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1 www.gapconnections.com
2019 Required Record Checklist 2019 Operation Records
� Contact Information � Primary and Associated Grower Information � 2019 Tobacco Type and Acres � Farm Infrastructure � Curing Information
Nutrient Management
� Field/Tract ID Records o Field/Tract ID o Farm Name or Location o County o FSA Number o Tobacco Acres o Latest Soil Testing Date o Date of Last Lime Application o Rate of Lime (tons/acre)
� Greenhouse Fertilization Records o Greenhouse ID Number o Transplant Batch Number o Date o Types of Fertilizer o Rate (per 1,000 gallons)
� Field/Tract Fertilization Records o Field/Tract ID o Date o Application Timing o Analysis (N-P-K) o Rate of Application (lbs./acre) o K20 from Muriate, if applied after
December 31 (lbs./acre) o Muriate of Potash Date of Application
� Animal Manure or Litter Application Records o Date(s) Animal Manure Tested for
Nutrient Content o Field/Tract ID o Date o Type of Manure o Rate
� Soil Test Results � Nutrient Management Plan (If Applicable)
IPM and CPA
� Scouting Records o Field Scouting Dates o Field/Tract ID o Pest Identified during Scouting o Level of Infestation of Pest Identified o Corrective Actions Taken (Include Date
of Action)
o Follow-up on Pest Control to Determine the Effectiveness of Actions Taken
� CPA Applicator License Information o Applicator Name o License Number
� CPA Information Records o Brand Name o EPA Registration Number o Active Ingredient o REI (Hours) o Label on File o SDS on File
� Greenhouse CPA Records o Greenhouse ID Number o Transplant Batch Number o Date o Applicator o Brand/Product Name or Reference
Number o Reason for Application o Rate per 1,000 square feet o Total Application o Start/Finish Time
� Field/Tract CPA & Sucker Control Records o Field/Tract ID o Date o Applicator o Reason for Application o Brand/Product Name or Reference
Number o Rate per Acre o Total Application o Size of Area Treated o Start/Finish Time o Method of Application
� Sprayer Calibration Records o Date Calibrated o Sprayer Brand and Model o Sprayer Type o Nozzle Type and Size o Pressure o Speed (mph) o Throttle (rpm) o Tractor Model o Tractor Gear o Spray Volume (gallons per acre)
� Pesticide License
Crop and Operations
� Seed Selection Records o Variety Selection o Greenhouse ID Number
2019 Required Record Checklist
2 www.gapconnections.com
2019 Required Record Checklist o Transplant Batch Number o Seedling Source o Variety Name o Seed Lot Number o LC Variety (Burley & Dark Only) o Date of Seeding
� Transplanting and Topping Records o Plant Population o Row Spacing o Plant Spacing in Row o Field/Tract ID o Transplanting Date o Transplant Batch Number o Date of Topping o Topping Height (approximate number of
leaves left) � Weed Prevention Program
o Herbicides used o Number of cultivations o Control of weeds in field borders o Preharvest scouting and cleanup
practices � FSA 578
Curing and Barn Management – Flue
� Flue Curing Facility Records o Barn Testing Report o Barn ID Number o Barn Make and Model o Heat Exchanger Brand o Initial Reading o Final Reading o Barn Status Pass/Fail
� Flue Harvesting and Curing Records o Field/Tract ID o Harvest Date o Method of Harvesting o Stalk Position o Barn ID o Fuel Source o Bale ID Number(s)
Curing and Barn Management – Air & Fire
� Air Curing Facility Records o Farm Name o Barn/Structure ID o Type
§ Outdoor Structure § Multi-tier § Number of tiers
o Barn Size
o Spacing of Sticks o Number of Stalks per Stick
� Air Harvesting and Curing Records o Harvest Date o Field/Tract ID o Barn/Structure ID o Date Housed o Date Removed from Housing o Spacing of Sticks o Tobacco Ordering Method o Bale, Box or Hogshead ID Number(s)
� Fire Curing Facility Records o Farm Name o Barn/Structure ID o Type
§ Outdoor Structure § Multi-tier § Number of tiers
o Barn Size o Spacing of Sticks o Number of Stalks per Stick
� Fire Harvesting and Curing Records o Harvest Date o Field/Tract ID o Barn/Structure ID o Date Housed o Date Removed from Housing o Spacing of Sticks o Tobacco Ordering Method o Bale, Box, or Hogshead ID Number(s)
� Firing Records o Barn/Structure ID o Date Fire Started o Date Fire Ended o Fuel Source o Maximum Temperature
� Barn Inspection Information – English & Spanish � Barn Inspection Log
o Barn ID o Date o Who did the Inspection o Comments
Non-Tobacco Related Materials
� NTRM Inspection Information – English & Spanish
� NTRM Inspection Log o Date o Who did the Inspection o Areas Inspected o Comments
2019 Required Record Checklist
3 www.gapconnections.com
2019 Required Record Checklist Agrochemical Storage and Soil & Water
� CPA Inventory Records o Reference Number o Brand Name/Product/Common Name o Storage Area o Amount
� Rainfall Records o Field/Tract ID o Date o Amount of Precipitation o Crop Condition
� Irrigation Records o Field/Tract ID o Date o Source of Irrigation Water o Application Type o Amount Applied o Crop Condition before Irrigating
� Crop Rotation Records o Field/Tract ID o Field HEL (Yes or No) o 2016
§ Crop § Tillage Type § Cover Crop
o 2017 § Crop § Tillage Type § Cover Crop
o 2018 § Crop § Tillage Type § Cover Crop
o 2019 § Crop § Tillage Type § Cover Crop
� Safety Data Sheets (SDS Sheets) � Agrochemical Labels � Conservation Plan (If Field/Tract ID considered
HEL)
Recruiting and Hiring Workers
� Labor Numbers Records � Worker Recruiting & Hiring Records
o Name o Date of Birth o Type of Labor o Work State Date o Work End Date o Date I-9 Completed
o Collected Emergency Contact Information
o Provided Terms & Conditions of Employment
o Discussed Anti-Discrimination Policy o Discussed Farm Emergency Plan
� Terms and Conditions of Employment US DOL Form WH-516
� Worker Termination Record o Employee Name o Reason for Termination o Documentation
� Non-Immediate Family Minors Working Record o Full Name o Date of Birth o Parental Consent o Residence o Permanent Address
� I-9 Forms � Parental Consent (if non-immediate family
minors, ie. under 18 on the farm) � Wage Statements � If using a Farm Labor Contractor (FLC)
o I-9 Forms o FLC Certificate of Registration from
DOL o Housing Inspection (If authorized to
house) o Copy of Vehicle Insurance (If authorized
to transport) o Driver’s License (If authorized to
transport) o Doctor’s Certificate (If authorized to
transport) o Employment Terms & Conditions for
FLC Workers o Wage Statements for FLC Workers
Worker’s Rights & Responsibilities & Worker Concern Helpline
� Worker Concern Process Documentation o Grower ID# o Grower Name o Farm Name o Trainer(s) o Date o Printed Name of worker o Signature of worker
� Anti-Discrimination Policy
2019 Required Record Checklist
4 www.gapconnections.com
2019 Required Record Checklist Housing, Sanitation, & Transportation
� Housing Terms & Conditions DOL WH-521 � Vehicle Information Records
o Vehicle o Make/Model o Year o Annual Checklist
§ Valid Tags § Insurance § State Inspection (If required) § Federal Inspection (If required)
� Driving Information Records o Driver’s Name o Driver’s License Number o Driver License Expiration Date o Date on Doctor Certificate o IF FLC or FLCE
§ Certificate § Authorized to Transport § Authorized to Drive
� Vehicle Inspection Log o Vehicle o Date
� Housing Inspection Certificate
Worker Training and Farm Safety
� OSHA Forms 300, 300A, & 301 � How to Prepare for an Emergency or Disaster
(English & Spanish) � Emergency Response Plan
o Farm Name o Address o Telephone o Contact Name o Last Revision Date o Employee Evacuation System o Person responsible for Farm Roster at
Evacuation Site o Evacuation Site Location
� Farm Roster o Name o Phone o Special Assistance Needed
� List of Important Numbers � In Case of Medical Emergency
o Name of Person Trained in CPR, First Aid or AED
o Contact number o Location of First Aid Kits o Location of Automate External
Defibrillators (AED)
� In Case of Fire Emergency � In Case of Severe Weather/Tornado Sheltering
o Severe weather/Tornado Shelter Locations
o Assigned Person to monitor severe weather
o Assigned Person to direct people to shelter
� Worker Safety Training Records o Farm Name o Source of Training
§ Verbal Discussion § Training Video § Tailgate Training Kits § Farm Safety & Compliance
Event o Trainer name o Date o Training Topics o Printed Name of worker o Signature of worker
� Worker Crop Integrity Training Records o Farm Name o Source of Training
§ Verbal Discussion § Training Video § Tailgate Training Kits § Farm Safety & Compliance
Event o Trainer name o Date o Training Topics o Printed Name of worker o Signature of worker
2019 Required Record Checklist
Operation Records
Contact Information
Farm Address:
City: State: Zip:
County:
Phone:
Email Address:
Primary Grower Name:
Grower ID: Grower Date of Birth: / /
Associated Grower Name:
Grower ID: Grower Date of Birth: / /
Associated Grower Name:
Grower ID: Grower Date of Birth: / /
Associated Grower Name:
Grower ID: Grower Date of Birth: / /
Associated Grower Name:
Grower ID: Grower Date of Birth: / /
2019 Operation Records 2019 Operation Records
Farm Infrastructure Type Total Number
Flue-cured Curing Barns
Dark-firedCuringBarns
Air-cured Curing Barns
Outdoor Air-cured Curing Structures*
Storage Facilities
Shipping Facilities (Air and Fire Only) Sand Reels/Tumblers (Flue Only) Leaf Loaders (Flue Only)
Mechanical Tobacco Harvesters
2019 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: ______________
2019 Operation Records
Box Barns
Rack Barns
Open
Enclosed
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:
* For outdoor curing structures, give total stick capacity for Total Number
Nutrie
nt
Ma
na
ge
me
nt
TAB 1
Included Records:• Field/Tract ID Records
• Greenhouse Fertilization Records
• Field/Tract ID Fertilization Records
• Animal Manure or Litter Application Records
Copies of the following will be required:• Soil Test Results• Nutrient Management Plan (if applicable)
Nutrient Management
Fiel
d/Tr
act I
D R
ecor
ds
1 | Nutrient Management
Fie
ld/T
ract
ID
Farm
Nam
e or
C
ount
y FS
A N
umbe
r To
bacc
o La
test
Soi
l D
ate
of L
ast
Rat
e of
Lim
e
Lo
catio
n
A
cres
Te
stin
g D
ate
Lim
e A
pplic
atio
n (to
ns/a
cre)
Gre
enho
use
Fert
iliza
tion
Rec
ords
2 | Nutrient Management
G
reen
hous
e ID
Tr
ansp
lant
D
ate
Type
s of
Fer
tiliz
er
Rat
e
Num
ber
Bat
ch N
umbe
r
(p
er 1
,000
/gal
lons
)
Fiel
d/Tr
act F
ertil
izat
ion
Rec
ords
3 | Nutrient Management
R
ate
of F
ield
/Tra
ct ID
*
Dat
e A
pplic
atio
n Ti
min
g A
naly
sis
(N-P
-K)
App
licat
ion
K20
from
Mur
iate
, if a
pplie
d M
uria
te o
f Pot
ash
(lb
s./a
cre)
af
ter D
ecem
ber 3
1 (lb
s./a
cre)
D
ate
of A
pplic
atio
n
Pre
-pla
nt
Tran
spla
ntin
g
Sid
e-dr
essi
ng
Folia
r App
licat
ion
Pre
-pla
nt
Tran
spla
ntin
g
Sid
e-dr
essi
ng
Folia
r App
licat
ion
Pre
-pla
nt
Tran
spla
ntin
g
Sid
e-dr
essi
ng
Folia
r App
licat
ion
Pre
-pla
nt
Tran
spla
ntin
g
Sid
e-dr
essi
ng
Folia
r App
licat
ion
Pre
-pla
nt
Tran
spla
ntin
g
Sid
e-dr
essi
ng
Folia
r App
licat
ion
Pre
-pla
nt
Tran
spla
ntin
g
Sid
e-dr
essi
ng
Folia
r App
licat
ion
Pre
-pla
nt
Tran
spla
ntin
g
Sid
e-dr
essi
ng
Folia
r App
licat
ion
Pre
-pla
nt
Tran
spla
ntin
g
Sid
e-dr
essi
ng
Folia
r App
licat
ion
Pre
-pla
nt
Tran
spla
ntin
g
Sid
e-dr
essi
ng
Folia
r App
licat
ion
Pre
-pla
nt
Tran
spla
ntin
g
Sid
e-dr
essi
ng
Folia
r App
licat
ion
Pre
-pla
nt
Tran
spla
ntin
g
Sid
e-dr
essi
ng
Folia
r App
licat
ion
Pre
-pla
nt
Tran
spla
ntin
g
Sid
e-dr
essi
ng
Folia
r App
licat
ion
Pre
-pla
nt
Tran
spla
ntin
g
Sid
e-dr
essi
ng
Folia
r App
licat
ion
Pre
-pla
nt
Tran
spla
ntin
g
Sid
e-dr
essi
ng
Folia
r App
licat
ion
*Fie
ld/T
ract
ID fr
om T
ab 1
Nut
rient
Man
agem
ent R
ecor
ds P
age
1
Ani
mal
Man
ure
or L
itter
App
licat
ion
Rec
ords
4 | Nutrient Management
Dat
e(s)
Ani
mal
Man
ure
Test
ed fo
r Nut
rient
Con
tent
: ___
____
____
____
____
____
____
____
__
Fie
ld/T
ract
ID*
Dat
e
Typ
e of
Man
ure
Rat
e
*Fie
ld/T
ract
ID fr
om T
ab 1
Nut
rient
Man
agem
ent R
ecor
ds P
age
1
TAB 2
Included Records:• Scouting Records
• CPA Applicator License Information
• CPA Information Records
• Greenhouse CPA Records
• Field/Tract CPA & Sucker Control Records
• Sprayer Calibration Records
Copies of the following will be required:• Pesticide license
IPM & CPA
IPM
&C
PA
Scou
ting
Rec
ords
1 | IPM and CPA
Follo
w-u
p on
Pes
t
Field
Pe
stIdentifi
ed
Levelof
Con
trolPracticesto
Sc
outin
gField/TractID*
DuringSc
outin
gInfestationof
CorrectiveActionsTaken(IncludeDateofAction)
Determinethe
Dates
PestIdentifi
ed
Effectivenessof
Act
ions
Tak
en
*Fie
ld/T
ract
ID fr
om T
ab 1
Nut
rient
Man
agem
ent R
ecor
ds P
age
1
2 | IPM and CPA
CPA Applicator License Information
List all the applicators and license numbers used on your farm operation below. If pesticideapplicator 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.
3 | IPM and CPA
CPA Information Records
Reference Brand EPARegistration ActiveIngredient REI Number Name Number (Hours)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
SaveTime:TheFederalrecordkeepingregulationsrequirethecertifiedprivateapplicatortorecordthebrand/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.
LabelonFile
“ 3 ”
SDSonFile
“ 3 ”
Gre
enho
use
CPA
Rec
ords
4 | IPM and CPA
T
rans
plan
t
B
rand
/ Pr
oduc
t
Gre
enho
use
Bat
ch
D
ate
App
licat
or*
Nam
e or
Ref
eren
ce
Rea
son
for A
pplic
atio
n
R
ate
/ 1,0
00
Tot
al
Star
t /
ID N
umbe
r
N
umbe
r
Num
ber*
*
sq. f
t.***
A
pplic
atio
n
Fin
ish
Tim
e
*App
licat
or o
r ref
eren
ce n
umbe
r fro
m T
ab 2
IPM
and
CPA
Pag
e 2
**C
PA In
form
atio
n R
ecor
ds fr
om T
ab 2
IPM
and
CPA
Pag
e 3
**
*Tot
al A
mou
nt o
f Pro
duct
Use
d pe
r 100
0ft2
(ind
icat
e un
it: o
z., l
b., p
t., q
t., g
al.)
Fiel
d/Tr
act C
PA a
nd S
ucke
r Con
trol
Rec
ords
5 | IPM and CPA
Fie
ld/
B
rand
/ Pr
oduc
t
Si
ze o
f St
art /
Tra
ct
N
ame
or R
efer
ence
R
ate
/ Acr
e To
tal
Are
a Fi
nish
M
etho
d of
ID
* D
ate
App
licat
or**
R
easo
n fo
r App
licat
ion
Num
ber
****
A
pplic
atio
n Tr
eate
d Ti
me
App
licat
ion
*Fie
ld/T
ract
ID fr
om T
ab 1
Nut
rient
Man
agem
ent P
age
1**
App
licat
or o
r ref
eren
ce n
umbe
r fro
m T
ab 2
IPM
and
CPA
Pag
e2**
*CPA
Info
rmat
ion
Rec
ords
from
Tab
2 IP
M a
nd C
PA P
age
3
****
Tota
l Am
ount
of P
rodu
ct U
sed
(indi
cate
uni
t: oz
., lb
., pt
., qt
., ga
l.)
Han
dS
pray
erH
and
Spr
ayer
Han
dS
pray
erH
and
Spr
ayer
Han
dS
pray
erH
and
Spr
ayer
Han
dS
pray
erH
and
Spr
ayer
Han
dS
pray
erH
and
Spr
ayer
Han
dS
pray
erH
and
Spr
ayer
Han
dS
pray
erH
and
Spr
ayer
Han
dS
pray
erH
and
Spr
ayer
Han
dS
pray
erH
and
Spr
ayer
6 | 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
SprayerBrand and Model
SprayerType
Nozzle Typeand Size
Pressure
Speed (mph)
Throttle (rpm)
TractorModel
Tractor Gear
SprayVolume(gal/ac)
TAB 3
Included Records:• Seed Selection Records
• Transplanting and Topping Records
• Weed Prevention Program
Copies of the following will be required:• FSA 578 Forms
• Publications on variety selection
Crop & Operations
Cro
p &
Op
era
tions
1 | Crop and Operations
Seed
Sel
ectio
n R
ecor
ds*R
equi
red
for P
lant
s Pr
oduc
ed a
nd P
urch
ased
Varie
tySelectio
n: P
leas
e lis
t the
reso
urce
s or
sou
rces
of i
nfor
mat
ion
used
to m
ake
varie
ty s
elec
tion
deci
sion
s: _
____
____
____
____
____
____
____
___
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
_
Bat
ch 1
: V
arie
ty, D
ate
Se
eded
:
Bat
ch 2
: Var
iety
, Dat
e S
eede
d:
Bat
ch 3
: V
arie
ty, D
ate
Se
eded
:
Seed
Sele
cti
on
Re
co
rds
*R
eq
uir
ed
fo
r P
lan
ts P
rod
uced
an
d P
urc
hased
Va
rie
ty S
ele
cti
on
: P
lease
list
th
e r
eso
urc
es o
r so
urc
es
of
info
rmatio
n u
sed
to
make
va
rie
ty s
ele
ctio
n d
eci
sio
ns:
Tra
ns
pla
nt
Ba
tch
No
.: T
he
tra
nsp
lant b
atc
h n
um
be
r is
cre
ate
d b
y yo
u a
nd is
use
d to
ide
ntif
y ea
ch s
epa
rate
ba
tch
of
tra
nsp
lan
ts u
sed
in y
ou
r op
era
tion
. A
se
pa
rate
nu
mbe
r sh
ou
ld b
e g
iven
to
ea
ch b
atc
h o
f tr
an
spla
nts
of th
e s
am
e s
ou
rce
, va
rie
ty, lo
t nu
mbe
r, a
nd s
ee
de
d a
t th
e s
am
e tim
e in
the
sa
me
g
reen
ho
use
. S
ee
dia
gra
m b
elo
w o
f g
ree
nh
ou
se b
ed
. G
reen
hous
e ID
No
.*
Tra
ns
pla
nt
Ba
tch
No
.
See
dlin
g S
ou
rce
V
arie
ty N
am
e
S
ee
d L
ot
#
LC
Var
iety
(B
urle
y &
Dar
k O
NL
Y)
D
ate
of S
eed
ing
□ G
row
n □
Pu
rch
ase
d
□ Y
es
□ N
o
□ G
row
n □
Pu
rch
ase
d
□ Y
es
□ N
o
□ G
row
n □
Pu
rch
ase
d
□ Y
es
□ N
o
□ G
row
n □
Pu
rch
ase
d
□ Y
es
□ N
o
□ G
row
n □
Pu
rch
ase
d
□ Y
es
□ N
o
□ G
row
n □
Pu
rch
ase
d
□ Y
es
□ N
o
□ G
row
n □
Pu
rch
ase
d
□ Y
es
□ N
o
□ G
row
n □
Pu
rch
ase
d
□ Y
es
□ N
o
□ G
row
n □
Pu
rch
ase
d
□ Y
es
□ N
o
□ G
row
n □
Pu
rch
ase
d
□ Y
es
□ N
o
□ G
row
n □
Pu
rch
ase
d
□ Y
es
□ N
o
*Th
is G
ree
nho
use
ID
nu
mb
er
is c
reate
d b
y yo
u a
nd
is u
sed
to
ide
ntif
y ea
ch s
ep
ara
te g
reen
ho
use
use
d in
you
r o
pe
ratio
n.
Gre
enho
use
Tran
spla
nt
Seed
ing
Varie
ty
Seed
LC
Var
iety
D
ate
of
ID N
o*
Bat
ch N
o.
Sour
ce
Nam
e Lo
t #
(Bur
ley
& D
ark
ON
LY)
Seed
ing
*Thi
s G
reen
hous
e ID
num
ber i
s cr
eate
d by
you
and
is u
sed
to id
entif
y ea
ch s
epar
ate
gree
nhou
se u
sed
in y
our o
pera
tions
.
TransplantBatchNo.:
The
trans
plan
t bat
ch n
umbe
r is
crea
ted
by y
ou a
nd is
use
d to
iden
tify
each
sep
arat
e ba
tch
of tr
ansp
lant
s us
ed in
you
r ope
ratio
n.A
sepa
rate
num
ber s
houl
d be
giv
en to
eac
h ba
tch
of tr
ansp
lant
s of
the
sam
e so
urce
, var
iety
, lot
num
ber,
and
seed
ed a
t the
sam
e tim
e in
the
sam
e gr
eenh
ouse
.S
ee d
iagr
am a
bove
of g
reen
hous
e be
d.
Gro
wn
Pur
chas
ed
Yes
No
Gro
wn
Pur
chas
ed
Yes
No
Gro
wn
Pur
chas
ed
Yes
No
Gro
wn
Pur
chas
ed
Yes
No
Gro
wn
Pur
chas
ed
Yes
No
Gro
wn
Pur
chas
ed
Yes
No
Gro
wn
Pur
chas
ed
Yes
No
Gro
wn
Pur
chas
ed
Yes
No
Gro
wn
Pur
chas
ed
Yes
No
Gro
wn
Pur
chas
ed
Yes
No
Gro
wn
Pur
chas
ed
Yes
No
2 | Crop and Operations
Tran
spla
ntin
g an
d To
ppin
g R
ecor
ds
To
ppin
g H
eigh
t
Fiel
d/Tr
act I
D*
Tran
spla
ntin
g Tr
ansp
lant
D
ate
(app
roxi
mat
e nu
mbe
r of
Date
BatchNum
ber**
ofTop
ping
leavesleft)
* Fi
eld/
Trac
t ID
from
Tab
1 N
utrie
nt M
anag
emen
t Pag
e 1
** T
rans
plan
t Bat
ch N
o. fr
om T
ab 3
Cro
p an
d O
pera
tions
Pag
e 1
Pla
nt P
opul
atio
n (P
lant
s/ac
re):
____
____
____
____
____
R
ow S
paci
ng: _
____
____
____
____
____
_
Pla
nt S
paci
ng in
Row
: ___
____
____
____
____
Prog
ramfo
rPreventingWeedSe
edCon
taminationofHarvestedLeaf(Pa
lmerAmaranth,otherPigweed,Ragweed,Grasses)
Her
bici
des
used
___
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
Num
berofC
ultivations_____________________Controlofw
eedsinfieldborders_____________________
Pre
harv
est s
cout
ing
and
clea
nup
prac
tices
___
____
____
____
____
____
____
____
____
____
____
____
____
__
Oth
er (h
and
hoei
ng, e
tc.)
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
TAB 4
Included Records:• Flue Curing Facility Records
• Flue Harvesting and Curing Records
Curing & Barn Management — Flue
Curin
g
and
Ba
rnM
ana
ge
me
nt
1 | Curing & Barn Mgmt.-Flue
Curing Facility Records - Flue
GAPConnectionsCertification--BarnTestingReport
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
BarnID BarnMakeand HeatExchanger Initial Final BarnStatus Number Model Brand Reading Reading Pass / Fail
2 | Curing & Barn Mgmt - Flue.
Curing Facility Records - Flue (Retest Report)
GAPConnectionsCertification--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
BarnID BarnMakeand HeatExchanger Initial Final BarnStatus Number Model Brand Reading Reading Pass / Fail
3 | Curing &
Barn M
gmt - Flue.
Field/Tract HarvestDate Methodof StalkPosition BarnID FuelSource BaleIDNumber(s) ID** Harvesting
HarvestingandCuringRecords-Flue
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 ________
TAB 5
Included Records:• NTRM Inspection Information – English & Spanish
• NTRM Inspection Log
Non-Tobacco Related Materials
No
n-T
ob
acco
Re
late
dM
ate
rials
1 | Non-Tobacco Related Materials
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 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.
NTRM Inspection Information
WorkerTrainingTips:
2 | 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 de Capacitación para 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.
ConsejosdeCapacitaciónparaelPersonal:
3 | Non-Tobacco Related Materials
NTRM Inspection LogRegisstro de Inspección NTRM
Comments(ex: No new sources of NTRM,
added a trash can in break area)
Comentarios(ej: No hay nuevas fuentes deNTRM, se agregó un bote debasura al área de descanso)
Areas Inspected(ex: market prep facilities,
baling equipment, break areas)
Areas Inspeccionadas(ej: instalaciones de
preparación del Mercado,equipos de emaque,áreas de descanso)
WhodidtheInspection?
¿Quién hizzo lainspección?
DateFecha
TAB 6
Included Records:• CPA Inventory Records
• Rainfall Records
• Irrigation Records
• Crop Rotation Records
Copies of the following will be required:• SDS (Safety Data Sheets)
• Agrochemical labels
• Conservation Plan (If Field/Tract ID considered HEL)
Agrochemical Storage and Soil & Water
Ag
roche
mic
al
Sto
rag
e a
nd
So
il & W
ate
r
1 | Agrochemical Storage Soil & Water
CPAInventoryRecords
Reference Brand Name / Product / Common Name Storage Area Amount Number*
*CPA Information Records from Tab 2 IPM and CPA Page 3
2 | Agrochemical Storage Soil & Water
Rainfall Records
Field/Tract ID* Date Amount of Crop Condition Precipitation
Rainfall records can be kept daily, weekly or monthly.
*Field/Tract ID from Tab 1 Nutrient Management Records Page 1
3 | Agrochemical Storage Soil & Water
Irrigation Records
Field/ Date Source of Application Amount Crop Condition before Irrigating Tract Irrigation Water Type Applied ID*
Irrigation records can be kept daily, weekly or monthly.
*Field/Tract ID from Tab 1 Nutrient Management Records Page 1
4 | Agrochem
ical Storage S
oil & W
ater
Crop Rotation Records
*Field/Tract ID from Tab 1 Nutrient Management Records Page 2** Tillage type indicates one of the following: conventional, strip-till, or minimum till
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
2016 2017 2018 2019
TAB 7
Included Records:• Labor Numbers
• Worker Recruiting & Hiring Records
• DOL Template of Terms & Conditions of Employment
(English & Spanish) – DOL WH-516
• Worker Termination Record
• Non-Immediate Family Minors Working Record
Copies of the following will be required:• Form I-9
• Terms & Conditions of Employment
• Parental Consent (if non-immediate family minors
(i.e. under 18 on the farm)
• Wage Statements
• If using an FLC:
• Form I-9 for FLC Workers
• FLC Certificate of Registration from DOL
• If authorized to house, Housing Inspection
• If authorized to transport, copy of insurance,
driver’s license, and doctor’s certificate
• FLC Disclosure of Employment/Terms and
Conditions for FLC Workers
• Wage Statements for FLC Workers
Recruiting and Hiring Workers
Re
cru
iting
and
Hirin
gW
ork
ers
Labor Numbers
1 | Recruiting & Hiring Workers
Workers
H-2A Hired by the Grower of Grower AssociationLiving on Farm
Not Living on Farm
H-2A Hired by a H-2ALC (H-2A FLC) Living on Farm
Not Living on Farm
Migrant LaborMigrant 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-family, non-H-2A, non-migrant)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 Labor*
Immediate Family (18 or older)
Immediate Family Minors (16-17)
Immediate Family Minors (15)
Immediate Family Minors (14)
Immediate Family Minors (13 or younger)
Number of workersemployed year-round
Number of workersemployed seasonally
Number of workers for whomhousingisprovided
Living onthe Farm
Year-round SeasonallyLiving onthe Farm
Working onthe Farm
Working onthe Farm
*Immediate family members include only: (1) spouse; (2) children, step children, and foster children; (3) parents, stepparents, and foster parents;and (4) brothers and sisters. If the worker doesn not fall into one of these four categories, then the worker is considered a hired worker.
2 | Recruiting &
Hiring W
orkers
WorkerRecruiting&HiringRecords
Collected Discussed Discussed Work Work Emergency Provided Anti- Farm Dateof TypeofLabor Start End Date1-9 Contact Terms& Discrimination Emergency Name Birth Date Date Completed Information Conditions Policy Plan 1/20/1985 Example: John Smith 6/5/19 12/5/19 6/5/2019 3 3 3 3 Under 18
Under 18
Under 18
Under 18
Under 18
Under 18
Under 18
H-2A MigrantFLC LocalFamily
H-2A MigrantFLC LocalFamily
H-2A MigrantFLC LocalFamily
H-2A MigrantFLC LocalFamily
H-2A MigrantFLC LocalFamily
H-2A MigrantFLC LocalFamily
H-2A MigrantFLC LocalFamily
No:
1.
2.
3.
4.
5.
6.
7.
3 | Recruiting & Hiring Workers
Migrant and Seasonal AgriculturalWorker Protection Act
U.S. Department of LaborWage 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 thereare 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 salesmade 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.
Persons are not required to respond to this information unless it displays a currently valid OMB number.Optional form WH516 ENG
REV 06/14
4 | Recruiting & Hiring Workers
5 | Recruiting &
Hiring W
orkers
WorkerName ReasonforTermination Documentation
WorkerTerminationRecord
6 | Recruiting &
Hiring W
orkers
Non-ImmediateFamilyMinors(UnderAge18)WorkingonFarmRecordU.S.Certification: Hired workers under 18 are restricted from Department of Labor (DOL) Hazardous Tasks (ForalistSeeCertificationStandardsAppendix1ListA)
InternationalCertification: Hired workers under 18 are restricted from International Restricted Tasks (ForalistSeeCertificationStandardsappendix1ListB)
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
TAB 8
Included Records:• Worker Concern Process Documentation
(English & Spanish)
• Anti-Discrimination Policy
(English & Spanish)
Workers Right & Responsibilities and Worker Concern Helpline
Wo
rke
rsR
ights
&R
esp
onsib
ilities
1 | WRR & WCH
WorkerConcernProcessDocumentation
Worker Concern Process Documentation
Grower ID#
Grower Name
Farm Name
Trainer (s)
Date
• Information on the Worker Rights and Responsibilities and Worker Concern Helpline poster was shared with you and is posted in a place that is visible to all workers.
