有机产品新认证调查表

1、有机产品认证调查表Questionnaire for Organic Product Certification（植物生产）申请单位（公章）Name of Applicant (Company Seal)法人/负责人（签字、盖章）Person in Charge (Name and Signature)申请日期年YYYY 月MM 日DDDate of Application(Plant Production)中绿华夏有机食品认证中心China Organic Food Certification Center地址：北京市海淀区学院南路59号 邮编：100081Address: No.59 Xu

2、eyuan South Road, Haidian District, BeijingPostcode: 100081官网： E-mail：cofccOfficial website: E-mail: cofcc注意事项NOTES1. 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QS证为准），应同时填写“加工”类别有机产品认证调查表。The questionnaire shall apply to plant harvest and pretreatment. Questionnaire for Organic Product Certification (Organi

3、c Products Processing) shall be filled out for products invovling post-harvest processing (QS certification shall prevail). 2. 本表无法人（负责人、内检员）签字和单位盖章均视为无效。The questionnaire shall, if without signature and seal of legal person (responsible person, or internal inspector), be deemed invalid.3. 本表涂改后无确认章

4、（或签字）无效。The questionnaire shall, if without confirmation seal (or signature) after altered, be deemed invalid.4. 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，若因故无法填写时，应注明原因。The questionnaire shall be printed or neatly and clearly written by pen or signing pen. Please indicate a slash mark where an item is

5、 not relevant and indicate the reason where an item is not available.5. 填报数据一律用阿拉伯数字，文字说明一律用汉字。Figures shall be expressed by Arabic numerals, and text in Chinese characters.第一部分 基本情况Part I Basic Information1. 生产单元名称与地址Production Unit Name and Address生产单元（基地）名称Production unit (base) name生产单元（基地）地址Pro

6、duction unit (base) address生产负责人Production head电话/手机Phone/ Mobile2. 生产组织模式与生产类型Organizational Model and Prduction Facilities2.1生产组织模式Organization model公司 Corporation 合作社 Cooperatives公司+农户或合作社+农户 Corporation + Farmer or farmer + 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 farmers a

7、re invovled in the actural production, please indicate the number of farmers: 2.2生产类型Production facilities大田种植 Field planting 设施栽培 Greenhouse大田种植+设施栽培 Field planting + Greenhouse3. 生产单元（基地）生态环境Ecological Environment of Production Unit (Farm) 海拔高度（米）Altitude (m)年降水量（mm/年）Annual precipitation (mm/year

8、)无霜期（天/年）Frost-free period (days/year)年平均气温（）Annual mean temperature ()4. 有机产品认证历史Organic Product Certification 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 the organic product ever been certified by other certification bodies? If yes, please indicate the certification bodies and the term of validit

9、y.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 base ever been refused to pass the organic certification or has certificate been revoked? If yes, please indicate the certification bodies, and the reason for refusal or revocation.第二部分 植物生产管理Part II Plant Production Management1. 转换期C

10、onversion Period1.1生产单元（基地）是否为新开垦土地或长期撂荒土地？Is the production unit (base) built on newly reclaimed land or long-term fallow land?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，并说明撂荒开始的时间。If yes, please provide the supporting documentation issued by relevant authorities at county level or above, and indicate the

11、 start date of fallow. 1.2本生产单元（基地）何时开始有机产品生产？When was organic production introduced into the production unit (base)? 2. 缓冲带Buffer Zone2.1有机生产区域附近有无以下污染源？Is there any source of pollution near the organic production site?城区 Urben Area工矿区 Mine lot交通主干线 Traffic trunk工业污染源 Industrial pollution sources生活

12、垃圾场Solid waste其他Others 如有，有机生产区域与以上污染区域的距离。If yes, please indicate the distance to the organic product site. 米m；有机生产区域处在以上区域的方位。And the direction relative to the organic product site: 上风向Upwind 下风向Downwide2.2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 the nearby conventional production site pose any risk of poll

