MONTANA DEPARTMENT OF LIVESTOCK USE ONLY Cooperative Interstate Shipment Program Application checklist – completed by MPI staff
Regulatory Compliance
Last FSA Completed Date:
Completed By:
Last FSA Completed Date: Completed By:
9 CFR 416: SPS and SSOP
9 CFR 417: HACCP
9 CFR 418: Recall Plan
Food Defense (Voluntary)
Verified: 9 CFR 416: SPS and SSOP 9 CFR 418: Recall Plan 9 CFR 332.13: Written plant to address separation by time & space Water and sewage approval Labels for Cooperative Interstate Shipment (CIS) in compliance
9 CFR 332.13: Written plant to address separation by time & space
Water and sewage approval
Source Material Verified source materials are from which USDA establishment:
Labels for Cooperative Interstate Shipment (CIS) in compliance
Verified source materials are from which USDA establishment:
Slaughter Last Review Date for Humane Handling/Good Commercial Practices review: Controls for SRM Controls for Listeria Monocytogenes
Last Review Date for Humane Handling/Good Commercial Practices review:
Controls for SRM Controls for Listeria Monocytogenes
Handling/Good
List of Products for CIS
Administrative
List Products
List Products (continued)
Has the establishment ever been under USDA inspection? Yes No
Yes
No
Has the establishment been under a state Grant of Inspection for 90 days? If No, date the establishment will reach 90 days of under state inspection:
Yes
No
Date to meet 90 days under Inspection
Authorization I acknowledge establishment is in good standing with Montana MPI and is recommended for selection. Bureau Chief Signature Print Name of Signer:
Date:
Bureau Chief Signature
Print Name of Signer:
Bureau Chief’s Recommendation for Selection
CIS Assigned Establishment Number:
CIS Assigned Establishment Number:
MI-1CIS 4-2022