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有机产品认证调查表Questionnaire forOrganic ProductCertification植物生产Plant Production申请单位公章Name ofApplicant CompanySeal法人/负责人签字、盖章申请日期年月日YYYY MMDDDate ofApplicationPerson inCharge Name and Signature中绿华夏有机食品认证中心China OrganicFood CertificationCenter地址邮编100081Address:No.59Xueyuan SouthRoad,Haidian District,Beijing Postcode:100081官网.cn E-mail Officialwebsite:.cn E-mail:施用量吨肥料来源外购/自制年度地块编号面积亩作物名称肥料名称原料组成Raw施用时间TimeFertilizer sourcepurchaused/Amount ofYear Plot No.Area mu Crop nameFertilizer namematerials compositionof applicationproducedon thefarm applicationton
8.本年度病虫草害防治Pest Controlof theCurrent Year
8.1病害防治Disease prevention
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1.1请选择采取的防治措施Measures□抗病品种Disease-resistant varieties□培育壮苗Nurturing seedlings□非化学药剂种子处理Non-chemical seedtreatment□适时耕种Timely tillage□耕翻晒堡Plowing andsolarizing□清洁田园Clean field□轮作倒茬Crop rotation□休闲摺荒Lying idle□将病株带出农场Elimininting disease-stricken plants□控制种植密度Plant densitycontrol□间作Intercropping□其彳也,请说明Others,please indicate.
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1.2列出有机生产中使用或计划使用的病害控制物质Susbstances usedor tobe used for disease control□不涉及,当生产单元内不使用时Not relevant,When Notused in the Production Unit.地块编号作物名称面积亩病害名称使用物质名称有效成分用量防治时间Plot No.Crop nameArea muDisease name Substance nameActive ingredientsAmount of applicaiton Durationof effect若使用铜盐作为病害防治物质,请列出单位面积年使用总量以铜计If copperis usedas adiseasecontrolsubstance,please indicatethe amountof applicationby copper□6千克铜/公顷•年6kg Cu/ha/year口或6千克铜/公顷•年,W6kgeu/ha/year
8.2虫害防治Pest control
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2.1请选择采取的防治措施Measues:口抗虫品种Pcst-resistant varieties□培育壮苗Nurturing seedlings□非化学药剂种子处理Non-chcmical seedtreatment□适时耕种Timely tillage口间作Intercropping□轮作倒茬Crop rotation□虫害监测Pest monitoring口危害植株带出农场Elimininting harmfulplants□释放寄生性天敌Releasing parasitoids□保护和发展有益生物栖息地Protection anddevelopment ofbeneficial habitat□人工捕捉Manual capture□机械捕捉Mechanical capture□诱捕作物Trap crops□物理屏障Physical barrier□物理清除Physical removal口陷阱Trap□灯光诱杀Light trapping□色彩诱杀Color trapping□昆虫驱避Insect repellent□动物驱避Animal repellent口其他,请说明Others,please indicate.___________________________________________________________________________________________
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2.2列出有机生产中使用或计划使用的虫害控制物质Susbstances usedor tobe usedfor pestcontrol□不涉及,当生产单元内不使用时Not relevant,When Notused in the ProductionUnit.地块编号作物名称面积亩虫害名称使用物质名称有效成分用量防治时间Plot No.Crop nameArea muPest nameSubstance nameActive ingredientsAmount ofapplicaiton Durationof effect
8.3草害防治Weed control
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3.1请列出生产单元中的主要草害及发生季节Please indicatethe mainweeds andseason ofoccuranceMeasures□加强栽培管理Strengthened cultivationmanagement□轮作倒茬Crop rotation□适时耕种Timely tillage□中耕除草Intertillage weeding□土壤消毒Soil fumigation□人工除草Manual weeding□火焰除草Flame weeding□蒸汽除草Steam weeding□除草机Weeder□放养动物Animal stocking□作物秸秆覆盖Mulching□地膜覆盖Stubble□灌水除草Irrigation weeding
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3.2请选择采取的防治措施□其他请说明Others please indicate:9,过去三年病虫草害防治情况Pest Controlin the Previous Three Years面积病虫害管理情况杂草管理地块编年度亩Pest controlWeed management号PlotYear Area作物病虫害名称使用物质名称使用量使用时间杂草名称防除方法No.muCrop name PestnameSubstancename AmountofapplicaitonTime ofapplicaiton Weedname Controlmethod
10.栽培管理措施Cultivation Management
10.1是否采用作物轮作、间作套作等栽培方式?Are cultivationmethods,such ascrop rotationand intercropping,used□是Yes□否No如是,请描述轮作植物名称If yes,please indciateplants forcrop rotation:如是,请描述间作套作植物名称If yes,please indciateplants forintercropping:
10.2是否存在冬季休耕?Is thewinter fallowinvolved□是Yes□否No
10.3是否进行灌溉?Is irrigationinvovled□是Yes□否No如是,采用何种方式If yes,irrigation methods:□漫灌Flood□滴灌Drip□喷灌Sprinkler□渗灌Subsurface□其他Others______________________________________________________________________灌溉水来源Irrigation watersources:□天然降水Natural precipitation□地下水Groundwater□河流River□市政供水Municipal watersupply□其他Others_______________________________________________________________________________________________________________
11.本年度种植及收获统计表IPlantting andHarvesting Statisticsof theCurrent Year1前一季的作物现在的作物下一季计划种植的作Previous seasonCun-ent season基地名称地块编号面积亩物Plan forthe next预计产量吨Base namePlot No.Area mu作物生长周期2作物生长周期2亩产Kg/亩seasonExpectedCrop nameGrowth cycle2Crop nameGrowth cycle2Yield kg/muproduction ton基地面积合计亩Total areamu注Notes
1.不同品种、不同位置的作物应分别编号,不能合并在同一地块中Crops ofdiffernt vareitiesand placesshall benumbered separatelyand shallnot benumbered ina plot.
2.生长周期应填写具体时间如5月X日—9月X日A specifictime spanshall beprovided forthe growthcycle e.g.May XX-September XX
12.过去三年种植及收获统计表Planting andHarvesting StatisticsDuring PreviousThree-Years年度地块编号Plot面积亩作物收获时间由产kg产量吨Year No.Area muCrop nameHarvest timeYield kg/mu Productionton
13.污染控制措施Pollution Control
13.1常规农田的水是否能渗透或漫入有机地块?Will waterpenetrate ordiffuse fromconventional farmlandinto theorganic plots□是Yes□否No口不涉及Not relevant
13.2外部来源的肥料是否会造成禁用物质对有机生产的污染?Will externalsources offertilizers causepollution ofbanned substancesto organic production□是Yes□否No□不涉及Not relevant
13.3常规农业系统的设备在用于有机生产前是否进行清洁?Does theapparatus forconventional farmingsystems cleanedbefore used in organic production□是Yes□否No□不涉及Not relevant
13.4是否使用保护性建筑覆盖物、塑料薄膜、防虫网等?Are protectivecover,plastic film,and insectnets used□是Yes□否No如是,请选择使用物材质If yes,please indicatethe materials:□聚乙烯Polyethylene□聚丙烯Polypropylene口聚碳酸酯Polychlorinate口聚氯类Polychlorinated materials口其他Others
13.5上述物质保护性覆盖物等使用完后,是否从土壤中清除?Are theseprotective coveringsremoved afterusage□是Yes□否No如是,选择措施方法If yes,methods forremoval:口焚烧Incineration□收拾集中处理Concentrated treatment□其他,请描述Others,please indicate
14.水土保持和生物多样性保护措施Water andSoil Conservationand BiodiversityConservation
14.1使用了哪些保护措施防止水土流失、土壤沙化和盐碱化?口梯田Terraces□等高耕作Contour plowing口条耕Strip-tillage口套种/间作Interplanting/intercropping□冬季覆盖作物Limited tillage/no-tillage口少耕/免耕Permanent irrigationcanal□永久性排灌水渠Windbreak facilities□防风设施Firebreaks□防火带Forest口林带Clarifier口澄清池Shoreline management□岸线管理Wildlife habitatprotection□保护野生动植物栖息地Winter cropcover口其他1(请说明)Others,please indicale_
14.2是否采取措施保护天敌及其栖息地?Measures taken to preventsoil erosion,desertification andsalinizationAre measurestakentoprotect thenatural enemiesand theirhabitats□是Yes□否No
14.3作物收获后如何处理作物秸秆How arecrop residuesdealt withafter harvest□秸秆还田Returned to the field口运出IB块Shipped outof thefield口焚烧Incineration口其他Others:如焚烧,请说明理由If incineralion,please explainthe reasons._______________________________第三部分收获后处理Part IIIPost-harvest Treatment此部分仅适用于植物收获及其简单处理产品对于收获后需进行加工的产品以QS证为准,应同时填写“加工”类别《有机产品认证调查表》This partapplies onlyto plantharvest andpre treatment.Questionnaire forOrganic ProductCertification Organic Products Processingshall be filledout forproducts invovling post-harvest processingin whichQS certificationshall prevail.
