Vs 7-13 Feed Mill Quality Assurance Affidavit

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OMB NUMBER
0579-XXXX

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES

TRICHINAE HERD CERTIFICATION FEED MILL QUALITY ASSURANCE AFFIDAVIT
Purpose: The presence of trichinae encysted larvae in the meat of dead mammals is a source for exposing swine to the organism. The feed that swine consume
in this program must not contain uncooked meat scraps, wildlife carcasses, or r odent carcasses to enable the certification of the site. This affidavit is intended
to lead the discussion between the producer and the mill manager or quality assurance officer to ensure the quality and safety of the feed that is being delivered
to the pork production site, especially as it relates to trichinae.
Objective: The trichinae auditor shall review this affidavit for completeness and indication of the quality assurances in place at the feed mill.
Name of production site :

Name of Producer:

Name of Feed Mill:

Address of Feed Mill:

Name and title of feed mill representative:
The above named feed mill is adhering to the following Good Manufacturing Processes Guidelines:

Within these guidelines the feed mill has implemented the following pest manage ment practices:

The rodent control system for the feed mill is maintained internally/by a pest control professional (circle one)
on a _______________________________________(indicate time length, i.e. "weekly ") basis.

If the services of a pest control professional are being used enter name and address here:

YES
NO (check one)The above named feed mill maintains records of pest management practices or has the records generated by the pest
control professional. These records will be made available upon request.

With this signature I attest to the accuracy of the above information as being true to the best of my knowledge.
Signature of Feed Mill Representative:

Date:

With this signature I attest to the accuracy of the above information as being true to the best of my knowledge.
Signature of Producer:

This affidavit is valid for a period of 2 years after the date of the above signatures.

VS FORM 7-13
JAN 2007

Date: