FSMA - Farm Inventory

Farm Information Survey

Food Safety Modernization Act (FSMA) - Produce Safety Rule
Farm Name:*
Farm RepresentativeTDA Outreach SpecialistOther
Farm Contact Personnel:*

First NameLast Name
E-mail Address:
Phone Number:*
Format: (000) 000-0000.
Farm Physical Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Texas County farm is located in:
Farm Mailing Address (if different from physical address):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
List any other states that your operation is located in:
Food Safety or Other Point of Contact Information
This is the same person as listed above.We do not currently have a person listed in this position.My Farm has a Food Safety point person.
POC Firm/Facility Name:
POC Name:

First NameLast Name
POC Phone Number:
Format: (000) 000-0000.
POC Email:
example@example.com
Farm Information
grow produceharvest producepack producehold produce
Less than $25KVery Small ($25K - $250K)Small ($250K - $500K)Large (Over $500K)Not Available
Select the crop(s) that you produce:*
YesNo
YesNo
YesNo
YesNo
Ground WaterSurface WaterWellPondCanalAquiferRain Water CollectionCity/Rural Water DistrictsOther
YesNo
DripOverheadSprayFloodFurrows
Website Address:
Should be Empty:

Farm Information Survey