nutrient Management Records Page 1

                                                                                      3 | Agrochemical Storage Soil & Water
Crop Rotation Records

                                                                                                         20__                               20__                       20__                        20__

                                             Field/             Field
                                             Tract              HEL                  Crop              Tillage             Cover		          Tillage   Cover		          Tillage   Cover		          Tillage   Cover
                                              ID*             (Yes/No)		                               Type**              Crop      Crop   Type**    Crop      Crop   Type**    Crop      Crop    Type**   Crop

                                        *Field/Tract ID from Tab 1 Operation & Nutrient Management Records Page 1 **
                                        Tillage type indicates one of the following: conventional, strip-till, or minimum till

4 | Agrochemical Storage Soil & Water
TAB 7
                                              Recruiting and Hiring Workers

                                              Included Records:
                                              • Labor Numbers
                                              • DOL Template Terms & Conditions of Employment
                                                (DOL WH-516)
                                              • Worker Termination Record
                                              • Non-Immediate Family Minors Working Record

                                                                                                     and Hiring
                                                                                                     Recruiting
                                                                                                Workers

Additional documents may be requested. See GAPC Certification Compliance Guide.
Labor Numbers
  Include all hired labor that steps foot on the farm and works in tobacco. This includes all part-time or
  seasonal employees who may only work during peak time.

    Workers                                     Number of workers                    Number of workers                    Number of workers for
                                                employed year-round                  employed seasonally                  whom housing is provided
                                                           H-2A Workers Hired Directly 1
    Living on Farm
    Not Living on Farm
                                                         H-2A Workers Hired Indirectly 2
    Living on Farm
    Not Living on Farm
                                                                      Migrant Labor3
    Migrant Non-H-2A (18 or older)
    Migrant Non-H-2A minors (16-17)
    Migrant Non-H-2A minors (15)
    Migrant Non-H-2A minors (14)
    Migrant Non-H-2A minors
    (13 or younger)

                              Local Labor (non-immediate family, non-H-2A, non-migrant)4
    Local labor (18 or older)
    Local minors (16-17)
    Local minors (15)
    Local minors (14)
    Local minors (13 or younger)
    Language(s) spoken by workers:
                                                             Immediate Family Labor5
                                                         Year-round                            Seasonally
                                                   Living on    Working on              Living on    Working on
                                                   the Farm      the Farm               the Farm      the Farm
    Immediate Family (18 or older)
    Immediate Family Minors (16-17)
    Immediate Family Minors (15)
    Immediate Family Minors (14)
    Immediate Family Minors
    (13 or younger)

1
  Hired Directly: Workers are hired directly by grower or with the assistance of a personal attorney, approved H-2A agent, or approved H-2A
agricultural association (i.e. NCGA, AWMA, VAGA, National Ag Consultants, and KY Farmers Aid).
2
  Hired Indirectly: Workers are not hired directly by grower or with the assistance of a personal attorney, approved H-2A agent, or approved H-2A
agricultural association. Grower solicits a third-party such as a FLC or H-2ALC to hire workers to work on grower’s operation.
3
  Migrant Labor: An individual who is employed in agricultural employment of a seasonal or other temporary nature, and who is required to be
absent overnight from his permanent place of residence.
4
  Local Labor: Workers engaged in agriculture who commute daily from their permanent residence.
5
  Immediate family members include only: (1) spouse; (2) children, stepchildren, and foster children; (3) parents, stepparents, and foster parents;
and (4) brothers and sisters. If the worker does not fall into one of these four categories, then the worker is considered a hired worker.

                                                                                                                    1 | Recruiting & Hiring Workers
Migrant and Seasonal Agricultural                                           U.S. Department of Labor
Worker Protection Act                                                       Wage and Hour Division

                                                                                                                                    OMB NO: 1235-0002
                                                                                                                                    Expires: 08/31/2020

                         Worker Information—Terms and Conditions of Employment
 1. Place of employment: ________________________________________________________________________________________________

 2. Period of employment: From _______________________           To ___________________________

 3. Wage rates to be paid: $ __________________ per Hour         Piece Rate $____________________ per _______________________

 4. Crops and kinds of activities: __________________________________________________________________________________________

 5. Transportation or other benefits, if any: __________________________________________________________________________________

     ________________________________________________________________________________________________________________

    Charge(s) to workers, if any: __________________________________________________________________________________________

 6. Workers’ compensation insurance provided: Yes ________ No _________

    Name of compensation carrier: ________________________________________________________________________________________

    Name and address of policyholder(s): ___________________________________________________________________________________

     ________________________________________________________________________________________________________________

    Person(s) and phone number(s) of person(s) to be notified to file claim:_________________________________________________________

     ________________________________________________________________________________________________________________

    Deadline for filing claim:______________________________________________________________________________________________