• You understand the following on this farm: □ The Grower is committed to providing a safe working environment for you
and satisfy your legal rights while you are on this farm. □ A method is available for workers to notify the Grower, orally and in writing,
of any concern related to the terms or conditions of work. □ The Grower will investigate concerns brought forth by workers and provide
notice to the workers, if known, of how the concern will be or was addressed. At the request of the workers, an informal meeting between the Growers and workers will be held to address the concern.
□ If you raise a concern with Grower and are not satisfied with the resolution or handling of the issue, you are encouraged to call the GAP Connections Worker Concern Helpline or legal authority to voice and address the concern.
• The Grower has discussed the following with you concerning the Worker Concern Helpline:
□ If you believe that your legal rights are not being met while working on this farm, and you are not comfortable discussing the issue with someone on this farm, please feel free to call this helpline.
□ Using this helpline will not limit any rights you currently have under U.S. Law, nor limit your ability to share a legal concern you may have with any other person or organization.
□ That the source of any information you provide will be treated as confidential.
□ If you call this helpline and share a concern, the service provider of this helpline will contact you within two weeks to provide an update.
□ You may also choose to remain anonymous when you report your concern. □ If you prefer to remain anonymous, the service provider of this helpline will
give you a number to call in two weeks, so you can receive an update. □ If at any time you feel you are being retaliated against for calling the
helpline, you should call the helpline again and share this with the helpline operator.
Grower ID #
Grower Name
Farm Name
Trainer(s)
Date
Worker Concern Process Documentation
Grower ID#
Grower Name
Farm Name
Trainer (s)
Date
• Information on the Worker Rights and Responsibilities and Worker Concern Helpline poster was shared with you and is posted in a place that is visible to all workers.
• You understand the following on this farm: □ The Grower is committed to providing a safe working environment for you
and satisfy your legal rights while you are on this farm. □ A method is available for workers to notify the Grower, orally and in writing,
of any concern related to the terms or conditions of work. □ The Grower will investigate concerns brought forth by workers and provide
notice to the workers, if known, of how the concern will be or was addressed. At the request of the workers, an informal meeting between the Growers and workers will be held to address the concern.
□ If you raise a concern with Grower and are not satisfied with the resolution or handling of the issue, you are encouraged to call the GAP Connections Worker Concern Helpline or legal authority to voice and address the concern.
• The Grower has discussed the following with you concerning the Worker Concern Helpline:
□ If you believe that your legal rights are not being met while working on this farm, and you are not comfortable discussing the issue with someone on this farm, please feel free to call this helpline.
□ Using this helpline will not limit any rights you currently have under U.S. Law, nor limit your ability to share a legal concern you may have with any other person or organization.
□ That the source of any information you provide will be treated as confidential.
□ If you call this helpline and share a concern, the service provider of this helpline will contact you within two weeks to provide an update.
□ You may also choose to remain anonymous when you report your concern. □ If you prefer to remain anonymous, the service provider of this helpline will
give you a number to call in two weeks, so you can receive an update. □ If at any time you feel you are being retaliated against for calling the
helpline, you should call the helpline again and share this with the helpline operator.
Youunderstandthefollowingonthisfarm:
The Grower has discussed the following with you concerningtheWorkerConcernHelpline:
Worker Concern Process Documentation
Grower ID#
Grower Name
Farm Name
Trainer (s)
Date
• Information on the Worker Rights and Responsibilities and Worker Concern Helpline poster was shared with you and is posted in a place that is visible to all workers.
• You understand the following on this farm: □ The Grower is committed to providing a safe working environment for you
and satisfy your legal rights while you are on this farm. □ A method is available for workers to notify the Grower, orally and in writing,
of any concern related to the terms or conditions of work. □ The Grower will investigate concerns brought forth by workers and provide
notice to the workers, if known, of how the concern will be or was addressed. At the request of the workers, an informal meeting between the Growers and workers will be held to address the concern.
□ If you raise a concern with Grower and are not satisfied with the resolution or handling of the issue, you are encouraged to call the GAP Connections Worker Concern Helpline or legal authority to voice and address the concern.
• The Grower has discussed the following with you concerning the Worker Concern Helpline:
□ If you believe that your legal rights are not being met while working on this farm, and you are not comfortable discussing the issue with someone on this farm, please feel free to call this helpline.
□ Using this helpline will not limit any rights you currently have under U.S. Law, nor limit your ability to share a legal concern you may have with any other person or organization.
□ That the source of any information you provide will be treated as confidential.
□ If you call this helpline and share a concern, the service provider of this helpline will contact you within two weeks to provide an update.
□ You may also choose to remain anonymous when you report your concern. □ If you prefer to remain anonymous, the service provider of this helpline will
give you a number to call in two weeks, so you can receive an update. □ If at any time you feel you are being retaliated against for calling the
helpline, you should call the helpline again and share this with the helpline operator.
2 | WRR & WCH
DocumentoParaElProcesoDeQuejas
ID del Granjero #
Nombre del Granjero
Nombre de la Granja
Entrenador(es)
Fecha
ID del Granjero #
Nombre del Granjero
Nombre de la Granja
Entrenador(es)
Fecha
• Se le entrego un poster con información de los Derechos y Responsabilidades de los Trabajadores y Línea de Ayuda de Quejas para Trabajadores y esta publicado en un lugar visible a todos.
• Entiende lo siguiente en esta Granja: □ El Granjero está comprometido a proveer un ambiente seguro de trabajo para usted y
satisfacer sus derechos legales mientras se encuentre en la granja. □ Hay un método disponible para notificar al Granjero, oralmente y por escrito, de
cualquier queja relacionada a los términos o condiciones de trabajo. □ El Granjero investigará la queja presentada por el trabajador y notificará a los
trabajadores, si se conoce, como se manejará su queja. A petición de los trabajadores, se hará una reunión entre el Granjero y los trabajadores para tratar la queja.
□ Si usted levanta una queja con el Granjero y no esta satisfecho con la resolución o manejo del problema, se le recomienda que llame a la Línea de Ayuda de Quejar para Trabajadores de GAP Connections o la autoridad legal para expresar y tratar su queja.
• El Granjero ha discutido con usted lo siguiente a cerca de la Línea de Ayuda para Trabajadores: □ Si usted cree que sus derechos legales no están siendo respetados mientras trabaja
en esta granja, y usted no se siente cómodo discutiendo sus problemas con alguien en esta granja, por favor siéntase en la libertad de llamar a esta línea de ayuda.
□ Usar la línea de ayuda no limitara los derechos que tiene bajo las leyes de los Estados Unidos, y tampoco limita su habilidad para compartir una queja legal que tenga con alguna otra persona u organización.
□ Que la fuente de cualquier información que usted aporte será tratada confidencialmente.
□ Si usted llama a la línea de ayuda y comparte una queja, el proveedor de la línea de ayuda le contactara dentro de un plazo de dos semanas para actualizarle.
□ Usted también puede escoger mantenerse anónimo cuando reporte su queja. □ Si usted prefiere mantenerse anónimo, el proveedor de la línea de ayuda le dará un
numero de teléfono al que podrá llamar en dos semanas para recibir una actualización.
□ Si en algún momento siente que se están tomando represalias hacia usted por llamar 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.
Documento Para El Proceso De Quejas
EntiendelosiguienteenestaGranja:
ElGrannjerohadiscutidoconustedlosiguienteacercadelaLineadeAyudaparaTrabajadores:
ID del Granjero #
Nombre del Granjero
Nombre de la Granja
Entrenador(es)
Fecha
• Se le entrego un poster con información de los Derechos y Responsabilidades de los Trabajadores y Línea de Ayuda de Quejas para Trabajadores y esta publicado en un lugar visible a todos.
• Entiende lo siguiente en esta Granja: □ El Granjero está comprometido a proveer un ambiente seguro de trabajo para usted y
satisfacer sus derechos legales mientras se encuentre en la granja. □ Hay un método disponible para notificar al Granjero, oralmente y por escrito, de
cualquier queja relacionada a los términos o condiciones de trabajo. □ El Granjero investigará la queja presentada por el trabajador y notificará a los
trabajadores, si se conoce, como se manejará su queja. A petición de los trabajadores, se hará una reunión entre el Granjero y los trabajadores para tratar la queja.
□ Si usted levanta una queja con el Granjero y no esta satisfecho con la resolución o manejo del problema, se le recomienda que llame a la Línea de Ayuda de Quejar para Trabajadores de GAP Connections o la autoridad legal para expresar y tratar su queja.
• El Granjero ha discutido con usted lo siguiente a cerca de la Línea de Ayuda para Trabajadores: □ Si usted cree que sus derechos legales no están siendo respetados mientras trabaja
en esta granja, y usted no se siente cómodo discutiendo sus problemas con alguien en esta granja, por favor siéntase en la libertad de llamar a esta línea de ayuda.
□ Usar la línea de ayuda no limitara los derechos que tiene bajo las leyes de los Estados Unidos, y tampoco limita su habilidad para compartir una queja legal que tenga con alguna otra persona u organización.
□ Que la fuente de cualquier información que usted aporte será tratada confidencialmente.
□ Si usted llama a la línea de ayuda y comparte una queja, el proveedor de la línea de ayuda le contactara dentro de un plazo de dos semanas para actualizarle.
□ Usted también puede escoger mantenerse anónimo cuando reporte su queja. □ Si usted prefiere mantenerse anónimo, el proveedor de la línea de ayuda le dará un
numero de teléfono al que podrá llamar en dos semanas para recibir una actualización.
□ Si en algún momento siente que se están tomando represalias hacia usted por llamar 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.
Documento Para El Proceso De Quejas
ID del Granjero #
Nombre del Granjero
Nombre de la Granja
Entrenador(es)
Fecha
• Se le entrego un poster con información de los Derechos y Responsabilidades de los Trabajadores y Línea de Ayuda de Quejas para Trabajadores y esta publicado en un lugar visible a todos.
• Entiende lo siguiente en esta Granja: □ El Granjero está comprometido a proveer un ambiente seguro de trabajo para usted y
satisfacer sus derechos legales mientras se encuentre en la granja. □ Hay un método disponible para notificar al Granjero, oralmente y por escrito, de
cualquier queja relacionada a los términos o condiciones de trabajo. □ El Granjero investigará la queja presentada por el trabajador y notificará a los
trabajadores, si se conoce, como se manejará su queja. A petición de los trabajadores, se hará una reunión entre el Granjero y los trabajadores para tratar la queja.
□ Si usted levanta una queja con el Granjero y no esta satisfecho con la resolución o manejo del problema, se le recomienda que llame a la Línea de Ayuda de Quejar para Trabajadores de GAP Connections o la autoridad legal para expresar y tratar su queja.
