Form FDA 1996 Form FDA 1996 Farm Inspection Report

DEPARTMENT OF HEALTH AND HUMAN SERVICES
FOOD AND DRUG ADMINISTRATION

Farm Number

Owner

Date

Address

FORM APPROVED; OMB No. 0910-0212
Expiration Date: 08/31/2024
See Burden Statement on page 2.

FARM INSPECTION REPORT

Milk Grade

Number of Gallons Daily

Person Interviewed

Time

Delivered To

An approved farm requires that all "Facilities" listed below be rated "Satisfactory"; that the TOTAL score for the applicable
"Methods" is not less than 85% of the total maximum score. Subitems may be rated in quarter points. Note: Do not score any
item or subitem unless information is available concerning it. SEE REVERSE FOR TYPICAL POINT DISTRIBUTION.
(For items 1 through 3, please check the appropriate boxes.)

FACILITIES

Satisfactory

1. Health of Herd
a. Appears healthy
1. Health
of Herd

c. Construction
4. Milkhouse/Milkroom

4. Milkhouse/Milkroom

4. Milkhouse/Milkroom

4. Milkhouse/Milkroom

4. Milkhouse/Milkroom

(2) walls and ceilings

(3) doors, screens and
partitions
d. Facilities (water, wash
vats, racks)
e. Usage for milk handling
and utensil care only
f. Cleanliness and flies
c. Construction

e. Sanitized before use
f. Cleaning supplies and
brushes available and
properly stored
6. Bulk Milk
a. Tank construction

5. Utensils and Equipment

g. Single service items
properly stored
h. Pesticides, antibiotics,
and insecticides
properly stored
5. Utensils and Equipment
a. Milking machines (head,
claw, pulsator, inflations,
tubes, air hoses, etc.) good condition, clean,
properly stored
b. Pails, strainers and
other utensils - good
condition, clean,
properly stored
c. Milk lines

2
3
3
3

6. Bulk Milk

2

6. Bulk Milk

2
6. Bulk Milk

4
1

5. Utensils and Equipment

5. Utensils and Equipment

d. Vacuum lines

Points deducted
Numerical score
Percentage score

7. Barn or Milking Area

2

7. Barn or Milking Area

7. Barn or Milking Area

2

b. Clean & good condition

5

c. Milk cooled promptly &
properly held (temp.
°F)

5

d. Properly located

2

e. Outside slab & hoseport

1

6.

5
6. Can Milk

6. Can Milk

6

Can Milk
a. Cooler, clean, good
operating order
b. Cans clean, good
condition
c. Milk cooled promptly &
properly held (temp.
d. Properly located

3

10. Milking Procedures

10. Milking Procedures

10. Milking Procedures

2

7. Barn or Milking Area
a. Size and arrangement
b. Fowl, swine & other
animals properly
confined
c. Lighting and ventilation

4

7. Barn or Milking Area

5
1

7. Barn or Milking Area

10. Milking Procedures

10. Milking Procedures

1

3
2

10. Milking Procedures

5

4

9. Yard or Loafing Area
a. Clean and drained
9. Yard or Loafing Area

5

4

8. Premises well kept

°F)
6. Can Milk

d. Floors & gutters, clean,
good repair
e. Walls & ceilings, clean,
good repair
f. Pens & alleyways clean

b. Manure properly
handled & stored
10. Milking Procedures
a. "Abnormal Milk
Program" procedures
followed
b. Cows clean

3

%
POINTS
MAX
SCORE
OFF
SCORE

5

OR

4. Milkhouse/Milkroom

5. Utensils and Equipment

Max. possible score

5. Utensils and Equipment

6. Bulk Milk

4. Milkhouse/Milkroom

Unsatisfactory

POINTS
MAX
SCORE
OFF
SCORE

1

b. Lighting and ventilation
c. Construction
(1) floors

Satisfactory

3. Sewage Disposal

POINTS
MAX
SCORE
OFF
SCORE

4. Milkhouse/Milkroom
a. Location and size

4. Milkhouse/Milkroom

2. Water supply
a. Safe, clean

b. Follows USDA animal
health program

METHODS

4. Milkhouse/Milkroom

Unsatisfactory

c. Udders & teats washed
& wiped before milking
d. Milker's clothing clean
& dry, no cuts or sores
e. Milk stools & surcingles
clean, properly stored
f. No dusty operations
during milking
g. Feed bin kept clean,
free from foul odors

3

4
2
3
2
1
1
1

1
1

REMARKS (Explain why points were deducted.)

On the basis of this inspection, the farm
approval

certification

is

is not eligible for farm

Signature

permit.

FORM FDA 1996 (11/21) – PREVIOUS EDITION IS OBSOLETE

Page 1

Reset Form

PSC Publishing Services (301) 443-6740

EF

TYPICAL POINT DISTRIBUTIONS
Item

Points

4a

location.............................................................. 1/2
size.................................................................... 1/2

4b

lighting............................................................... 1
ventilation.......................................................... 1

4c(2) walls.................................................................. 1 1/2
ceilings.............................................................. 1 1/2
4c(3) doors................................................................. 1
screens............................................................. 1
partitions........................................................... 1
4d

water................................................................. 1
wash vats.......................................................... 1/2
racks................................................................. 1/2

5b

pails................................................................... 2
strainers............................................................ 2

5e

sanitizer present................................................
sanitizer present and all equipment clean......
no sanitizer........................................................
sanitizer present, equipment dirty

7c

lighting............................................................... 1/2
ventilation.......................................................... 1/2

7d

floors and gutters clean..................................... 2
floors and gutters good repair
2

7e

walls clean.........................................................
walls good repair...............................................
ceilings clean.....................................................
ceiling good repair.............................................

1/2 (min)
5
0
graduate points as to degree of dirty equipment

1
1
1
1

In general, subitems will be weighed according to the above table. However, in unusual situations a
greater point value may be deducted as long as the value of the item is not exceeded.

This section applies only to requirements of the Paperwork Reduction Act of 1995.
*DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.*
The burden time for this collection of information is estimated to average 1.5 hours per response, including the time
to review instructions, search existing data sources, gather and maintain the data needed and complete and review
the collection of information. Send comments regarding this burden estimate or any other aspect of this information
collection, including suggestions for reducing this burden, to:
Department of Health and Human Services
Food and Drug Administration
Office of Chief Information Officer
Paperwork Reduction Act (PRA) Staff
[email protected]

FORM FDA 1996 (11/21) – PREVIOUS EDITION IS OBSOLETE

“An agency may not conduct or sponsor,
and a person is not required to respond to, a
collection of information unless it displays a
currently valid OMB number.”

Page 2