13、ution to organic production site?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 indicate the type of buffer zone or physical barrier in between:林带 Forest 道路 Road 灌木 Shrubs 野生植物Wild plants 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 or width of buffer zone or physical barri

14、er. 米m3. 生产单元内其他情况Other Matters3.1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 there other uncertifited non-organic crops grown in the same production unit, apart from proposed product?是 Yes 否 No如是，请填写作物名称及面积。If yes, please indicate the crop name and planting area. 亩Mu3.2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？A

15、re non-organic crops grown in the same production unit? 是 Yes 否 No如是，填写这些作物的名称及面积。If yes, please indicate the crop name and planting area. 名称/亩Name/Mu 4. 种子和植物繁殖材料Seeds and Plant Propagation Materials不涉及，当生产单元内不使用时。Not Relevant, When not Used in the Production Unit.编号No.作物名称Crop name种子/种苗来源Seed/seed

16、ling source种子属性Seed properties使用量(千克/亩)Used amount(kg/mu)播种时间Planting time是否为转基因种子、包衣种子或使用化学农药浸种Are the seeds genetically modified, coated or pesticide-soaked?自留Retention外购Purchase有机Organic常规Conventional123455. 过去三年土地及种子、种苗管理情况Land, Seed, and Seedling Management during the Previous Three Years不涉及 No

17、t Relevant年度Year地块编号Plot No.作物名称Crop name种子/种苗来源Seed/seedling source种子属性种子属性Seed properties 使用量(kg/亩)Used amount(kg/mu)播种时间Planting time是否为转基因种子、包衣种子或使用化学农药浸种?Are the seeds genetically modified, coated or pesticide-soaked?自留种Retention外购Purchase有机Organic常规Conventional6. 土肥管理Soil Fertilty Management6.

18、1生产单元采取何种措施维持和提高土壤肥力？Measures taken to maintain and improve soil 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 green manurecrops深翻 Deep plowing种植豆科作物 Planting leguminous crops少耕/免耕 Limited tillage/no-tillage休闲撂荒 Lying idle其他 Others 6.2施用或计划使用的肥料：Fert

19、ilizers Used or to Be Used in the Current Year:地块编号Plot No.面积(亩)Area (mu)作物名称Crop name肥料名称Fertilizer name原料组成Raw materials composition肥料来源（外购/自制）Fertilizer source (purchaused/ produced on the base)施用或计划施用的数量（吨）Amount of application (ton)施肥时间Time of application6.3 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）

20、：If Compost is Applied, Please Desribe the Composting Process, Raw Material Composition and Proportion (a Separate Page Attached if needed) 7. 过去三年土地培肥管理情况Land Fertility Management in the Previous Three Years年度Year地块编号Plot No.面积（亩）Area (mu) 作物名称Crop name肥料名称Fertilizer name原料组成Raw materials compositi

21、on肥料来源（外购/自制）Fertilizer source (purchaused/ produced on the farm)施用量（吨）Amount of application (ton)施用时间Time of application8. 本年度病虫草害防治Pest Control of the Current Year8.1病害防治Disease prevention 8.1.1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 seed tr

22、eatment适时耕种 Timely tillage耕翻晒垡 Plowing and solarizing清洁田园 Clean field轮作倒茬 Crop rotation休闲撂荒 Lying idle将病株带出农场 Elimininting disease-stricken plants控制种植密度 Plant density control间作 Intercropping其他，请说明。Others, please indicate. 8.1.2列出有机生产中使用或计划使用的病害控制物质Susbstances used or to be used for disease control不涉

23、及，当生产单元内不使用时。Not relevant, When Not used in the Production Unit.地块编号Plot No.作物名称Crop name面积 (亩)Area (mu)病害名称Disease name使用物质名称Substance name有效成分Active ingredients用量Amount of applicaiton防治时间Duration of effect8.1.3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 copper is used as a disease control substance, please