• El Granjero ha discutido con usted lo siguiente a cerca de la Línea de Ayuda para Trabajadores: □ Si usted cree que sus derechos legales no están siendo respetados mientras trabaja
en esta granja, y usted no se siente cómodo discutiendo sus problemas con alguien en esta granja, por favor siéntase en la libertad de llamar a esta línea de ayuda.
□ Usar la línea de ayuda no limitara los derechos que tiene bajo las leyes de los Estados Unidos, y tampoco limita su habilidad para compartir una queja legal que tenga con alguna otra persona u organización.
□ Que la fuente de cualquier información que usted aporte será tratada confidencialmente.
□ Si usted llama a la línea de ayuda y comparte una queja, el proveedor de la línea de ayuda le contactara dentro de un plazo de dos semanas para actualizarle.
□ Usted también puede escoger mantenerse anónimo cuando reporte su queja. □ Si usted prefiere mantenerse anónimo, el proveedor de la línea de ayuda le dará un
numero de teléfono al que podrá llamar en dos semanas para recibir una actualización.
□ Si en algún momento siente que se están tomando represalias hacia usted por llamar 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.
Documento Para El Proceso De Quejas
WorkerConcernProcessDocumentationDocumentoParaElProcesoDeQuejas
3 | WRR & WCH
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
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.
Anti-Discrimination Policy
4 | WRR & WCH
* _______________________________________ 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,leavesofabsence,benefits,
and training.
* _______________________________________ seeks to comply with all applicable federal, state
and local laws related to discrimination.
* _______________________________________ makes decisions concerning employment
basedstrictlyonanindividual’squalificationsandabilitytoperformthejobunderconsideration,
thecomparativequalificationsandabilitiesofotherapplicantsoremployees,andtheindividual’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.
Therewillbenoretaliationagainstanyemployeewhofilesacomplaintingoodfaith,eveniftheresult
oftheinvestigationproducesinsufficientevidencetosupportthecomplaint.
*INSERT FARM NAME OR GROWER NAME
Politica Antidiscriminación Borrador
5 | WRR & WCH
* _______________________________________ 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,permisosparaausentarse,beneficios,yentrenamiento.
* _______________________________________ busca cumplir con las leyes locales, estatales y
federales relacionadas a la discriminación.
* _______________________________________ toma decisiones en cuanto a empleo basado
estrictamenteenlascalificacionesindividualesylascapacidadesderealizaruntrabajobajo
consideración,lascalificacionescomparativasyhabilidadesdeotrosaplicantesoempleados,
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
elresultadodelainvestigaciónnotienesuficientespruebasqueapoyenlaqueja.
*NOMBRE DE LA GRANJA O AGRICULTAR
TAB 9
Included Records:• DOL Template Housing Terms & Conditions
(DOL WH-521)
• Vehicle Information Records
• Driver Information Records
• Vehicle Inspection Log
Copies of the following will be required:• Housing Inspection Certificate
Housing, Sanitation and Transportation
Ho
usin
g,
Sanita
tion a
nd
Tra
nsp
orta
tion
1 | Housing, Sanitation & Transportation
2 | Housing, S
anitation & Transportation
Vehicle Make/Model Year Annual Checklist
Vehicle Information
Valid Tags InsuranceIf required: State Safety Inspection, Date: __________ Federal Safety Inspection, Date: ________
Valid Tags InsuranceIf required: State Safety Inspection, Date: __________ Federal Safety Inspection, Date: ________
Valid Tags InsuranceIf required: State Safety Inspection, Date: __________ Federal Safety Inspection, Date: ________
Valid Tags InsuranceIf required: State Safety Inspection, Date: __________ Federal Safety Inspection, Date: ________
Valid Tags InsuranceIf required: State Safety Inspection, Date: __________ Federal Safety Inspection, Date: ________
3 | Housing, S
anitation & Transportation
DriverInformation
Driver License Date on Doctor Driver’sName DriverLicenseNumber ExpirationDate Certificate IfFLCorFLCE
CertificateAuthorized to transport (FLC Only)
Authorized to drive
CertificateAuthorized to transport (FLC Only)
Authorized to drive
CertificateAuthorized to transport (FLC Only)
Authorized to drive
CertificateAuthorized to transport (FLC Only)
Authorized to drive
CertificateAuthorized to transport (FLC Only)
Authorized to drive
CertificateAuthorized to transport (FLC Only)
Authorized to drive
CertificateAuthorized to transport (FLC Only)
Authorized to drive
CertificateAuthorized to transport (FLC Only)
Authorized to driveCertificateAuthorized to transport (FLC Only)
Authorized to drive
4 | Housing, Sanitation & Transportation
Vehicle Inspection Log
4 | Housing, Sanitation & Transportation
Vehicle Inspection 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 parkingbrake functional)
Windshield (free of cracks)
Windshield Wipers (operational)
Floors/Sides (passenger compartmentfree of openings or defects)
Seats (securely fastened)
Exiting Capability (properly functioningdoor 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, dischargeaway from passenger compartment)
Comments:
Maintenance:
TAB 10
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
Worker Training and Farm Safety
Wo
rkin
g
Tra
inin
g a
nd
Farm
Safe
ty
1 | Worker Training &
Farm S
afety
U.S. Department of LaborOccupational Safety and Health Administration
OSHA’s Form 300 (Rev. 01/2004) Year 20__ __Log of Work-Related Injuries and IllnessesYou 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 healthcare 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 touse 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 thisform. If you’re not sure whether a case is recordable, call your local OSHA office for help.
Form approved OMB no. 1218-0176
Page ____ of ____
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Be sure to transfer these totals to the Summary page (Form 300A) before you post it.
Page totals
Establishment name ___________________________________________
City ________________________________ State ___________________
Injury
Enter the number ofdays the injured orill worker was:
Check the “Injury” column orchoose one type of illness:
month/day
month/day
month/day
month/day
month/day
month/day
month/day
month/day
month/day
month/day
month/day
month/day
month/day
Public reporting burden for this collection of information is estimated to average 14 minutes per response, including time to reviewthe instructions, search and gather the data needed, and complete and review the collection of information. Persons are not requiredto respond to the collection of information unless it displays a currently valid OMB control number. If you have any commentsabout these estimates or any other aspects of this data collection, contact: US Department of Labor, OSHA Office of StatisticalAnalysis, Room N-3644, 200 Constitution Avenue, NW, Washington, DC 20210. Do not send the completed forms to this office.
(A) (B) (C) (D) (E) (F)
(M)
(K) (L)(G) (H) (I) (J)
DeathDays awayfrom work
On jobtransfer orrestriction
Awayfromwork
Attention: This form contains information relating toemployee health and must be used in a manner thatprotects the confidentiality of employees to the extentpossible while the information is being used foroccupational safety and health purposes.
CHECK ONLY ONE box for each casebased on the most serious outcome forthat case:
Job transferor restriction
Other record-able cases
Remained at Work
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Injury
Identify the person Describe the case Classify the case
Case Employee’s name Job title Date of injury Where the event occurred Describe injury or illness, parts of body affected,
of illness or made person ill (
no. or onset and object/substance that directly injured
e.g., Second degree burns on
e.g., Welder e.g., Loading dock north end
right forearm from acetylene torch
( ) ( )
)
_____ ________________________ ____________ ______/__________ ______________________ ___________________________________________________ ____ ____
_____ ________________________ ____________ ______/__________ ___________________ ___________________________________________________ ____ ____
_____ ________________________ ____________ ______/__________ ___________________ ___________________________________________________ ____ ____
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days days
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days days
2 | Worker Training &
Farm S
afety
U.S. Department of LaborOccupational Safety and Health Administration
OSHA’s Form 300A (Rev. 01/2004)Year 20__ __
Summary of Work-Related Injuries and IllnessesForm approved OMB no. 1218-0176
Total number ofdeaths
__________________
Total number ofcases with daysaway from work
__________________
Number of Cases
Total number of days awayfrom work
___________
Total number of days of jobtransfer or restriction
___________
Number of Days
Post this Summary page from February 1 to April 30 of the year following the year covered by the form.
All establishments covered by Part 1904 must complete this Summary page, even if no work-related injuries or illnesses occurred during the year. Remember to review the Log
to verify that the entries are complete and accurate before completing this summary.
Using the Log, count the individual entries you made for each category. Then write the totals below, making sure you’ve added the entries from every page of the Log. If you
had no cases, write “0.”
Employees, former employees, and their representatives have the right to review the OSHA Form 300 in its entirety. They also have limited access to the OSHA Form 301 or
its equivalent. See 29 CFR Part 1904.35, in OSHA’s recordkeeping rule, for further details on the access provisions for these forms.
Establishment information
Employment information
Your establishment name __________________________________________
Street _________________________ _______
City ____________________________ State ______ ZIP _________
Industry description ( )
_______________________________________________________
Standard Industrial Classification (SIC), if known ( )
____ ____ ____ ____
North American Industrial Classification (NAICS), if known (e.g., 336212)
e.g., Manufacture of motor truck trailers
e.g., 3715
(I ee the
Worksheet on the back of this page to estimate.)
_____________________
OR
____ ____ ____ ____ ____ ____
Annual average number of employees ______________
Total hours worked by all employees last year ______________
f you don’t have these figures, s
Sign here
Knowingly falsifying this document may result in a fine.
I certify that I have examined this document and that to the best of myknowledge the entries are true, accurate, and complete.
___________________________________________________________
___________________________________________________________
Company executive Title
Phone Date( ) - / /
Public reporting burden for this collection of information is estimated to average 58 minutes per response, including time to review the instructions, search and gather the data needed, andcomplete and review the collection of information. Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. If you have anycomments 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.
Total number of . . .
Skin disorders ______
Respiratory conditions ______
Injuries ______
Injury and Illness Types
Poisonings ______
Hearing loss
All other illnesses ______
______
(G) (H) (I) (J)
(K) (L)
(M)(1)
(2)
(3)
(4)
(5)
(6)
Total number ofcases with jobtransfer or restriction
__________________
Total number ofother recordablecases
__________________
3 | Worker Training &
Farm S
afety
Information about the employee
Information about the physician or other health careprofessional
Full name
Street
City State ZIP
Date of birth
Date hired
Male
Female
Name of physician or other health care professional
If treatment was given away from the worksite, where was it given?
Facility
Street
City State ZIP
Was employee treated in an emergency room?
Yes
No
Was employee hospitalized overnight as an in-patient?
Yes
No
_____________________________________________________________
________________________________________________________________
______________________________________ _________ ___________
______ / _____ / ______
______ / _____ / ______
__________________________
________________________________________________________________________
_________________________________________________________________
_______________________________________________________________
______________________________________ _________ ___________
�
�
�
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U.S. Department of LaborOccupational Safety and Health Administration
OSHA’s Form 301Injury and Illness Incident Report
Form approved OMB no. 1218-0176
This is one of the
first forms you must fill out when a recordable work-
related injury or illness has occurred. Together with
the and the
accompanying these forms help the
employer and OSHA develop a picture of the extent
and severity of work-related incidents.
