Double click on the Produce Safety Alliance Image to open the complete document or start using the templates on the following pages. Qualified Exemption Review Template Name and address of farm: Date: _______________ Sales receipts or records reflecting total food sales over the previous 3 years: Year 1 (Sales year: __________) $____________________ Year 2 (Sales year: __________) $____________________ Year 3 (Sales year: __________) $____________________ Average total food sales $____________________ sales to qualified end users (E.g. consumers, or grocery stores and restaurants within 275 Total food miles or within the same state or Indian reservation) $_____________________ $__________ ÷ $ __________ x 100 =__________% Sales to qualified Average sales Percent sales end users to qualified end users
Double click on the Produce Safety Alliance Image to open the complete document or start using the templates on the following pages. Qualified Exemption Review Template Name and address of farm: Date: _______________ Sales receipts or records reflecting total food sales over the previous 3 years: Year 1 (Sales year: __________) $____________________ Year 2 (Sales year: __________) $____________________ Year 3 (Sales year: __________) $____________________ Average total food sales $____________________ Total food sales to qualified end users (E.g. consumers, or grocery stores and restaurants within 275 miles or within the same state or Indian reservation) $_____________________ $__________ ÷ $ __________ x 100 =__________% Sales to qualified end users Average sales Percent sales to qualified end users
PSA-Fact-Sheet-Records-Required-by-FSMA-Produce-Safety-Rule-003.docx