1.分选清洗及其他收获后处理Sorting,Cleaning,and OtherPost-Harvest Treatment
1.1收获方式Harvesting methods□机械Machinery□人工Manual
1.2收获后处理Post-harvest treatment□无需进行处理No treatment口清洁Cleaning□分拣Sorting□脱粒Threshing□脱壳Shelling□切割Cutting□保鲜Preservation□干燥Drying□其彳也,请描述Others,please indicate__________________________________________________________________________
1.3用于处理有机植物的设备是否也被用于处理非有机植物?Are theequipment usedfor bothorganic andnon-organic plants□是Yes□否No
1.4是否对设备器具进行清洁或消毒?Are detergentsor disinfectantsusedforequipment□是Yes□否No注意事项NOTES本表仅适用于植物收获及其简单处理产品对于收获后需进行加工的产品以证为准,应同时填写
1.QS“加工”类别《有机产品认证调查表》The questionnaireshall applyto plantharvest andpretreatment.Questionnaire forOrganic ProductCertificationOrganic ProductsProcessing shallbe filledout forproducts invovlingpost-harvest processingQS certificationshallprevail.本表无法人负责人、内检员签字和单位盖章均视为无效
2.The questionnaireshall,if withoutsignature andseal oflegal personresponsible person,or internalinspector,bedeemed invalid.本表涂改后无确认章或签字无效
3.The questionnaireshall,if withoutconfirmation sealor signatureafter altered,be deemedinvalid.本表应打印或用钢笔、签字笔填写,字迹工整、清晰如无某项目内容时应划斜线表示,若因故无法填
4.写时,应注明原因The questionnaireshallbeprinted orneatly andclearly writtenby penor signingpen.Please indicatea slashmarkwhere anitem isnot relevantand indicatethe reasonwhere anitem isnot available..填报数据一律用阿拉伯数字,文字说明一律用汉字5Figures shallbe expressedby Arabicnumerals,and textin Chinesecharacters.如是,请列出清洁或消毒剂的名称If yes,please indicatethe nameof detergentor disinfectant:_______________________________________________________________________________
2.投入产出统计Inputs andOutputs成品名原料名称原料用量吨出成率%成品量吨Finished productname Input material nameInputmaterialamount tonProduction efficiency%Finished productyield ton
3.包装、贮藏和运输Packaging,Storage andTransportation
3.1包装Packaging产品是否包装?Are productspackaged□是Yes□否No如是,请说明包装材料If yes,please indicatethe packaging materials.包装物或容器是否接触过禁用物质?Has thepackagingmaterialsor containerscontact bannedsubstances□是Yes□否No如是,请描述物质名称If yes,please indicatethe nameof subsances:包装过程中是否使用填充物质?Are fillersusedinpackaging□是Yes□否No如是,请描述物质名称If yes,please indicatethe nameof filler.
3.2产品储臧Storage□无关Not Relevant仓库属性仓库名称Nature of warehouse储藏能力吨Capacity tonNameofwarehouse自有仓库Owned外租仓库Leased第四部分标识与销售Part IVLabling andMarketing标识
1.Labeling□不涉及Not relevant是否计划在获证产品或者产品的最小销售包装上加施有机认证标志、有机码?