Within 7 calendar days after you receive
information that a recordable work-related injury or
illness has occurred, you must fill out this form or an
equivalent. Some state workers’ compensation,
insurance, or other reports may be acceptable
substitutes. To be considered an equivalent form,
any substitute must contain all the information
asked for on this form.
According to Public Law 91-596 and 29 CFR
1904, OSHA’s recordkeeping rule, you must keep
this form on file for 5 years following the year to
which it pertains.
If you need additional copies of this form, you
may photocopy and use as many as you need.
Injury and Illness Incident Report
Log of Work-Related Injuries and Illnesses
Summary,
Information about the case
Case number from the
Date of injury or illness
Time employee began work
Time of event Check if time cannot be determined
Date of death
Log _____________________ (Transfer the case number from the Log after you record the case.)
______ / _____ / ______
____________________
____________________
______ / _____ / ______
AM / PM
AM / PM �
What was the employee doing just before the incident occurred?
What happened?
What was the injury or illness?
What object or substance directly harmed the employee?
If the employee died, when did death occur?
Describe the activity, as well as the
tools, equipment, or material the employee was using. Be specific. “climbing a ladder while
carrying roofing materials”; “spraying chlorine from hand sprayer”; “daily computer key-entry.”
Tell us how the injury occurred. “When ladder slipped on wet floor, worker
fell 20 feet”; “Worker was sprayed with chlorine when gasket broke during replacement”; “Worker
developed soreness in wrist over time.”
Tell us the part of the body that was affected and how it was affected; be
more specific than “hurt,” “pain,” or sore.” “strained back”; “chemical burn, hand”; “carpal
tunnel syndrome.”
“concrete floor”; “chlorine”;
“radial arm saw.”
Examples:
Examples:
Examples:
Examples:
If this question does not apply to the incident, leave it blank.
Completed by
Title
Phone Date
_______________________________________________________
_________________________________________________________________
(________)_________--_____________ _____/ ______ / _____
Public reporting burden for this collection of information is estimated to average 22 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Persons are not required to respond to the
collection of information unless it displays a current valid OMB control number. If you have any comments about this estimate or any other aspects of this data collection, including suggestions for reducing this burden, 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.
10)
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6)
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Attention: This form contains information relating toemployee health and must be used in a manner thatprotects the confidentiality of employees to the extentpossible while the information is being used foroccupational safety and health purposes.
Growers can follow these steps below and use the provided Emergency Disaster Plan template to prepare for unexpected emergencies or disasters on their farming operations.1. Plan carefully.2. Identify the risks on Your operation.3. Put emergency procedures in place.4. Create a communication plan.5. Practice for all kinds of emergencies.
Planning includes considering man-made and natural disasters. Decide how you will assess the situation and use available resources to take care of yourself, family, workers and property in the case of an emergency or disaster. It is also important to review insurance policies annually to ensure they meet your coverage needs in case of an emergency or disaster.
Determine which disasters are most common in your area including but not limited to: Fire Tornado Hurricane SevereWeather(i.e.awarenessofthepresenceoflighteningwhenworkinginfields) Flooding Earthquake Medical/Accident Explosions Biological (i.e. human or animal disease outbreak) Chemical/Hazardous Material Spill and/or Human Exposure
Carefully assess how the farm functions, determine the information, workers, materials and equip-ment that are necessary to keep operating after an emergency or disaster. The following are sug-gestions to help in preparing emergency procedures.
Create a list of important numbers for emergency services, utilities, service providers, medical providers, veterinarians, insurance companies, etc. Identify a safe shelter and/or create an evacuation plan. Prepareformedicalemergenciesbykeepingfirstaidkitsclosebyandbypostingphone numbersforemergencyresponderssuchaspolice,EMS,firedepartmentandothers. Create a map or description of building site including utility lines and where CPA’s or fuel tanks are located. Create a list of equipment. Ensure that you have a backup of payroll & accounting systems. Maintain storage of important paper documents (such as insurance policies) off site. Develop and maintain an Emergency Supply Kit. Equipbuildingsandfacilitieswithsafetyandemergencygearsuchasfireextinguishers, smokeandheatdetectors/alarms,flashlightsandbatteries,batterypoweredradiosand weatherradiosandelevateequipmentoffthefloortoavoidelectricalhazards.
4 | Worker Training & Farm Safety
HowtoPrepareforanEmergencyorDisaster
1. Plan Carefully
2. Identify the Risks on your Operation
3.PutEmergencyProceduresinPlace
5 | Worker Training & Farm Safety
HowtoPrepareforanEmergencyorDisaster
Communication is important tool in your emergency plan. A communication plan helps ensure every-one knows how to reach each other and where to meet in an emergency. Mobile phones and comput-ers could be unreliable during or after a disaster, as well as, electricity could be disrupted.Plan for extended disruptions and carefully examine which utilities are vital to the operation. Talk with service providers about potential alternatives and identify back-up options such as portable genera-tors. Have a written copy of all phone numbers and email address of workers and family on the farm and decide on a safe and familiar place for workers and family on the farm to go for protection or to reunite. Identify the following meet up places:
• Indoor - If you live in an area where tornadoes, hurricanes or other weather can happen, make sure everyone knows where to go for protection. • IntheNeighborhood-Aplacewhereeveryonecanmeetifthereisafireorotheremergency and need to leave the residence or farm. • Outside of the Neighborhood -A place to meet if a disaster happens and everyone is not able to get back to the home or farm. • Outside of your Town or City - A place to meet when everyone is outside of the neighborhood and outside of your town/city locations are in an evacuation area.
The best method of preparation for a disaster is to talk to your employees. A good plan is only as good as the workers’ awareness and understanding of the plan.
Conduct education and training for workers and family on the farm with information on disaster preparedness skills. Plan to conduct evacuation drills and other emergency exercises together. Talkwithfirstresponders,emergencymanagers,communityorganizationsandutilityproviders so they are aware and familiar with the farm and include them in emergency/disaster drills on the farm. Annually review the farm emergency/disaster plan and update as the changes occur. Make sure employees are trained annually and new employees are familiar with the plan.
The following pages are templates that can be used by growers to prepare for an emergency ordisaster.Postthesepageswhereworkerscanviewthemeasilyorhavetheminalocationwhere all workers know where they are and an access them at any time.
FOR MORE INFORMATION ON DISASTER OR EMERGENCY PREPAREDNESS GO TO WWW.READY.GOV
4. Create a Communication Plan
5.PracticeforAllKindsofEmergencies
6 | Worker Training & Farm Safety
Los productores pueden seguir los pasos siguientes y usar la plantilla proporcionada del Plan de Emergencia de Desastres para prepararse para las emergencias inesperadas o desastres en sus operaciones agricolas.1. Planee cuidadosamente.2. ldentifiquelosriesgosdesusactividadesenlalistaacontinuaci6nuotrosrecurses.3. Ponga en marcha procedimientos de emergencia.4. Cree un plan de comunicaci6n.5. Practique ejercicios para todo tipo de emergencia.
Planear incluye considerar desastres naturales y creados por el hombre. Decida coma evaluaria la situaci6n y usaria los recurses disponibles para cuidarse a si mismo, la familia, trabajadores, y propiedad en el caso de una emergencia o desastre. Tambien es importante revisar las p61izas de seguro anualmente y asegurarse que cumpla con la cobertura necesaria en caso de una emergen-cia o desastre.
Determine cuales desastres son los mas comunes en su area incluyendo, pero no limitado a: lncendio D Tornado Huracan Clima lnclemente ( ej. conciencia de la presencia de rayos cuando se trabaja en los campos ) lnundaci6n Terremoto Medico/Accidente Explosion es Biol6gico (ej. brote de enfermedad humana o animal ) Quimico /Derrame de Material Peligroso y/o Exposici6n Humana
Cuidadosamente evalue como funciona su granja, determine la informaci6n, trabajadore s, materiales yequipo que son necesarios para mantenerse operando despues de una emergenciao desastre. Las siguientes sugerencias le ayudaran a preparar procedimientos de emergencia.
Crear una lista de numeros importantes para servicios de emergencia, proveedores de servicios publicos , proveedores medicos, veterinarios, compa iiia de seguros, etc.
ldentificarunrefugioSeguray/ocrearunplandeevacuaci6n. Prepararse para emergencias medicas, teniendo cerca un botiquin de primeros auxilios y publicando los numeros de emergenciacomo la policia, EMS (Servicios de Emergencias medicas ) , departamento de bomberos y otros. Hagaunmapaconladescripci6ndeledificioincluyendolaslineasdelosserviciospublicosy donde se encuentran ubicadoslos tanques de gasolina o CPA’s. Haga una lista de los equipos. Asegurese de tener una co pia de seguridadde los sistemas de n6mina y contabilidad. Almacene documentos importantes (coma p61izas de seguros) fuera del sitio. Desarrolle y mantenga un Kit con Suministros de Emergencia. Equipelasinstalacionesyedificiosconequiposdeseguridadcomoextinguidoresdeincendio, detectores/alarmas de calor e incendios, linternas y baterias , radios de baterias y radios del clima, y eleve todos los equipos del suelo para evrtar un peligro electrico.
Como p-bep-ababse p-abu emebge C10 Desastre
1. Planee Cuidadosamente
2.IdentifiqueLosRiesqosDeSusActividades
3.PongaenMarchaProcedimientosdeEmergencia
7 | Worker Training & Farm Safety
ComoPrepararseparaunaEmergenciaodeSastre
CLa comunicaci6n es una herramienta importante en su plan de emergencia. Un plan de comuni-caci6n de emergencia le ayuda a asegurarse que todos sepan c6mo llegar a los demas y donde reunirse en caso de una emergencia. Los telefonos celulares y las computadoras pueden ser poco confiablesduranteodespuesdeundesastre,tantocomo,laelectricidadpuedefallar.Planee para la interrupci6n prolongada y cuidadosamente examine cuales servicios publicos son vitales para la operaci6n. Hable con los proveedores de dichos servicios a cerca de alternativas e identifiqueopcionescomogeneradores.Tenga una copia escrita con todos los numeros de telefonos y direcciones electr6nicas de todos lostrabajadores y familias en la granja y escoja un lugar seguro y familiar para los trabajadores y famili-asenlagranjaparareunirseyestarprotegidos.ldentifiqueloslugaresdereunion: Interior - Si vive en un area de tornados, huracanes u otros climas pueden suceder, asegurese que todos sepan a donde ir por protecci6n. En el vecindario - Un lugar d onde todos puedan encontrarse si hubiera un incendio u otra emergencia y necesitan evacuar la residencia o la granja Fuera del vecindario - Un lugar donde encontrarse si pasara un desastre y no pueden regresar a la casa o la granja Fuera del pueblo o ciudad - Un lugar donde encontrarse cuando todos estan fuera del vecindario y lugares fuera del pueblo/cuidad que esten en un area de evacuaci6n.
TEl mejor metodo de preparaci6n para un desastre es hablar con sus empleados. Un buen plan solamente sera bueno si todos los trabajadores entienden y estan conscientes del plan.
Eduque y entrene a los trabajadores y las familias en la granja para prepararlos con informaci6n y destrezas en desastres. Hagan ejercicios para conducir un plan de evacuaci6n y otros ejercicios de emergencias juntos. Hable con los cuerpos de emergencias, jefes de emergencias, organizaciones comunitarias, proveedores. de servicios publicos para que ellos esten al tanto y conozcan la granja e incluyalos en los ejercicios de emergencia/desastres en la granja. Revise los planes de emergencia/desastres anualmente y actualicelos cuando ocurran cambios. Asegurese que sus empleados sean entrenados anualmente y que los nuevos empleados esten. familiarizados con el plan.
Las siguientes paginas son plantillas que pueden usar los granjeros para prepararse para una emergenciaodesastre.P6ngalasdondelostrabajadorespuedenverlosfacilmente,sepand6nde estan, y puedan acceder en cualquier momento.
PARA MAS INFORMACION EN PREPARACION DE DESASTRES O EMERGENCIA DIRIJASE AWWW.READY.GOV
4. Haga un plan de emergencia
5. Practique para todo tipo de emergencias
8 | Worker Training & Farm Safety
EmergencyResponsePlan
Farm Name:
Address:
Telephone:
Contact Name:
Last Revision Date:
Employees will be warned to evacuate thebuilding, site, or area using the following system:
Person who will bring the farm roster to theevacuatoin assembly area to account everyone:
If an evacuation required, everyone shouldassemble at the following location for roll call:
PlandeRespuestadeEmergencia
Nombre de la Finca:
Direccion:
Telefono:
Responsable
Fecha de laultima revision:
Seusarael siguiente sistema para advertir a los empleados que deben evacuar el lugar oarea:
La siguiente personatraera la lista de la granja al lugar de encuentro para contarlos a todos:
Si serequiere una evacuaci6n todos deben encontrarse en el siguiente lugar para ser contados:
Is special assistance needed Name Phone for this person (i.e. Person with disability)
9 | Worker Training & Farm Safety
Farm Roster
10 | Worker Training & Farm Safety
ISe necesita asistencia Nombre Telefono especial para esta persona (ej. persona con discapacidad)?
Lista de la Ganja
11 | Worker Training & Farm Safety
List of Important Numbers
Emergency Name Emergency Non-Emergency Service Telephone Telephone
Fire Department
Emergency MedicalService
Police Department
Emergency Management Agency
Hospital
Public Health Department
State EnvironmentalAuthority
National ResponseCenter (EPA)
Electrician
Plumber
Fire Protection Contractor
Hazardous MaterialsCleanup
Cleanup/DisasterRestoration
12 | Worker Training & Farm Safety
Lista de Numeros Importantes
Serviciade Telefonode Telefonodeno Emergencia Nombre Emergencia Emergencia
Departmento deBomberos
Servicios deEmergencia Medica
Departamento dePolicias
Agenciade Manejo deEmergencia
Hospital
Departamento deSalud Publica
Autoridad Estatal delAmbiente
Centro Nacional deRespuesta (EPA)
Electricista
Pbmero
Contratista deProtecci6n de Incendios
Lipieza de MaterialesPeligrosos
Limpieza/Restauraci6nde Desastres
13 | Worker Training & Farm Safety
In Case of Medical Emergency
1. If a medical emergency is reported, dial 9-1-1 and request an ambulance. Provide the following information:
• Number and location of victim(s)
• Nature of injury or illness
• Hazards involved
• Nearest emergency access point (entrance)
2. Alert those trained (members of the medical response team if no one is trained on the farm) to respond to the victim's location and bring a first aid kit or AED. Only trained responders should provide first aid assistance.
3. Do not move the victim unless the victim's location is unsafe. 4. Control access to the scene. 5. Take "universal precautions" to prevent contact with body fluids and exposure to bloodborne
pathogens. 6. Meet the ambulance at the nearest entrance or emergency access point; direct them to the
victim(s).
List of those trained to administer first aid, CPR, or use automated external defibrillator (AED)
Name Contact Number(s)
Locations of first aid kits and automated external defibrillator(s) (AEDs)
Locations of First Aid Kits
Locations of Automated External Defibrillator(s) (AEDs)
InCaseofMedicalEmergency
14 | Worker Training & Farm Safety
InCasodeUnaEmergenciaMedica
1. Sise reporta umemergenciamedica, marque al 9-1-1 y pida una ambulancia
Provea la siguiente informaci6n :
• Numero y ubicaci6n de la(s) victima(s)
• Naturaleza de lalesi6n y enfermedad
• Si hay material peligroso
• Punto de accesomas cercano a la emergencia (entrada)
2. Alerte a aquellos que han sido entrenados (miembros del equipo de respuesta medica sino ha sido
entrenado ninguno en la granja) para responder al lugar donde se encuentra la victima y traer el equipo
de primeros auxilios a AED. Unicamente los entrenados deben proporcionar asistencia de primeros
auxilios.
3. No mueva a lavictimaa menos que lavictimase encuentre en un lugar inseguro.
4. Controle el acceso a la escee1a.
5. Tome las "precauciones universales" para prevenir el contacto con fluidos corporales y la exposici6na
los pat6genos trasmitidos por la sangre.
6. Recibaa laambulanciaen la entradamascercana o acceso de emergencia cercano, dirijale a la(s)
victima(s).
Lista de aquellos entrenados para suministrar primeros auxilios, CPR o parar usa el desfibrilador externo
automatico(AED)
Nombre Nombre(s) y Numero(s) de los Responsables
Ubicaci6nde los equipos de primeros auxilios y el/los desfibriladores (es)automatico(s)(AEDs)
Ubicaci6nde los equipos de primeros auxilios
Ubicaci6ndel/los equipo (s) destibrilador(es)automatico(s)
(AEDs)
15 | Worker Training & Farm Safety
InCaseofaFireEmergency
InCaseofSevereWeather/TornadoSheltering
In Case of a Fire Emergency 1. If a fire is reported, pull the fire alarm (if available and not already activated) to warn
everyone to evacuate.
2. Dial 9-1-1 to alert the fire department.
Provide the following information:
• Name of person reporting fire
• Telephone number for a return call
• Farm Name and Street Address
• Nature of fire
• Fire location (building, barn, field, house equipment, etc.)
3. Evacuate people to a primary assembly area outside.
4. Account for all family and workers at the assembly area (use List of Individuals on the Farm).
5. Meet the fire department when they arrive and inform fire department commander if everyone has been accounted for and if there are any injuries.
6. Provide an update on the nature of the emergency and actions taken.
7. Provide building layout, map of site, etc. and other assistance as requested.
In Case of Severe Weather/Tornado Sheltering 1. Identify location of tornado shelter(s)
2. If a tornado warning is issued instruct everyone to move to shelter
Severe Weather/Tornado Shelter Locations
3. Assign someone the following responsibilities in advance of severe weather:
Shelter-in-place Team Assignments Name
Person to monitor weather sources for updated
emergency instructions and broadcast warning if
issued by weather services
Person(s) to direct people to designated tornado
shelter(s)
In Case of a Fire Emergency 1. If a fire is reported, pull the fire alarm (if available and not already activated) to warn
everyone to evacuate.
2. Dial 9-1-1 to alert the fire department.
Provide the following information:
• Name of person reporting fire
• Telephone number for a return call
• Farm Name and Street Address
• Nature of fire
• Fire location (building, barn, field, house equipment, etc.)
3. Evacuate people to a primary assembly area outside.
4. Account for all family and workers at the assembly area (use List of Individuals on the Farm).
5. Meet the fire department when they arrive and inform fire department commander if everyone has been accounted for and if there are any injuries.
6. Provide an update on the nature of the emergency and actions taken.
7. Provide building layout, map of site, etc. and other assistance as requested.
In Case of Severe Weather/Tornado Sheltering 1. Identify location of tornado shelter(s)
2. If a tornado warning is issued instruct everyone to move to shelter
Severe Weather/Tornado Shelter Locations
3. Assign someone the following responsibilities in advance of severe weather:
Shelter-in-place Team Assignments Name
Person to monitor weather sources for updated
emergency instructions and broadcast warning if
issued by weather services
Person(s) to direct people to designated tornado
shelter(s)
In Case of a Fire Emergency 1. If a fire is reported, pull the fire alarm (if available and not already activated) to warn
everyone to evacuate.
2. Dial 9-1-1 to alert the fire department.
Provide the following information:
• Name of person reporting fire
• Telephone number for a return call
• Farm Name and Street Address
• Nature of fire
• Fire location (building, barn, field, house equipment, etc.)
3. Evacuate people to a primary assembly area outside.
4. Account for all family and workers at the assembly area (use List of Individuals on the Farm).
5. Meet the fire department when they arrive and inform fire department commander if everyone has been accounted for and if there are any injuries.
6. Provide an update on the nature of the emergency and actions taken.
7. Provide building layout, map of site, etc. and other assistance as requested.
In Case of Severe Weather/Tornado Sheltering 1. Identify location of tornado shelter(s)
2. If a tornado warning is issued instruct everyone to move to shelter
Severe Weather/Tornado Shelter Locations
3. Assign someone the following responsibilities in advance of severe weather:
Shelter-in-place Team Assignments Name
Person to monitor weather sources for updated
emergency instructions and broadcast warning if
issued by weather services
Person(s) to direct people to designated tornado
shelter(s)
16 | Worker Training & Farm Safety
EnCasodeUnaEmergenciaporIncendio
EnCasodeUnaEmergenciaporIncendio
EN CASO DE UNA EMERGENCIA POR INCENDIO
1. Sise reporta un incendio, active la alarma (siestadisponible y no ha sido previamente activada) para alertar a todos que debenevacuar.
2. Marque 9-1-1 para reportarlo al departamento de bomberos. Provea la siguiente informaci6n:
• Nombre de la persona reportando el incendio
• Numero de telefono para recibir llamadas
• Nombre y Direcci6n de la finca
• Naturaleza del incendio
• Ubicaci6n del incendio (edificio, granero, campo, casa, equipo, etc.)
3. Evacuar a las personas al area de reunion en el exterior. 4. Cuente a todas las familiasy trabajadores en el area de reunion (use la lista de los individuos en la
granja). 5. Reciba al departamento de bomberos cuando lleguene informele al comandante si todos han sido
contados y si hayalg(m herido. 6. De un informe de la naturaleza de la emergencia y las acciones a seguir. 7. Provea un diseno del edificio, un mapa del sitio y cualquier otra asistencia requerida.
EN CASO DE UNA EMERGENCIA POR INCENDIO 1. ldentifique el/los refugio(s) 2. Si se emite una alerta de tornados aviselea todos que se vayan al refugio
Ubicacionde Refugio de Tornado/Clima Severo
3. Asigne con tiempo a alguien para las siguientes responsabilidades en caso de clima severo:
Equipo Asignado para las tareas en el refugio Nombre
Persona que monitorea las fuentes del clima para
instrucciones actualizadas de emergencia y
comunicar alertas si son emitidas por el servicio
meteorol6gico
Personas paradirigir a las personas alAos refugios de
tornado(s)
EN CASO DE UNA EMERGENCIA POR INCENDIO
1. Sise reporta un incendio, active la alarma (siestadisponible y no ha sido previamente activada) para alertar a todos que debenevacuar.
2. Marque 9-1-1 para reportarlo al departamento de bomberos. Provea la siguiente informaci6n:
• Nombre de la persona reportando el incendio
• Numero de telefono para recibir llamadas
• Nombre y Direcci6n de la finca
• Naturaleza del incendio
• Ubicaci6n del incendio (edificio, granero, campo, casa, equipo, etc.)
3. Evacuar a las personas al area de reunion en el exterior. 4. Cuente a todas las familiasy trabajadores en el area de reunion (use la lista de los individuos en la
granja). 5. Reciba al departamento de bomberos cuando lleguene informele al comandante si todos han sido
contados y si hayalg(m herido. 6. De un informe de la naturaleza de la emergencia y las acciones a seguir. 7. Provea un diseno del edificio, un mapa del sitio y cualquier otra asistencia requerida.
EN CASO DE UNA EMERGENCIA POR INCENDIO 1. ldentifique el/los refugio(s) 2. Si se emite una alerta de tornados aviselea todos que se vayan al refugio
Ubicacionde Refugio de Tornado/Clima Severo
3. Asigne con tiempo a alguien para las siguientes responsabilidades en caso de clima severo:
Equipo Asignado para las tareas en el refugio Nombre
Persona que monitorea las fuentes del clima para
instrucciones actualizadas de emergencia y
comunicar alertas si son emitidas por el servicio
meteorol6gico
Personas paradirigir a las personas alAos refugios de
tornado(s)
17 | Worker Training & Farm Safety
WorkerSafetyTrainingRecords
Worker Safety Training Records
Farm Name:
Source of Training:
□ Verbal Discussion
□ Training Video
□ Tailgate Training Kits
□ Farm Safety & Compliance Event
Trainer Name: Date:
The following Worker Safety and Training Topics have been presented and discussed:
Se han presentado y discutido los siguientes temas de Seguridad y Formación Laboral:
□ Prevention of Carbon Monoxide Poisoning (Fire-Cured Only)
□ General Farm Safety
□ Safe Operation of Farm Equipment and Machinery
□ Green Tobacco Sickness – Symptoms & Treatments
□ Heat Stress – Symptoms & Treatments
□ Storage, Handling, Application & Disposal of Agrichemicals
□ Use of Personal Protective Equipment (PPE)
□ Recognition of Restricted Entry Interval (REI)
□ Required Worker Protection Standard Training
□ Farm Emergency Plan & Emergency Response
□ Prevención de la Intoxicación por Monóxido de Carbono (Solo Curado al Fuego)
□ Seguridad General de la Granja
□ Operación Segura de Maquinaria y Equipos Agrícola
□ Enfermedad del Tabaco Verde - Síntomas & Tratamientos
□ Estrés por el Calor - Síntomas & Tratamientos
□ Almacenamiento, Manejo, Aplicación & Eliminación de Agroquímicos
□ Uso de Equipo de Protección Personal (PPE)
□ Reconocimiento del Intervalo de Entrada Restringida (REI)
□ Capacitación Estándar Requerida para la Protección del Trabajador
□ Plan de Emergencia Agrícola y Respuesta de Emergencia
By signing below, the employee agrees to having received this training and understands the dangers
associated.
Al firmar abajo, el empleado está de acuerdo en que ha recibido el entrenamiento y entiende el riesgo asociado.
Printed Name (Nombre impreso) Signature (Firma)
1
2
5
6
7
Worker Safety Training Records
Farm Name:
Source of Training:
□ Verbal Discussion
□ Training Video
□ Tailgate Training Kits
□ Farm Safety & Compliance Event
Trainer Name: Date:
The following Worker Safety and Training Topics have been presented and discussed:
Se han presentado y discutido los siguientes temas de Seguridad y Formación Laboral:
□ Prevention of Carbon Monoxide Poisoning (Fire-Cured Only)
□ General Farm Safety
□ Safe Operation of Farm Equipment and Machinery
□ Green Tobacco Sickness – Symptoms & Treatments
□ Heat Stress – Symptoms & Treatments
□ Storage, Handling, Application & Disposal of Agrichemicals
□ Use of Personal Protective Equipment (PPE)
□ Recognition of Restricted Entry Interval (REI)
□ Required Worker Protection Standard Training
□ Farm Emergency Plan & Emergency Response
□ Prevención de la Intoxicación por Monóxido de Carbono (Solo Curado al Fuego)
□ Seguridad General de la Granja
□ Operación Segura de Maquinaria y Equipos Agrícola
□ Enfermedad del Tabaco Verde - Síntomas & Tratamientos
□ Estrés por el Calor - Síntomas & Tratamientos
□ Almacenamiento, Manejo, Aplicación & Eliminación de Agroquímicos
□ Uso de Equipo de Protección Personal (PPE)
□ Reconocimiento del Intervalo de Entrada Restringida (REI)
□ Capacitación Estándar Requerida para la Protección del Trabajador
□ Plan de Emergencia Agrícola y Respuesta de Emergencia
By signing below, the employee agrees to having received this training and understands the dangers
associated.
Al firmar abajo, el empleado está de acuerdo en que ha recibido el entrenamiento y entiende el riesgo asociado.
Printed Name (Nombre impreso) Signature (Firma)
1
2
5
6
7
Worker Safety Training Records
Farm Name:
Source of Training:
□ Verbal Discussion
□ Training Video
□ Tailgate Training Kits
□ Farm Safety & Compliance Event
Trainer Name: Date:
The following Worker Safety and Training Topics have been presented and discussed:
Se han presentado y discutido los siguientes temas de Seguridad y Formación Laboral:
□ Prevention of Carbon Monoxide Poisoning (Fire-Cured Only)
□ General Farm Safety
□ Safe Operation of Farm Equipment and Machinery
□ Green Tobacco Sickness – Symptoms & Treatments
□ Heat Stress – Symptoms & Treatments
□ Storage, Handling, Application & Disposal of Agrichemicals
□ Use of Personal Protective Equipment (PPE)
□ Recognition of Restricted Entry Interval (REI)
□ Required Worker Protection Standard Training
□ Farm Emergency Plan & Emergency Response
□ Prevención de la Intoxicación por Monóxido de Carbono (Solo Curado al Fuego)
□ Seguridad General de la Granja
□ Operación Segura de Maquinaria y Equipos Agrícola
□ Enfermedad del Tabaco Verde - Síntomas & Tratamientos
□ Estrés por el Calor - Síntomas & Tratamientos
□ Almacenamiento, Manejo, Aplicación & Eliminación de Agroquímicos
□ Uso de Equipo de Protección Personal (PPE)
□ Reconocimiento del Intervalo de Entrada Restringida (REI)
□ Capacitación Estándar Requerida para la Protección del Trabajador
□ Plan de Emergencia Agrícola y Respuesta de Emergencia
By signing below, the employee agrees to having received this training and understands the dangers
associated.
Al firmar abajo, el empleado está de acuerdo en que ha recibido el entrenamiento y entiende el riesgo asociado.
Printed Name (Nombre impreso) Signature (Firma)
1
2
5
6
7
Printed Name (Nombre Impreso) Signature (Firma)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
18 | Worker Training & Farm Safety
WorkerCropIntegrityTrainingRecords
Worker Crop Integrity Training Records
Farm Name:
Source of Training:
□ Verbal Discussion
□ Training Video
□ Tailgate Training Kits
□ Farm Safety & Compliance Event
Trainer Name: Date:
The following Worker Crop Integrity Training Topics have been presented and discussed:
Se han introducido los siguientes temas de información de integridad de cultivos y se han examinado:
□ Grade Separation (Air & Fire Only)
□ Proper Baling and Market Separation
□ NTRM Prevention
□ Harvesting Tobacco
□ Separación de la Categoría (Solo Aire & Fuego)
□ Embalado Adecuado y Separación del Mercado
□ Prevención del NTRM
□ Cosecha del Tabaco
By signing below, the employee agrees to having received this training and understands the dangers
associated.
Al firmar abajo, el empleado está de acuerdo en que ha recibido el entrenamiento y entiende el riesgo asociado.
Printed Name (Nombre impreso) Signature (Firma)
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Worker Crop Integrity Training Records
Farm Name:
Source of Training:
□ Verbal Discussion
□ Training Video
□ Tailgate Training Kits
□ Farm Safety & Compliance Event
Trainer Name: Date:
The following Worker Crop Integrity Training Topics have been presented and discussed:
Se han introducido los siguientes temas de información de integridad de cultivos y se han examinado:
□ Grade Separation (Air & Fire Only)
□ Proper Baling and Market Separation
□ NTRM Prevention
□ Harvesting Tobacco
□ Separación de la Categoría (Solo Aire & Fuego)
□ Embalado Adecuado y Separación del Mercado
□ Prevención del NTRM
□ Cosecha del Tabaco
By signing below, the employee agrees to having received this training and understands the dangers
associated.
Al firmar abajo, el empleado está de acuerdo en que ha recibido el entrenamiento y entiende el riesgo asociado.
Printed Name (Nombre impreso) Signature (Firma)
1
2
3
4
6
7
8
9
10
Worker Crop Integrity Training Records
Farm Name:
Source of Training:
□ Verbal Discussion
□ Training Video
□ Tailgate Training Kits
□ Farm Safety & Compliance Event
Trainer Name: Date:
The following Worker Crop Integrity Training Topics have been presented and discussed:
Se han introducido los siguientes temas de información de integridad de cultivos y se han examinado:
□ Grade Separation (Air & Fire Only)
□ Proper Baling and Market Separation
□ NTRM Prevention
□ Harvesting Tobacco
□ Separación de la Categoría (Solo Aire & Fuego)
□ Embalado Adecuado y Separación del Mercado
□ Prevención del NTRM
□ Cosecha del Tabaco
By signing below, the employee agrees to having received this training and understands the dangers
associated.
Al firmar abajo, el empleado está de acuerdo en que ha recibido el entrenamiento y entiende el riesgo asociado.
Printed Name (Nombre impreso) Signature (Firma)
1
2
3
4
6
7
8
9
10