24、indicate the amount of application (by copper)6千克 铜/公顷年 6kg Cu/ha/year 6千克 铜/公顷年，6kg Cu/ha/year8.2虫害防治Pest control 8.2.1请选择采取的防治措施Measues:抗虫品种 Pest-resistant varieties培育壮苗 Nurturing seedlings非化学药剂种子处理Non-chemical seed treatment适时耕种Timely tillage间作 Intercropping轮作倒茬 Crop rotation虫害监测 Pest monitoring危

25、害植株带出农场Elimininting harmful plants释放寄生性天敌 Releasing parasitoids保护和发展有益生物栖息地Protection and development of beneficial 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

26、repellent其他，请说明。Others ,please indicate. 8.2.2列出有机生产中使用或计划使用的虫害控制物质Susbstances used or to be used for pest control不涉及，当生产单元内不使用时。Not relevant, When Not used in the Production Unit.地块编号Plot No.作物名称Crop name面积 (亩)Area (mu)虫害名称Pest name使用物质名称Substance name有效成分Active ingredients用量Amount of applicaiton防治

27、时间Duration of effect8.3草害防治Weed control8.3.1请列出生产单元中的主要草害及发生季节Please indicate the main weeds and season of occurance 8.3.2请选择采取的防治措施Measures加强栽培管理 Strengthened cultivation management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

28、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其他（请说明）Others (please indicate): 9. 过去三年病虫草害防治情况Pest Control in the Previous Three Years年度Year地块编号Plot No.面积(亩)Area(mu)病虫害管理情况Pest control杂草管理Weed management作物Crop name病虫害名称Pest name使用物质名称Substance name使用量Amoun

29、t of applicaiton使用时间Time of applicaiton杂草名称Weed name防除方法Control method10. 栽培管理措施Cultivation Management10.1是否采用作物轮作、间作套作等栽培方式？Are cultivation methods, such as crop rotation and intercropping, used?是 Yes 否 No如是，请描述轮作植物名称：If yes, please indciate plants for crop rotation: 如是，请描述间作套作植物名称：If yes, please i

30、ndciate plants for intercropping: 10.2 是否存在冬季休耕？Is the winter fallow involved?是 Yes 否 No10.3是否进行灌溉？Is irrigation invovled?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 water sources:天然降水Natural precipitation 地下水Groundwater 河流River 市

31、政供水 Municipal water supply其他Others 11. 本年度种植及收获统计表¹Plantting and Harvesting Statistics of the Current Year¹基地名称Base name地块编号Plot No.面积(亩)Area (mu)前一季的作物Previous season现在的作物Current season下一季计划种植的作物Plan for the next season作物Crop name生长周期²Growth cycle²作物Crop name生长周期²Growth cyc

32、le²亩产（Kg/亩）Yield (kg / mu)预计产量（吨）Expected production (ton)基地面积合计（亩）Total area (mu)注Notes1.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 of differnt vareities and places shall be numbered separately and shall not be numbered in a plot. 2.生长周期应填写具体时间（如5月X日9月X日。）A specific time span shall be provided for the

33、 growth cycle (e.g. May XX-September XX)12. 过去三年种植及收获统计表Planting and Harvesting Statistics During Previous Three-Years年度Year地块编号Plot No.面积（亩）Area (mu)作物Crop name收获时间Harvest time亩产（kg）Yield (kg/mu)产量（吨）Production (ton)13. 污染控制措施Pollution Control13.1常规农田的水是否能渗透或漫入有机地块？Will water penetrate or diffuse f

34、rom conventional farmland into the organic plots?是Yes 否No 不涉及Not relevant13.2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 external sources of fertilizers cause pollution of banned substances to organic production? 是Yes 否No 不涉及Not relevant13.3常规农业系统的设备在用于有机生产前是否进行清洁？ Does the apparatus for conventional farming syst