 7. Unemployment compensation insurance provided: Yes _________ No ___________

 8. Other benefits: __________________________________________________________________________ Charge(s) _________________

 9. For migrant workers who will be housed, the kind of housing available and cost, if any:_____________________________________________

     ________________________________________________________________________________________________________________

    Charge(s)_________________________________________________________________________________________________________

 10. List any strike, work stoppage, slowdown, or interruption of operation by employees at the place where the workers will be employed. (If there
 are no strikes, etc., enter “None”):

     ________________________________________________________________________________________________________________

     ________________________________________________________________________________________________________________

 11. List any arrangements that have been made with establishment owners or agents for the payment of a commission or other benefits for sales
 made to workers. (If there are no such arrangements, enter “None”):

     ________________________________________________________________________________________________________________

     ________________________________________________________________________________________________________________

 Name of Person(s) Providing This Information: ______________________________________________________________________________

 Note: The Department of Labor–Wage and Hour Division makes this form available in certain other languages to enable employers to satisfy the
 requirement that the terms and conditions of employment be disclosed in a language common to the workers. Contact the nearest office of the
 Wage and Hour Division to obtain such forms.
 While completion of Form WH516 is optional, it is mandatory for Farm Labor Contractors, Agricultural Employers, and Agricultural Associations
 to disclose employment terms and conditions in writing to migrant and day-haul workers upon recruitment, and to seasonal workers other than
 day-haul workers upon request when an offer of employment is made to respond to the information collection contained In 29 CFR §§ 500.75-
 500.76. This optional form may be used to disclose the required information. Thereafter, any migrant or seasonal worker has the right to have, upon
 request, a written statement provided to him or her by the employer, of the information described above. This optional form may also be used for
 this purpose.
 We estimate that it will take an average of 32 minutes to complete this collection of information, including the time to review instructions, search
 existing data sources, gather and maintain the data needed, and complete and review the collection of information. If you have any comments
 regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, send them to the
 Administrator, Wage and Hour Division, Room S3502, 200 Constitution Avenue NW, Washington, D.C. 20210. Do NOT send the completed form
 to this office.

                                                                                                                                    Optional form WH516 ENG
Persons are not required to respond to this information unless it displays a currently valid OMB number.                                           REV 06/14

                                                                                                                   2 | Recruiting & Hiring Workers
3 | Recruiting & Hiring Workers
Worker Termination Record

                                  Worker Name              Reason for Termination   Documentation

5 | Recruiting & Hiring Workers
Non-Immediate Family Minors (Under Age 18) Working on Farm Record
                            U.S. Certification: Hired workers under 18 are restricted from Department of Labor (DOL) Hazardous Tasks (For a list See Certification Standards Appendix 1 List A)
                            International Certification: Hired workers under 18 are restricted from International Restricted Tasks (For a list See Certification Standards appendix 1 List B)

                                                                                        Date of          Parental
                                                    Full Name                            Birth           Consent                  Residence                          Permanent Address

                                                                                                             YES
                                                                                                             NO

                                                                                                             YES
                                                                                                             NO

                                                                                                             YES
                                                                                                             NO

                                                                                                             YES
                                                                                                             NO

                                                                                                             YES
                                                                                                             NO

                                                                                                             YES
                                                                                                             NO

                                                                                                             YES
                                                                                                             NO

                                                                                                             YES
                                                                                                             NO

                                                                                                             YES
                                                                                                             NO

6 | Recruiting & Hiring Workers
TAB 8
                                           Workers Right & Responsibilities and
                                                     Worker Concern Helpline

                                        Included Records:
                                        • Worker Concern Process Documentation
                                          (English & Spanish)
                                        • Anti-Discrimination Policy
                                          (English & Spanish)

                                                                                         WWR
                                                                                   WCH
                                                                                     and

