Pre-Harvest Food Safety Assessment Form
Evaluate your farm or field’s readiness for harvest with this pre-harvest food safety assessment. Complete all sections to ensure compliance with food safety standards.
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Field or Block Name/ID
*
Has a pre-harvest field inspection been conducted within the last 24 hours?
*
Yes
No
Are there any signs of animal intrusion or fecal contamination in the field?
*
No evidence
Minor evidence (e.g., tracks, but no droppings)
Significant evidence (e.g., droppings, nests)
Water Source Safety
*
Rows
Condition
Risk Level
Irrigation water is from a tested, approved source
1
2
No evidence of water contamination near the field
3
4
Have any chemicals (pesticides, herbicides, fertilizers) been applied in the pre-harvest interval?
*
Yes, within the last 7 days
Yes, over 7 days ago
No chemicals applied
Worker Hygiene Compliance
*
1
2
3
4
5
Are harvest equipment and containers clean and in good repair?
*
All equipment clean and functional
Some equipment needs cleaning/repair
Significant equipment issues
Overall Pre-Harvest Food Safety Risk Level
*
Low Risk
Moderate Risk
High Risk
Additional Comments or Observations
Submit Assessment
Should be Empty: