KTDA Farm Data 01May12

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_________________ Factory Co. Ltd: Farm Data for the Rainforest Alliance Certification Program

Name of farm owner: ________________________________________

Registration no:_____________________ Total farm area (estimate):______acres, No. of tea bushes:________

Simple farm sketch

(show homestead, tea plot, other crops, main roads, water bodies etc)

General comments on the map (e.g. Tea shared by e.g. 2 Family Members, No homestead, Tea under lease, Absent farmer etc): ………

Farmer declaration

I have understood and am committed to comply with the Sustainable Agriculture Standard, the rules and regulations of the group and my duties to collaborate in all implementation activities of this program. I am aware of my right to resign from the program.

Signature/Thumb print of the farmer:

____________________________________ Date___________

Internal inspector:

____________________________________

Registration no._______________________ Signature____________________________ Date_____________

TESA: _____________________________

Signature____________________________ Date_____________

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Internal Inspection Checklist

Year 1 Year 2 Year 3 Answer options: Put  for “Yes”,



for “No” or NA for “Not-Applicable”.

1. Social and Environmental Management System

1.1 Farmer has participated in meetings and activities related to the Rainforest Alliance program 1.3 Farmer has agreed to Rainforest Alliance certification program

1.4 Farmer understands factory structure & roles (Board, BC committee, Management & Staff) 1.5 Farmer keeps farm records (production records, pay slip, input records etc.)

1.7 Farmer has corrected non-conformities agreed in previous internal inspection 1.9 Farmer has a training plan for the workers

1.10 Farmer avoids receiving tea from non-certified farms

1.11 Farmer uses renewable energy and uses it efficiently e.g. biogas, woodlot, energy-saving stove etc.

2. Ecosystem conservation

2.1 Farmer constantly puts effort to protect forests and water bodies

2.2 Farmer has always respected the conservation of national parks and protected forests

2.4 Farmer has planted and/or conserved indigenous fruit and fuelwood trees

2.5 Forests next to farms are protected from agrochemicals by no-spray zones or by vegetative barriers 2.6 Areas next to water bodies (6 meters or more) are protected with vegetative cover, such as Napier grass 2.7 There is a planted/live hedge around homestead and between different farming plots

2.9 Farmer maintains/restores natural & other vegetation along rivers & public roads

3. Wildlife protection

3.3 Hunting, capturing, extracting or trafficking of wild animals is prohibited on this farm 4. Water conservation

4.1 Farmer makes efforts to harvest and conserve water in the homestead

4.5 Farmer manages domestic waste water in a way that does not contaminate any water body 4.7 Farmer manages solid waste in a way that does not contaminate any water body

5. Fair treatment and good working conditions for workers 5.2 Famer gives fair chance to all without discrimination 5.5 Hired labor rates meet national legal minimum wage

5.6 For hired labor, farmer follows working hours regulations as per the national law

5.8 Farmer only contracts workers above the age 18

5.9 Children work under supervision & only do jobs that don’t compromise their health/education

5.10 Workers have a freedom to stay or leave without conditions imposed by the farm

5.13 Farmer consults workers in case of changes that may impact them

5.16 Workers on the farm have access to medical services (e.g. nearby government dispensary)

Year 1 Year 2 Year 3

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Answer options: Put  for “Yes”,



for “No” or NA for “Not-Applicable”. 6. Occupational Health and Safety

6.3 Farmer has been trained on the safe handling of agrochemicals

6.4 Farmers/workers who handle agrochemicals receive a medical checkup once a year 6.7 Farmer has an agrochemical store

6.8 Store is used exclusively for agrochemical storage

6.9 Store shelves/floor are made of non absorbent materials or covered with plastic

6.10 Farmer rinses empty agrochemical containers three times and puncture them before disposal

6.13 Personal protective equipment is always used during application of chemicals & fertilizer

6.15 Farmer ensures that nobody enters or harvests the sprayed plot, as per label instruction 6.16 Farmer washes his PPE and application equipments at the farm before going home

7. Community Relations

7.4 Farmer cooperates with other farmers, supports and participates in community activities

8. Integrated Crop Management

8.1 Farmer controls pests and diseases in ways that minimizes the use of agrochemicals

8.2 When famer uses agrochemicals, application record is kept (product, date, dosage, plot, sprayer name etc.) 8.3 Equipment for applying chemicals is repaired and calibrated to reduce waste and excesses

8.4 Farmer avoids the use or storage of banned agrochemicals

8.5 Farmer plans to reduce the use of class I and II type of pesticides over time

8.6 Farmer only plants crops that are not genetically modified

8.9 Farmer avoids the use of fire for pest control, except for the control of stem canker

9. Soil management and conservation

9.1 Farmer controls soil erosion by mulching, terracing, contour planting and other suitable measures 9.2 Farmer follows fertilizer application rates and method recommended by KTDA/TRFK

9.3 There is vegetative ground cover (grass, trees, mulch) on areas prone to soil erosion (roads, river banks)

9.5 Cutting of natural forest or burning for new planting is prohibited on the farm 10. Integrated waste management

10.1 Waste is separated, and biodegradable waste is composted and used as manure

10.2 Farmer coordinates with the group administrator to dispose plastic waste using an approved incinerator 10.5 Homestead and the farm are clean and free of waste

10.6 Farmer practices minimum tillage and applies fertilizers efficiently

Continuous Improvement Plan :

Year 1

Criterion Finding Corrective action Responsible person Timing of action Follow up

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Continuous Improvement Plan :

Year 2

Continuous Improvement Plan :

Year 3

Note: For “Follow-up”, if you see that the action is completed, put your signature. If not completed, keep it blank.