Additional documents may be requested. See GAPC Certification Compliance Guide.
Worker Concern Process Documentation
   Worker Concern Process Documentation
   Worker
  Grower ID
         ID##
              Concern Process Documentation
   Worker
  Grower
Grower
         ID#
GrowerName
       Name
              Concern Process Documentation
  Grower
Grower    ID#
       Name
 Farm
  FarmName
        Name
Grower
 Farm  Name
   Trainer (s)
    Trainer(s)
 Farm  Name
   Trainer (s)
         Date
         Date
   Trainer (s)
         Date
•  Information on the Worker Rights and Responsibilities and Worker Concern
•        Date
   Helpline  poster
   Information   on thewasWorker sharedRights
                                           with you    andand    is posted in aand
                                                             Responsibilities         place    that isConcern
                                                                                            Worker       visible to all
   workers. poster was shared with you and is posted in a place that is visible to all
   Helpline
• Information on the Worker Rights and Responsibilities and Worker Concern
• workers.
   You   understand         theshared
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                                           with on   youthis
                                                           andfarm:
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   Helpline  poster was           the     following             on     this infarm:
                                                                 is posted          a place that is visible to all
   You understand the following on this farm:a safe working environment for you
       □
• workers.The    Grower        is  committed         to  providing
          and satisfy
       □ The     Groweryour          legal rights
                               is committed          to while   you are
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• You understand the following on this farm:
          and   satisfyisyour        legal rights       while you      are on    this  farm. orally and in writing,
       □ A
       □  Themethod
                 Grower available
                               is committed  for workers        to notify
                                                     to providing      a safetheworking
                                                                                    Grower,  environment for you
       □ of   any   concern         related     to  the   terms    or  conditions      of
          and satisfy your legal rights while you are on this farm. orally and in writing,
          A  method        is  available     for    workers     to   notify  the    Grower,work.
       □ The     Grower
          of method
              any   concern    willrelated
                                     investigate    theconcerns
                                                to workers            brought
                                                          termstoornotify
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                                                                                       of by   workers and provide
                                                                                           work.
       □ A                 is available      for                             the Grower,        orally and in writing,
       □ notice
          The       to
                 Grower the     workers,
                               will          if
                                     investigate  known,     of
                                                        concernshow
          of any concern related to the terms or conditions of work.    the
                                                                      broughtconcern
                                                                                   forth   will
                                                                                          by    be or was
                                                                                               workers     and provide
          addressed.
          notice    to theAt      the request
                                workers,     if known,of theofworkers,  thean
                                                                howbrought       informal
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                                                                                                be or was  between the
       □ The     Grower        will  investigate        concerns                   forth by    workers     and provide
          Growers
          addressed.    and workers          will be  of held   to address       the   concern.
          notice    to theAtworkers,
                                  the requestif known,    theofworkers,
                                                                how thean        informal
                                                                             concern       willmeeting
                                                                                                be or was  between the
          Growers
       □ If  you raise
          addressed.    and  aAtworkers
                                 concern
                                  the requestwill
                                              withbe      held
                                                       Grower
                                                      of        toandaddress
                                                          the workers,   areannotthe   concern.
                                                                                    satisfied
                                                                                 informal        with the
                                                                                             meeting         resolution
                                                                                                           between    the
       □ or
          If  handling
             you   raise     aof  the  issue,
                                 concern      with you    are
                                                       Grower encouraged
          Growers and workers will be held to address the concern.and    are  not to  call the
                                                                                    satisfied    GAP
                                                                                                 with    Connections
                                                                                                        the  resolution
          Worker
          oryou
              handlingConcern     theHelpline        or legal   authority to to    voice
                                                                                      call and   address      the
       □ If        raise aofconcern    issue, with you    are encouraged
                                                       Grower     and are not satisfied    the GAP
                                                                                                 with theConnections
                                                                                                             resolution
          concern.Concern Helpline or legal authority to voice and address the
          Worker
          or handling of the issue, you are encouraged to call the GAP Connections
          concern.
          Workerhas   Concern         Helpline
• The Grower                discussed          theor     legal authority
                                                      following       with youto voice     and address
                                                                                     concerning               the
                                                                                                       the Worker
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• The         Helpline:
          concern.
        Grower     has      discussed          the following          with you concerning              the Worker
       Grower
       □  If you
                       has
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                                  discussed
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                                                           the are
                                                         rights
                                                                   following
                                                                        not  being
                                                                                        with
                                                                                       met   while
                                                                                                  you working    on this
   Concern Helpline:
• concerning
   The Grower
          farm,    hasthe       Worker
                            discussed          the Concern
                                                      following       Helpline:
                                                                      with   you     concerning        the   Worker
       □ If  you and
                   believe you that
                                  are not
                                        yourcomfortable
                                                 legal rights discussing
                                                                  are not being    themet
                                                                                        issue    withworking
                                                                                             while     someone   on on
                                                                                                                    this
   Concern Helpline:
          this farm,      please  arefeel   free to call this        helpline. the issue with someone on
       □ farm,
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                   believe you that     not
                                        yourcomfortable
                                                 legal rights discussing
                                                                  are not being        met while working on this
          Using
          farm, and you are not comfortable discussing the issue have
       □ this      this
                farm,       helpline
                          please         will
                                      feel     not
                                            free      limit
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                                                              thisrights   you
                                                                     helpline.     currently            under U.S.
                                                                                                 with someone       on
