[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-166096-en":3,"doc-seo-166096-105":30,"detail-sidebar-cat-1-en-105":91},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":11,"category_id":12,"category_name":13,"doc_title":14,"doc_description":15,"doc_content":16,"file_id":17,"file_url":18,"file_type":19,"file_size":20,"view_count":11,"is_deleted":4,"is_public":11,"is_downloadable":11,"audit_status":11,"page_count":21,"language":22,"language_code":23,"site_id":24,"html_lang":23,"table_of_contents":25,"faqs":26,"seo_title":27,"seo_description":15,"update_tm":28,"read_time":29},166096,34359740700684,"Finn","https://ap-avatar.wpscdn.com/avatar/1f400023980c374ae676?_k=1777273430885731487",1,17,"Forms","Templates - Confidential Record Templates","Collection of FSMA Produce Safety Rule (FSMA PSR) confidential record and template forms for farms, covering qualified exemption review criteria based on total food sales, sales to qualified end users, and sales to non-qualified end users with inflation-adjusted thresholds. Includes worker training records with trainer details, covered topics, and worker signatures, as well as agricultural water inspection, water assessment, corrective measures documentation, and water treatment monitoring records. References specific FSMA PSR sections and notes retention requirements for supporting sales receipts and corrective documentation.","Have you seen the Required Records Document Description?\nIf not, start with: \u0013 HYPERLINK \"https://resources.producesafetyalliance.cornell.edu/documents/Records-Required-by-the-FSMA-PSR.pdf\" \u0014Records Required by the FSMA Produce Safety Rule\u0015\n(https://resources.producesafetyalliance.cornell.edu/documents/Records-Required-by-the-FSMA-PSR.pdf)\n\u000f\nQualified Exemption Review Template\nFarm name and location: __________________________________Date: _______________\nTotal food sales (in addition to produce, these sales include all other food for humans, feed for animals, and sales of live food animals)\nYear 1\t (Sales year: __________)\t\t\t$____________________\nA must be smaller than B for eligibility\nYear 2\t (Sales year: __________)\t\t\t$____________________\nYear 3\t (Sales year: __________)\t\t\t$____________________\nAverage total food sales\t\t\t\t$____________________ A\nInflation adjusted1 threshold for (range)\t\t$____________________ B\n(for example, B is $638,491 for 2021-2023)\nSales to qualified end users (QEUs) (e.g. consumers anywhere, or grocery stores and restaurants within 275 miles or within the same state or Indian reservation)\nYear 1\t (Sales year: __________)\t\t\t$____________________\nYear 2\t (Sales year: __________)\t\t\t$____________________\nYear 3\t (Sales year: __________)\t\t\t$____________________\nAverage food sales to QEUs\t\t\t$____________________ C\nC must be larger than D for eligibility\nSales to non-QEUs (e.g. wholesale buyers)\nYear 1\t (Sales year: __________)\t\t\t$____________________\nYear 2\t (Sales year: __________)\t\t\t$____________________\nYear 3\t (Sales year: __________)\t\t\t$____________________\nAverage food sales to non-QEUs\t\t\t$____________________ D\nBased on this information, this farm satisfies the criteria for a qualified exemption.\nReviewed by:\tTitle:\tDate_____________\nSales receipts must also be retained to support this record.\nFSMA PSR Reference § 112.7(b) Confidential Record\n1FDA updates the inflation adjusted value (B) around April each year: \u000b  \u0013 HYPERLINK \"https://www.fda.gov/food/food-safety-modernization-act-fsma/fsma-inflation-adjusted-cut-offs\" \u0014https://www.fda.gov/food/food-safety-modernization-act-fsma/fsma-inflation-adjusted-cut-offs\u0015\n\u000f\nWorker Training Record Template\nFarm name and location:____________________________  Date of training: _______________\nTrainer: __________________________________________  Training time:\nTopics Covered: _______________________________________________________________\nTraining materials: Please attach any printed materials related to the training. Also reference any relevant SOPs or sections of the farm food safety plan that apply.\nName of Worker(s)Trained (please print)\tWorker(s) Signature\n1.\n2.\n3.\n4.\n5.\n6.\n7.\n8.\n9.\n10.\n11.\n12.\nFSMA PSR reference § 112.30(b) Confidential Record\nModified from On-Farm Decision Tree Project: Worker Health, Hygiene, and Training—v14 7/16/2014 gaps.cornell.edu\u000bE.A. Bihn, M.A. Schermann, A.L. Wszelaki, G.L. Wall, and S.K. Amundson, 2014\nUpdated 2020 by L.E. Acuña-Maldonado, E.A. Bihn, D.P. Clements, C.L. Fisk, T.P. Saunders, D.M. Stoeckel, G.L. Wall, and K. Woods.\nReviewed by:\tTitle: _____________________\tDate:\nAgricultural Water Systems Inspection Record Template\n§§ 112.42(a)(1-5) Requirements Relating to Agricultural Water Source or System\nFarm name and location: __________________________________________________________________________________________\nDate and time of inspection: ______________________ __________                 Name:  _______________________________________\nPurpose: To identify any conditions that are reasonably likely to introduce known or reasonably foreseeable hazards into or onto covered produce or food contact surfaces.\nUnsafe conditions: For conditions where water is not safe, or not of adequate sanitary quality for its intended use, immediately stop use and address the condition with a corrective measure. Documentation of corrective measures is required – see Measures for Agricultural Water Management Record Template\n§ 112.42(b) requi","cbCaijJpNi3wIh4n","https://ap.wps.com/l/cbCaijJpNi3wIh4n","docx",81049,12,"English","en",105,"# Qualified Exemption Review Template\n## Sales thresholds and eligibility criteria\n# Worker Training Record Template\n## Training details and worker signatures\n# Agricultural Water Systems Inspection Record Template\n## Inspection purpose, unsafe conditions, and actions\n# Agricultural Water Assessment Template\n## Written determinations\n# Measures for Agricultural Water Management Template\n## Corrective and mitigation measures\n# Water Treatment Monitoring Record Template\n## Monitoring factors and record guidance","[{\"question\":\"What is included in the Qualified Exemption Review Template?\",\"answer\":\"It collects farm food sales by year, calculates averages, and uses inflation-adjusted thresholds. It also records sales to qualified end users and non-qualified end users to confirm eligibility based on required inequalities.\"},{\"question\":\"What information must be captured in the Worker Training Record Template?\",\"answer\":\"The template requires farm name and location, training date, trainer details, training time, topics covered, and training materials references. It also includes a list of trained worker names and signatures.\"},{\"question\":\"What does the Agricultural Water Systems Inspection Record Template document?\",\"answer\":\"It records the farm, inspection date and time, inspector name, inspection purpose, and notes unsafe conditions. It emphasizes stopping unsafe water use and documenting corrective measures.\"}]","Templates - Confidential Record Templates | DOCX",1788183137,4,{"code":4,"msg":31,"data":32},"ok",{"site_id":24,"language":23,"slug":33,"title":14,"keywords":34,"description":15,"schema_data":35,"social_meta":86,"head_meta":88,"extra_data":90,"updated_unix":28},"templates-confidential-record-templates","",{"@graph":36,"@context":85},[37,53,68],{"@type":38,"itemListElement":39},"BreadcrumbList",[40,44,48,51],{"item":41,"name":42,"@type":43,"position":11},"https://docshare.wps.com","Home","ListItem",{"item":45,"name":46,"@type":43,"position":47},"https://docshare.wps.com/template/","Template",2,{"item":49,"name":13,"@type":43,"position":50},"https://docshare.wps.com/template/forms/",3,{"item":52,"name":14,"@type":43,"position":29},"https://docshare.wps.com/template/templates-confidential-record-templates/166096/",{"url":52,"name":14,"@type":54,"author":55,"headline":14,"publisher":57,"fileFormat":60,"inLanguage":23,"description":15,"dateModified":61,"datePublished":62,"encodingFormat":60,"isAccessibleForFree":63,"interactionStatistic":64},"DigitalDocument",{"name":9,"@type":56},"Person",{"url":41,"name":58,"@type":59},"DocShare","Organization","application/vnd.openxmlformats-officedocument.wordprocessingml.document","2026-09-03","2026-08-31",true,{"@type":65,"interactionType":66,"userInteractionCount":11},"InteractionCounter",{"@type":67},"ViewAction",{"@type":69,"mainEntity":70},"FAQPage",[71,77,81],{"name":72,"@type":73,"acceptedAnswer":74},"What is included in the Qualified Exemption Review Template?","Question",{"text":75,"@type":76},"It collects farm food sales by year, calculates averages, and uses inflation-adjusted thresholds. It also records sales to qualified end users and non-qualified end users to confirm eligibility based on required inequalities.","Answer",{"name":78,"@type":73,"acceptedAnswer":79},"What information must be captured in the Worker Training Record Template?",{"text":80,"@type":76},"The template requires farm name and location, training date, trainer details, training time, topics covered, and training materials references. It also includes a list of trained worker names and signatures.",{"name":82,"@type":73,"acceptedAnswer":83},"What does the Agricultural Water Systems Inspection Record Template document?",{"text":84,"@type":76},"It records the farm, inspection date and time, inspector name, inspection purpose, and notes unsafe conditions. 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