35、ems cleaned before 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 protective cover, plastic film, and insect nets used?是Yes 否No如是，请选择使用物材质：If yes, please indicate the materials:聚乙烯Polyethylene 聚丙烯Polypropylene 聚碳酸酯Polychlorinate 聚氯类Polychlorinated materials其他Other

36、s 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 these protective coverings removed after usage?是Yes 否No 如是，选择措施方法：If yes, methods for removal: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 and Soil Conservation and Biodiversity Conservation14.1使用了哪些保护措施防止水土流失、

37、土壤沙化和盐碱化？Measures taken to prevent soil erosion, desertification and salinization梯田Terraces等高耕作Contour plowing条耕Strip-tillage套种/间作Interplanting/intercropping冬季覆盖作物Limited tillage/no-tillage少耕/免耕Permanent irrigation canal永久性排灌水渠Windbreak facilities防风设施Firebreaks防火带Forest林带Clarifier澄清池Shoreline manage

38、ment岸线管理Wildlife habitat protection保护野生动植物栖息地Winter crop cover其他（请说明）Others, please indicate 14.2是否采取措施保护天敌及其栖息地？Are measures taken to protect the natural enemies and their habitats?是Yes 否No 14.3作物收获后如何处理作物秸秆？How are crop residues dealt with after harvest?秸秆还田Returned to the field 运出田块Shipped out of

39、 the field 焚烧Incineration 其他Others: ；如焚烧，请说明理由。If incineration, please explain the reasons. 第三部分 收获后处理Part III Post-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 part applies only to plant harvest and pre treatment. Questionnaire for Organic Product Certificati

40、on Organic Products Processing shall be filled out for products invovling post-harvest processing (in which QS certification shall prevail).1. 分选清洗及其他收获后处理Sorting, Cleaning, and Other Post-Harvest Treatment1.1收获方式 Harvesting methods机械Machinery 人工Manual1.2收获后处理Post-harvest treatment无需进行处理No treatment

41、清洁Cleaning分拣Sorting脱粒Threshing脱壳Shelling切割Cutting保鲜Preservation干燥Drying其他，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 the equipment used for both organic and non-organic plants?是Yes 否No1.4 是否对设备器具进行清洁或消毒？Are detergents or disinfectants used for equipment?是Yes 否No如是，请列出清洁或消毒剂的名称：If ye

42、s, please indicate the name of detergent or disinfectant: 2. 投入产出统计Inputs and Outputs成品名Finished product name原料名称Input material name原料用量（吨）Input material amount (ton)出成率（%）Production efficiency (%)成品量(吨)Finished product yield (ton)3. 包装、贮藏和运输Packaging, Storage and Transportation3.1包装Packaging 产品是否包装

43、？Are products packaged?是Yes 否No 如是，请说明包装材料。If yes, please indicate the packaging materials. 包装物或容器是否接触过禁用物质？Has the packaging materials or containers contact banned substances? 是Yes 否No 如是，请描述物质名称。If yes, please indicate the name of subsances: 包装过程中是否使用填充物质？Are fillers used in packaging?是Yes 否No 如是，

44、请描述物质名称。If yes, please indicate the name of filler. 3.2产品储藏Storage无关Not Relevant仓库名称Name of warehouse仓库属性Nature of warehouse储藏能力（吨）Capacity (ton)自有仓库Owned外租仓库Leased第四部分 标识与销售Part IV Labling and Marketing1. 标识Labeling不涉及 Not relevant1.1 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？Do you plan to put an organic

45、product label or code on the certified products or the minimum sales package? 是Yes 否No如是，请选择加施的方式 If yes, please indicate the way:购买使用有机产品防伪标签 Apply for purchasing organic label申请自行印制Apply for printing by self2. 销售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 taken to ensure the completeness and traceability of organic products in sales:避免将有机产品与非有机产品混合Preventing contamination by non-organic products避免将有机产品与禁用物质接触Preventing the contact with prohibited susbtances建立有机产品的