          Law,
       □ Using    nor
                   this  limit   your
                            helpline     ability
                                         will  not  to  share
                                                      limit
          this farm, please feel free to call this helpline. anya   legal
                                                                  rights   concern
                                                                           you           you
                                                                                   currently   may
                                                                                                have  have
                                                                                                        under with any
                                                                                                                 U.S.
          other nor
                  person or          organization.
       □ Law,
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                                                                                          be treated
                                                                                               may have   as with any
          confidential.
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          otherthe     source
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                                or organization.
       □ confidential.
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          That     callsource
                           this helpline
                                     of any and        share a you
                                                information       concern,
                                                                        provide thewill
                                                                                      service     provider
                                                                                          be treated      as of this
          helpline
       □ If  you call will
          confidential.       contact
                           this   helplineyouand  within
                                                       sharetwoa weeks
                                                                  concern,  to provide
                                                                                the service an update.
                                                                                                  provider of this
          You maywill
       □ helpline        also     choose
                              contact     you to within
                                                   remaintwo  anonymous         when you    anreport     your concern.
       □ If you call       this   helpline     and share       a weeks
                                                                  concern,  to provide
                                                                                the service      update.
                                                                                                  provider of this
       □ You
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          helpline preferalso
                      will     tochoose
                                   remain
                              contact     you to   remaintwo
                                               anonymous,
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             youmay     aalso
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                                                                   the service
                                                              anonymous         when can   receive
                                                                                     provider
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                                                                                                 of this
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             youany     a number
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                                                                                                             thehelpline
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              operator.                                                                                          1 | WRR & WCH
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                       fuente
            confidencialmente.
            tenga                de cualquier
                             alguna    otra persona información      que usted aporte será tratada
                                                         u organización.
        □
        □   confidencialmente.
            Si usted
            Que           llamade
                   la fuente      a lacualquier
                                        línea deinformación
                                                     ayuda y comparteque ustedunaaporte
                                                                                    queja, será
                                                                                             el proveedor
                                                                                                    tratada de la línea de
        □   Si usted
            ayuda     le llama    a la línea
                           contactara
            confidencialmente.            dentrode deayuda     y comparte
                                                        un plazo     de dosuna      queja,para
                                                                               semanas       el proveedor
                                                                                                    actualizarle.de la línea de
        □
        □   ayuda
            Usted
            Si  usted le   contactara
                      también
                          llama apuede    dentro
                                    la línea escogerde
                                                de ayudaun   plazo
                                                        mantenerse   de
                                                               y comparte dos  semanas
                                                                          anónimo
                                                                              una queja,     para
                                                                                        cuando      actualizarle.
                                                                                                  reporte sude
                                                                                             el proveedor         queja.
                                                                                                                     la línea de
        □   Usted
            Si  usted también
                          prefierepuede      escoger
                                     mantenerse         mantenerse
                                                       anónimo,      el   anónimo
                                                                        proveedor       cuando
            ayuda le contactara dentro de un plazo de dos semanas para actualizarle. dará un
                                                                                        de la     reporte
                                                                                               línea   de     su
                                                                                                           ayuda  queja.
                                                                                                                     le
        □
        □   Si  usted
            numero
            Usted         prefiere
                         de
                      también        mantenerse
                              teléfono
                                  puede   al escoger
                                             que podrá anónimo,
                                                            llamar el
                                                        mantenerse    enproveedor
                                                                          dos  semanas
                                                                          anónimo       de lapara
                                                                                        cuando línea   de ayuda
                                                                                                     recibir
                                                                                                  reporte    suuna   le dará un
                                                                                                                  queja.
        □   numero       de
            actualización.
            Si                teléfono    al que   podrá    llamar    en  dos  semanas       para
                usted prefiere mantenerse anónimo, el proveedor de la línea de ayuda le dará un      recibir   una
        □   actualización.
            Si  en algún
            numero             momento
                         de teléfono      al siente
                                             que podráque se     están
                                                            llamar    entomando
                                                                          dos semanas represalias     hacia una
                                                                                             para recibir      usted por llamar
        □   Si
            a laenlínea
                     algún
            actualización.  demomento
                                ayuda, usted siente   quellamar
                                                   debe     se estána latomando
                                                                          línea de represalias
                                                                                      ayuda otra vez  hacia    usted por esto
                                                                                                            y compartir     llamar
        □   a la  línea
            conenelalgún
            Si              de
                      operador  ayuda,    usted
                                    de la línea
                               momento             debe
                                             sientede     llamar
                                                        ayuda.
                                                      que           a  la línea  de   ayuda     otra  vez   y
                                                            se están tomando represalias hacia usted por llamarcompartir    esto
            con   el  operador      de   la línea   de  ayuda.
            a la línea de ayuda, usted debe llamar a la línea de ayuda otra vez y compartir esto
            con el operador de la línea de ayuda.