1.1Do youplan toput anorganic productlabel orcode onthe certifiedproducts orthe minimumsalespackage□是□否Yes No如是,请选择加施的方式If yes,please indicatethe way:□购买使用有机产品防伪标签Apply forpurchasing organiclabel□申请自行印制Apply forprinting byself销售
2.Marketing□不涉及Not relevant在产品销售时采取何种措施保证有机产品的完整性和可追溯性Measures takento ensurethe completenessand traceabilityof organic productsinsales:□避免将有机产品与非有机产品混合Preventing contaminationby non-organic products口避免将有机产品与禁用物质接触Preventing thecontact withprohibited susbtances□建立有机产品的购买、运输、储存、出入库和销售等记录Establishing andimplementing recordson sales,transportation,storage,warehouse,and sales□其他,请说明Others please indicate第五部分管理体系Part VManagement System.文件控制1Documentation提交的质量管理体系文件是否为最新有效版本?
1.1Is thequality managementsystem documentsubmitted inthe latestvalid version□是□否Yes No是否能确保在使用时可获得适用文件的有效版本?
1.2Is theaccess tovalid versionof applicabledocuments secured□是□否Yes No是否保存了有效的有机生产记录?
1.3Are therevalid recordsof organic production□是□否Yes No资源管理
2.Resource Management是否了解或熟悉国家有机标准要求姓名职务任职年限Familiarity withnational standardsforName PostTenureorganic products生产管理者□不了解口口掌握口Little GreatProductionmanager熟悉Detailed了解Basic内部检查员口掌握□不了解口GreatLittleInternal inspector熟悉Detailed口了解Basic声明Statement我在此声明,在我个人的经历、知识和能力范围内,本调查表中所填写并反映的所有生产、加工和经营的情况都是真实的、准确的我在此认同,后续必要的现场检查包括抽样检测,查验原始记录及票据是为了验证符合有机产品标准的需要同时我也知道,即使本调查内容经审查得到通过,并不意味着申报产品通过了有机产品认证I herebyassert,within therange ofmy personalexperience,knowledge andcapabilities,that theinformationabout production,processing andmanagement providedby thequestionnaire hereofisauthentic andaccurate.I herebyagree thatthe follow-up necessaryon-site inspectionincludingsampling,inspection tooriginal records,and billsserve forthe purposeof verifyingcompliance withorganic product standards.I amaware thatthe content,even ifreviewed andadopted,does notmean thattheproposed productpasses the certification oforganicproducts.负责人签字Person inCharge Signature:内检员签字Internal inspectorSignature:第一部分基本情况Part IBasic Information生产单元名称与地址
1.ProductionUnitNameandAddress生产单元基地名称Production unit base name生产单元基地地址Production unitbase address生产负责人电话/手机Production headPhone/Mobile生产组织模式与生产类型
2.Organizational Modeland PrductionFacilities生产组织模式
2.1Organization model□公司□合作社Corporation Cooperatives□公司+农户或合作社+农户Corporation+Farmer orfarmer+cooperatives□其他,请描述Others,please indicate:_______________________________________________如实际生产涉及农户,请填写农户数If farmersare invovledintheactural production,please indicatethenumber offarmers:________________________________________________________________生产类型
2.2Production facilities□大田种植□设施栽培Field plantingGreenhouse□大田种植+设施栽培Field planting+Greenhouse生产单元基地生态环境
3.Ecological Environmentof ProductionUnit Farm海拔高度米Altitude m年降水量年mm/Annual precipitationmm/year无霜期天/年Frost-free perioddays/year年平均气温℃Annual meantemperature℃有机产品认证历史
4.OrganicProductCertification History此前是否通过其他认证机构的有机认证?如是,哪家认证机构?证书有效期?Has theorganicproductever beencertified byother certificationbodiesIf yes,please indicatethecertification bodies and the termofvalidity.此前是否被拒绝通过有机认证或被撤销过认证证书?哪家认证机构?被拒绝或撤销认证的原因是什么?Has the production baseever beenrefused topass theorganiccertification orhas certificatebeen revokedIf yes,please indicatethecertificationbodies,andthereason forrefusal orrevocation.第二部分植物生产管理Part IIPlant ProductionManagement
1.转换期Conversion Period
1.1生产单元基地是否为新开垦土地或长期揩荒土地?Is theproduction unitbase builton newlyreclaimed landor long-term fallowland□是Yes□否No如是,请提供相应的县级或县级以上主管部门出具的证明文件,并说明揩荒开始的时间If yes,please providethe supportingdocumentation issuedby relevantauthorities atcounty levelor above,and indicatethe startdate offallow.
1.2本生产单元基地何时开始有机产品生产?When wasorganic productionintroduced into theproduction unitbase
2.缓冲带Buffer Zone
2.1有机生产区域附近有无以下污染源?Is thereany sourceof pollutionnear theorganic production site口城区Urben Area口工.矿区Mine lot口交通主干线Traffic trunk口工业污染源Industrial pollutionsources口生活垃圾场Solid waste口其他Others如有,有机生产区域与以上污染区域的距离If yes,please indicatethe distancetotheorganicproductsite.米m;有机生产区域处在以上区域的方位And thedirection relativetotheorganicproductsite:□上风向Upwind□下风向Downwide
2.2邻近常规生产区域是否可能对有机生产区域造成污染风险?Will thenearby conventionalproductionsitepose anyrisk ofpollution toorganicproductionsite□是Yes□否No如是,有机生产区域与常规生产区域之间的缓冲带或物理屏障类型If yes,please indicatethe typeof buffer zone or physical barrierin between:□林带Forest□道路Road□灌木Shrubs口野生植物Wild plants口农田Farmland□河流Rivers□草地Grass□其他Others:_____________________________________________________________________________________________缓冲带或物理屏障的高度或宽度Height orwidth ofbufferzoneorphysicalbarrier.米m
3.生产单元内其他情况Other Matters
3.1除申报产品外,同一生产单元内是否还有其它按有机方式生产但不申请认证的植物产品?Are thereother uncertifitcdnon-organic cropsgrown inthe sameproduction unit,apart fromproposed product□是Yes□否No如是,请填写作物名称及面积If yes,pleaseindicatethe cropname andplanting area.亩Mu
3.2除申报产品外,同一生产单元内是否还有非有机方式种植的作物?Are non-organic cropsgrown inthe sameproductionunit口是Yes□否No如是,填写这些作物的名称及面积If yes,pleaseindicatethe cropname andplanting area.名称/亩Name/Mu______________________________________________________________________________________________________
4.种子和植物繁殖材料Seeds andPlant PropagationMaterials□不涉及,当生产单元内不使用时Not Relevant,When notUsed inthe ProductionUnit.种子/种苗来源种子属性是否为转基因种子、包衣种子或使用编号作物名称Seed/seedling sourceSeed properties使用量千克/亩播种时间化学农药浸种No.Crop name自留外购有机常规Used amountkg/mu Plantingtime Arethe seedsgenetically modified,coated or pesticide-soakedRetention PurchaseOrganic Conventional□□1□□□□2□□□□3□□□□4□□□5□□□5,过去三年土地及种子、种苗管理情况Land,Seed,and SeedlingManagement duringthe PreviousThree Years□不涉及Not Relevant种子/种苗来源种子属性使用量是否为转基因种子、包衣种子或使用Seed/seedling sourceSeed properties年度地块编号作物名称kg/亩Used播种时间化学农药浸种?YearPlotNo.Crop nameamount Plantingtime Arethe seedsgenetically modified,自留种外购有机常规kg/mu coatedorpesticide-soakedRetention PurchaseOrganic Conventional□□□□□□□□□□□□□□□□□□□□□□□□
6.土肥管理Soil FertiltyManagement
6.1生产单元采取何种措施维持和提高土壤肥力?Measures takento maintainand improvesoil fertility□作物轮作Crop rotation□间作/套种Intercropping/interplanting□秸秆还田Returning straws□绿肥作物翻埋Burying greenmanurecrops口深翻Deep plowing□种植豆科作物Planting leguminouscrops口少耕/免耕Limited tillage/no-tillage□休闲摺荒Lying idle口其他Olhers
6.2施用或计划使用的肥料Fertilizers Usedor toBe UsedintheCurrent Year:施用或计划施用的肥料来源外购/自制施肥时间地块编号面积亩作物名称肥料名称原料组成数量(吨)Fertilizer sourcepurchaused/Time ofPlotNo.Area muCropnameFertilizer nameRaw materialscomposition Amountofproduced onthe baseapplicationapplication(ton)
6.3如生产单元使用堆肥,请详细描述堆制过程,原料组成及其所占比例(可另附页):If Compostis Applied,Please Desribethe CompostingProcess,Raw MaterialComposition andProportion aSeparate PageAttached ifneeded7,过去三年土地培肥管理情况Land FertilityManagement inthePreviousThreeYears。