                                                                                                                          2 | WRR & WCH
Worker Concern Process Documentation
              Documento Para El Proceso De Quejas
Sign below if you understand the Worker Concern Process being used on this farm.

Firme abajo si usted entendió el Proceso de Quejas para Trabajadores usado en esta granja.

           Printed Name (Nombre Impreso)                                Signature (Firma)

 1.

 2.

 3.

 4.

 5.

 6.

 7.

 8.

 9.

 10.

 11.

 12.

 13.

 14.

 15.

 16.

 17.

 18

 19

 20

                                                                                             3 | WRR & WCH
Anti-Discrimination Policy

* _______________________________________ is an equal opportunity employer and makes all
employment decisions without regard to race, color, age, religion, sex, disability, genetic information,
national origin, and other situations protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including but not limited to; compen-
sation, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, benefits,
and training.

* _______________________________________ seeks to comply with all applicable federal, state
and local laws related to discrimination.

* _______________________________________ makes decisions concerning employment
based strictly on an individual’s qualifications and ability to perform the job under consideration,
the comparative qualifications and abilities of other applicants or employees, and the individual’s
past performance.

If you believe that an employment decision has been made that does not conform with

* ___________________________________________________________________________
commitment to equal opportunity, you should promptly bring the matter to the attention of

* ___________________________________________________________________________
for an equitable resolution.

There will be no retaliation against any employee who files a complaint in good faith, even if the result
of the investigation produces insufficient evidence to support the complaint.

*INSERT FARM NAME OR GROWER NAME

                                                                                           4 | WRR & WCH
Politica Antidiscriminación Borrador

* _______________________________________ es un empleador de oportunidades equitativas
y hace todas las decisiones de empleo sin importar la etnicidad, color, edad, religión, sexo, disca-
pacidades, información genética, nacionalidad, y otras situaciones protegidas por las leyes locales,
estatales y federales.

Esta política es implementada para todos los términos y condiciones de empleo, incluyendo, pero
no limitado a; compensación, contratación, colocación, promoción, despidos, reducción de personal,
revisión, transferencia, permisos para ausentarse, beneficios, y entrenamiento.

* _______________________________________ busca cumplir con las leyes locales, estatales y
federales relacionadas a la discriminación.

* _______________________________________ toma decisiones en cuanto a empleo basado
estrictamente en las calificaciones individuales y las capacidades de realizar un trabajo bajo
consideración, las calificaciones comparativas y habilidades de otros aplicantes o empleados,
y actuaciones pasadas del individuo.

Si usted cree que se ha tomado una decisión de empleo que no está de acuerdo con el compromiso

de   * ___________________________________________________________________________
de oportunidades equitativas, debe reportar el asunto lo más pronto posible a

* ___________________________________________________________________________
para una resolución equitativa..

No habrá represalias en contra de ningún empleado que presente una queja en buena fe, inclusive si
el resultado de la investigación no tiene suficientes pruebas que apoyen la queja.

*NOMBRE DE LA GRANJA O AGRICULTAR

                                                                                         5 | WRR & WCH
TAB 9
                                     Housing, Sanitation and Transportation

                                        Included Records:
                                        • DOL Template Housing Terms & Conditions
                                            (DOL WH-521)
                                        •   Vehicle Information Records
                                        •   Driver Information Records
                                        •   Vehicle Inspection Log
                                        •   Field Sanitation Inspection Log

                                                                                      Transportation
                                                                                      Sanitation and
                                                                                         Housing,

Additional documents may be requested. See GAPC Certification Compliance Guide.
1 | Housing, Sanitation & Transportation
Vehicle Information

                                           Vehicle   Make/Model      Year                Annual Checklist

                                                                                Valid Tags
                                                                                Insurance
                                                                            If required:
                                                                                State Safety Inspection, Date: __________
                                                                                Federal Safety Inspection, Date: ________

                                                                                Valid Tags
                                                                                Insurance
                                                                            If required:
                                                                                State Safety Inspection, Date: __________
                                                                                Federal Safety Inspection, Date: ________

                                                                                Valid Tags
                                                                                Insurance
                                                                            If required:
                                                                                State Safety Inspection, Date: __________
                                                                                Federal Safety Inspection, Date: ________

                                                                                Valid Tags
                                                                                Insurance
                                                                            If required:
                                                                                State Safety Inspection, Date: __________
                                                                                Federal Safety Inspection, Date: ________

                                                                                Valid Tags
                                                                                Insurance
                                                                            If required:
                                                                                State Safety Inspection, Date: __________
                                                                                Federal Safety Inspection, Date: ________

2 | Housing, Sanitation & Transportation
Driver Information

                                                                                   Driver License     Date on Doctor
                                           Driver’s Name   Driver License Number   Expiration Date   Certificate (if required)         If FLC or FLCE
                                                                                                                                 Certificate
                                                                                                                                 Authorized to transport (FLC Only)
                                                                                                                                 Authorized to drive
                                                                                                                                 Certificate
                                                                                                                                 Authorized to transport (FLC Only)
                                                                                                                                 Authorized to drive
                                                                                                                                 Certificate
                                                                                                                                 Authorized to transport (FLC Only)
                                                                                                                                 Authorized to drive
                                                                                                                                 Certificate
                                                                                                                                 Authorized to transport (FLC Only)
                                                                                                                                 Authorized to drive
                                                                                                                                 Certificate
                                                                                                                                 Authorized to transport (FLC Only)
                                                                                                                                 Authorized to drive
                                                                                                                                 Certificate
                                                                                                                                 Authorized to transport (FLC Only)
                                                                                                                                 Authorized to drive
                                                                                                                                 Certificate
                                                                                                                                 Authorized to transport (FLC Only)
                                                                                                                                 Authorized to drive
                                                                                                                                 Certificate
                                                                                                                                 Authorized to transport (FLC Only)
                                                                                                                                 Authorized to drive
                                                                                                                                 Certificate
                                                                                                                                 Authorized to transport (FLC Only)
                                                                                                                                 Authorized to drive

3 | Housing, Sanitation & Transportation
Vehicle
                                           Vehicle Inspection
                                                    Inspection Log
                                                               Log

                                            Vehicle _____ Vehicle _____   Vehicle _____ Vehicle _____ Vehicle _____

                                            Date ______    Date ______    Date ______     Date ______     Date ______
                                                “ 3”          “ 3”            “ 3”           “ 3”             “ 3”
Head Lights

Stop Lights

Tail Lights

Back up Lights

Hazard Warning Lights

Turn Signals

Brakes (free of leaks and parking
brake functional)

Windshield (free of cracks)

Windshield Wipers (operational)

Floors/Sides (passenger compartment
free of openings or defects)

Seats (securely fastened)

Exiting Capability (properly functioning
door handles and latches)

Fire Extinguishers

Flares/Reflectors/Lanterns

Tires (tread and equal size)

Steering (safe and accurate)

Horn

Ventilation (Windows operational)

Mirrors (full vision of sides and rear)

Fuel System (free of leaks, cap secure)

Exhaust System (free of leaks, discharge
away from passenger compartment)

Comments:

Maintenance:

                                                                                 4 | Housing, Sanitation & Transportation
Field Sanitation Inspection Log
For operations with eleven (11) or more workers, employed during the past twelve months, at any one time,
engaged in hand-labor operations. Grower must provide proof of purchase or rental of hand washing facilities.
In the case where the grower owns the Field Sanitation (porta potty and/or hand washing) or the Field Sanitation
has been returned to a rental business, the Field Sanitation Log can be used as documentations to meet the
Field Sanitation Certification Standard.

                                     		                                                       Toilet     Trash
                                                           Potable Water &
                                                                                              Paper     Emptied
                                                                Soap
                                       “3”                      “3”                “3”         “3”       “3”

                                                                        5 | Housing, Sanitation and Transportation
TAB 10
                                              Worker Training and Farm Safety

                                        Included Records:
                                        • OSHA Form 300, Form 300A, and Form 301
                                        • How to Prepare for an Emergency or Disaster
                                            (English & Spanish)
                                        •   Emergency Response Plan
                                            (English & Spanish)
                                        •   Farm Roster
                                            (English & Spanish)
                                        •   List of Important Numbers
                                            (English & Spanish)
                                        •   In Case of Medical Emergency
                                            (English & Spanish)
                                        •   In Case of a Fire Emergency
                                            (English & Spanish)
                                        •   In Case of Severe Weather/Tornado Sheltering
                                            (English & Spanish)
                                        •   Worker Safety Training Records
                                        •   Worker Crop Integrity Training Records         Training &
                                                                                           Farm Safety

Additional documents may be requested. See GAPC Certification Compliance Guide.
                                                                                             Worker
Attention: This form contains information relating to
                                    OSHA’s Form 300 (Rev. 01/2004)                                                                                                                                                     employee health and must be used in a manner that
                                                                                                                                                                                                                       protects the confidentiality of employees to the extent                                              Year 20__ __
                                                                                                                                                                                                                       possible while the information is being used for                                                    U.S. Department of Labor
                                    Log of Work-Related Injuries and Illnesses                                                                                                                                         occupational safety and health purposes.                                                Occupational Safety and Health Administration

                                                                                                                                                                                                                                                                                                                                 Form approved OMB no. 1218-0176
                                    You must record information about every work-related death and about every work-related injury or illness that involves loss of consciousness, restricted work activity or job transfer,
                                    days away from work, or medical treatment beyond first aid. You must also record significant work-related injuries and illnesses that are diagnosed by a physician or licensed health
                                    care professional. You must also record work-related injuries and illnesses that meet any of the specific recording criteria listed in 29 CFR Part 1904.8 through 1904.12. Feel free to                                                                        Establishment name ___________________________________________
                                    use two lines for a single case if you need to. You must complete an Injury and Illness Incident Report (OSHA Form 301) or equivalent form for each injury or illness recorded on this
                                    form. If you’re not sure whether a case is recordable, call your local OSHA office for help.                                                                                                                                                                   City ________________________________ State ___________________

                                     Identify the person                                                        Describe the case                                                                                                      Classify the case
                                                                                                                                                                                                                                       CHECK ONLY ONE box for each case                            Enter the number of
                                     (A)            (B)                                      (C)                    (D)                     (E)                                                     (F)                                based on the most serious outcome for                       days the injured or        Check the “Injury” column or
                                     Case       Employee’s name                           Job title            Date of injury Where the event occurred                     Describe injury or illness, parts of body affected,         that case:                                                  ill worker was:            choose one type of illness:
                                     no.                                                  (e.g., Welder)       or onset       (e.g., Loading dock north end)               and object/substance that directly injured
                                                                                                                                                                                                                                                                   Remained at Work                                           (M)
                                                                                                               of illness                                                  or made person ill (e.g., Second degree burns on
                                                                                                                                                                                                                                                                                                   Away        On job
                                                                                                                                                                           right forearm from acetylene torch)                                                                                     from      transfer or
                                                                                                                                                                                                                                                  Days away Job transfer Other record-
                                                                                                                                                                                                                                      Death       from work or restriction able cases                        restriction
                                                                                                                                                                                                                                                                                                                                Injury

                                                                                                                                                                                                                                                                                                   work
                                                                                                                                                                                                                                                                                                                                         Skin disorder
                                                                                                                                                                                                                                                                                                                                                         Respiratory
                                                                                                                                                                                                                                                                                                                                                         condition
                                                                                                                                                                                                                                                                                                                                                                       Poisoning
                                                                                                                                                                                                                                                                                                                                                                                   Hearing loss
                                                                                                                                                                                                                                                                                                                                                                                                   All other
                                                                                                                                                                                                                                                                                                                                                                                                   illnesses

                                                                                                                                                                                                                                        (G)         (H)             (I)            (J)                 (K)         (L)         (1)       (2)              (3)          (4) (5)                      (6)
                                     _____ ________________________                       ____________ __
                                                                                                       ____/___
                                                                                                       _______                      __________________
                                                                                                                                                  ____                 ___________________
                                                                                                                                                                                    _______________________________
                                                                                                                                                                                                                 _                      ■
                                                                                                                                                                                                                                        ❑           ■
                                                                                                                                                                                                                                                    ❑              ■
                                                                                                                                                                                                                                                                   ❑               ■
                                                                                                                                                                                                                                                                                   ❑              ____ days ____ days
                                                                                                              month/day

                                     _____ ________________________                       ____________ __
                                                                                                       ____/___
                                                                                                       _______                      ___________________                ________________________________
                                                                                                                                                                                                 __________________
                                                                                                                                                                                                                 _                      ■
                                                                                                                                                                                                                                        ❑           ■
                                                                                                                                                                                                                                                    ❑              ■
                                                                                                                                                                                                                                                                   ❑               ■
                                                                                                                                                                                                                                                                                   ❑              ____ days ____ days
                                                                                                              month/day

                                     _____ ________________________                       ____________ __
                                                                                                       ____/___
                                                                                                       _______                      ___________________                ______________________
                                                                                                                                                                                       ____________________________
                                                                                                                                                                                                                 _                      ■
                                                                                                                                                                                                                                        ❑           ■
                                                                                                                                                                                                                                                    ❑              ■
                                                                                                                                                                                                                                                                   ❑               ■
                                                                                                                                                                                                                                                                                   ❑              ____ days ____ days
                                                                                                              month/day

                                     _____ ________________________                       ____________ __
                                                                                                       ____/___
                                                                                                       _______                      ___________________                ______________________
                                                                                                                                                                                       ____________________________
                                                                                                                                                                                                                 _                      ■
                                                                                                                                                                                                                                        ❑           ■
                                                                                                                                                                                                                                                    ❑              ■
                                                                                                                                                                                                                                                                   ❑               ■
                                                                                                                                                                                                                                                                                   ❑              ____ days ____ days
                                                                                                              month/day

                                     _____ ________________________                       ____________ __
                                                                                                       ____/___
                                                                                                       _______                      ___________________                ___________________
                                                                                                                                                                                    _______________________________
                                                                                                                                                                                                                 _                      ■
                                                                                                                                                                                                                                        ❑           ■
                                                                                                                                                                                                                                                    ❑              ■
                                                                                                                                                                                                                                                                   ❑               ■
                                                                                                                                                                                                                                                                                   ❑              ____ days ____ days
                                                                                                              month/day

                                     _____ ________________________                       ____________ __
                                                                                                       ____/___
                                                                                                       _______                      ___________________                ______________________________
                                                                                                                                                                                               ____________________
                                                                                                                                                                                                                 __                     ■
                                                                                                                                                                                                                                        ❑           ■
                                                                                                                                                                                                                                                    ❑              ■
                                                                                                                                                                                                                                                                   ❑               ■
                                                                                                                                                                                                                                                                                   ❑              ____ days ____ days
                                                                                                              month/day

                                     _____ ________________________                       ____________ __
                                                                                                       ____/___
                                                                                                       _______                      ___________________                ______________________________
                                                                                                                                                                                               ____________________
                                                                                                                                                                                                                 __                     ■
                                                                                                                                                                                                                                        ❑           ■
                                                                                                                                                                                                                                                    ❑              ■
                                                                                                                                                                                                                                                                   ❑               ■
                                                                                                                                                                                                                                                                                   ❑              ____ days ____ days
                                                                                                              month/day

                                     _____ ________________________                       ____________ __
                                                                                                       ____/___
                                                                                                       _______                      ___________________                ______________________________
                                                                                                                                                                                               ____________________
                                                                                                                                                                                                                 __                     ■           ■
                                                                                                                                                                                                                                                    ❑              ■
                                                                                                                                                                                                                                                                   ❑               ■
                                                                                                                                                                                                                                                                                   ❑              ____ days ____ days
                                                                                                              month/day
                                                                                                                                                                                                                                        ❑
                                     _____ ________________________                       ____________ __
                                                                                                       ____/___
                                                                                                       _______                      ___________________                ______________________________
                                                                                                                                                                                               ____________________
                                                                                                                                                                                                                 __                     ■           ■
                                                                                                                                                                                                                                                    ❑              ■
                                                                                                                                                                                                                                                                   ❑               ■
                                                                                                                                                                                                                                                                                   ❑              ____ days ____ days
                                                                                                              month/day
                                                                                                                                                                                                                                        ❑
                                     _____ ________________________                       ____________ __
                                                                                                       ____/___
                                                                                                       _______                      ___________________                ___________________
                                                                                                                                                                                    _______________________________
                                                                                                                                                                                                                 __                     ■           ■              ■
                                                                                                                                                                                                                                                                   ❑               ■
                                                                                                                                                                                                                                                                                   ❑              ____ days ____ days
                                                                                                              month/day
                                                                                                                                                                                                                                        ❑           ❑
                                     _____ ________________________                       ____________ __
                                                                                                       ____/___
                                                                                                       _______                      ___________________                ______________________________
                                                                                                                                                                                               ____________________
                                                                                                                                                                                                                 __                     ■           ■              ■
                                                                                                                                                                                                                                                                   ❑               ■
                                                                                                                                                                                                                                                                                   ❑              ____ days ____ days
                                                                                                              month/day
                                                                                                                                                                                                                                        ❑           ❑
                                     _____ ________________________                       ____________ __
                                                                                                       ____/___
                                                                                                       _______                      ___________________                ______________________________
                                                                                                                                                                                               ____________________
                                                                                                                                                                                                                 __                     ■           ■              ■
                                                                                                                                                                                                                                                                   ❑               ■
                                                                                                                                                                                                                                                                                   ❑              ____ days ____ days
                                                                                                              month/day
                                                                                                                                                                                                                                        ❑           ❑
                                     _____ ________________________                       ____________ __
                                                                                                       ____/___
                                                                                                       _______                      __________________
                                                                                                                                                  ____                 ___________________
                                                                                                                                                                                    _______________________________
                                                                                                                                                                                                                 __                     ■           ■              ■               ■              ____ days ____ days
                                                                                                              month/day
                                                                                                                                                                                                                                        ❑           ❑              ❑               ❑
                                                                                                                                                                                                                Page totals

                                    Public reporting burden for this collection of information is estimated to average 14 minutes per response, including time to review                                        Be sure to transfer these totals to the Summary page (Form 300A) before you post it.
                                                                                                                                                                                                                                                                                                                               Injury

                                    the instructions, search and gather the data needed, and complete and review the collection of information. Persons are not required
                                                                                                                                                                                                                                                                                                                                                                                                   illnesses
                                                                                                                                                                                                                                                                                                                                                                                                   All other

                                                                                                                                                                                                                                                                                                                                                          condition
                                                                                                                                                                                                                                                                                                                                                                       Poisoning

                                    to respond to the collection of information unless it displays a currently valid OMB control number. If you have any comments
                                                                                                                                                                                                                                                                                                                                                         Respiratory
                                                                                                                                                                                                                                                                                                                                                                                    Hearing loss

                                                                                                                                                                                                                                                                                                                                         Skin disorder

                                    about these estimates or any other aspects of this data collection, contact: US Department of Labor, OSHA Office of Statistical
                                    Analysis, Room N-3644, 200 Constitution Avenue, NW, Washington, DC 20210. Do not send the completed forms to this office.                                                                                                                                  Page ____ of ____              (1)        (2)             (3)           (4) (5)                      (6)

1 | Worker Training & Farm Safety
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