U.S. DEPARTMENT OF AGRICULTURE

FEDERAL GRAIN INSPECTION SERVICE

INSPECTION LOG

PAGE OF

NAME OF VESSEL LOCATION

SHIPPING BINS1

LOADING 

STARTED

LOADING 

FINISHED

STOWAGE EXAMINATION

GRADE TO BE LOADED QUANTITY DATE TIME DATE TIME

DESTINATION CERTIFICATION OPTION SAMPLING METHOD SHIP

TYPE OF SAMPLE DELIVERY SYSTEMS PASSED PRIOR 

TO LOADING

BY: AT: ON:

NAME OF SHIPPER/AGENT/ACCOUNT

LOAD ORDER NUMBER

DATE SUBLOT TIMES BINS STOWAGE QUANTITY ODOR

NAME OF INSPECTOR / CODE NO. Average

Rounded

GRADE Form Approved OMB No. 0581-0309. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless 

it displays a valid OMB control number. The valid OMB control number for this information collection is 0581-0309. The time required to complete this information collection is estimated to average 6.66 hours 

per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 

Form FGIS-921 (1/24) (Previous editions are obsolete.) Expires 03-25
U.S. DEPARTMENT OF AGRICULTURE

FEDERAL GRAIN INSPECTION SERVICE

INSPECTION LOG

PAGE OF

NAME OF VESSEL LOCATION

SHIPPING BINS1

LOADING 

STARTED

LOADING 

FINISHED

STOWAGE EXAMINATION

GRADE TO BE LOADED QUANTITY DATE TIME DATE TIME

DESTINATION CERTIFICATION OPTION SAMPLING METHOD SHIP

TYPE OF SAMPLE DELIVERY SYSTEMS PASSED PRIOR 

TO LOADING

BY: AT: ON:

NAME OF SHIPPER/AGENT/ACCOUNT

LOAD ORDER NUMBER

Sublot Notes

General Remarks

SUBLOT NOTIFIED WHEN INSPECTOR SAMPLER

NAME OF INSPECTOR / CODE NO.

GRADE

Form FGIS-921 (1/24) Reverse
U.S. DEPARTMENT OF AGRICULTURE

FEDERAL GRAIN INSPECTION SERVICE

INSPECTION LOG

PAGE OF

NAME OF VESSEL LOCATION

SHIPPING BINS1

LOADING 

STARTED

LOADING 

FINISHED

STOWAGE EXAMINATION

GRADE TO BE LOADED QUANTITY DATE TIME DATE TIME

DESTINATION CERTIFICATION OPTION SAMPLING METHOD SHIP

TYPE OF SAMPLE DELIVERY SYSTEMS PASSED PRIOR 

TO LOADING

BY: AT: ON:

NAME OF SHIPPER/AGENT/ACCOUNT

LOAD ORDER NUMBER

DATE SUBLOT TIMES BINS STOWAGE QUANTITY ODOR

NAME OF INSPECTOR / CODE NO. Average

Rounded

GRADE Form Approved OMB No. 0580-0013. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it 

displays a valid OMB control number. The valid OMB control number for this information collection is 0580-0013. The time required to complete this information collection is estimated to average 6.66 hours per 

response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 

Form FGIS-921 (01/24) Previous versions are obsolete. Expires 03-25

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3 4

5

6

7 8 9 10

11

12

13

14

34

17 18 19 20 21 22 23 24 25

15 16

32

33

35
U.S. DEPARTMENT OF AGRICULTURE

FEDERAL GRAIN INSPECTION SERVICE

INSPECTION LOG

PAGE OF

NAME OF VESSEL LOCATION

SHIPPING BINS1

LOADING 

STARTED

LOADING 

FINISHED

STOWAGE EXAMINATION

GRADE TO BE LOADED QUANTITY DATE TIME DATE TIME

DESTINATION CERTIFICATION OPTION SAMPLING METHOD SHIP

TYPE OF SAMPLE DELIVERY SYSTEMS PASSED PRIOR 

TO LOADING

BY: AT: ON:

NAME OF SHIPPER/AGENT/ACCOUNT

LOAD ORDER NUMBER

Sublot Notes

General Remarks

SUBLOT NOTIFIED WHEN INSPECTOR SAMPLER

NAME OF INSPECTOR / CODE NO.

GRADE

Form FGIS-921 (1/24) Reverse

28 29 26 27 30

31
Instructions for Completng FGIS-921

1. Identification of the grain in terms of name, number, or initials of the carrier(s). Precede the

name of a ship with its means of propulsion (M/T, M/V, S/S, etc.). Barges and other carriers

shall be identified by initials and number or name.

2. Name of the pier, elevator, or other specific location where the grain is sampled. Name of the

city and State where the loading or unloading facility is located.

3. Contract grade along with any special grade or contract requirements.

4. Approximate amount of grain loaded or unloaded in terms of pounds, bushels, short tons, or

metric tons.

5. Destination of the shipment.

6. Load Order Number (Field Office or customer’s).

7. Name of the applicant, agent, or account number.

8. Certification option, (e.g., Option 1 or 2).

9. Enter in the type of sampling device (e.g., diverter, probe, pelican, Ellis cup, or Woodside).

10. Place whether a “Official” or “Official File” sample.

11. Date and military time the elevator (a) begins to preload shipping or surge bin(s), if any, and

(b) begins delivering the grain to the carrier. Enter the date and military time the elevator (a)

finished loading into shipping or surge bin(s), if any, and (b) finished delivering grain to the

carrier.

12. Date, time, and initials of the person(s) who passed the delivery system prior to loading.

13. (a) the identification of the stowage area(s) examined; (b) whether or not the stowage

area(s) was fit to receive grain; (c) the date, time, and examiner’s initials; and (d) if rejected,

the reason(s) why the stowage area was unacceptable.

14. Enter the factor names for the type grain loading and results of any additional factor analysis

(e.g., garlic, ergot, and sprout damage) or other information (e.g., belt numbers, file sample

numbers, etc.) as needed.

15. Grade limit for each factor to be examined.

16. Breakpoint for each factor to be examined and starting value for each factor to be examined

(e.g., “3.0/0.3”).

Date(s) that each sublot is loaded aboard the carrier or into shipping bin(s) whichever is

earliest.

17. Date (s) that each sublot is loaded aboard the carrier or into shipping bin (s), whichever is

earliest.

18. Each sublot number.

19. Military time that each sublot started and finished being loaded aboard the carrier or into shipping

bin(s), enter like this “1103/1145”.

20. Identification of the shipping bin(s) that comprises each sublot. (Shipping bin facilities only.)

21. Stowage area(s) for each sublot. If additional space is needed, use the “Remarks” section. (See

item 36 .)

22. Weight of each sublot in pounds, unless in Canada.

23. Odor of each sublot as OK, SOUR, MUSTY, or COFO.

24. Factor results for each sublot.

25. Cu-Sum for each sublot.

(Reverse side of form)

26. Name(s) of the inspector(s) grading each sublot.

27. Name(s) of the sampler(s) sampling each sublot.

28. Name of the elevator superintendent, applicant for inspection, or representative notified of each

sublot’s results.

29. Military time that the person in item 28 was notified.

30. Notes which pertain to this sublot or sample only.

31. General remarks or notes for loading history of vessel. The final stowage statement for the

vessel, grain quality improvement act checks, buyer requests etc. placed here.

NOTE: If the lot is completed in the available space on file of the FGIS-921, complete items 32 

through 35. Otherwise, complete as many sheets of this form as necessary.

(Front side of form)

32. Mathematical or weighed average to the hundredth place for each factor.

33. Rounded and adjusted averages, if applicable, for each factor as they will appear on the official

certificate.

34. Name(s) and code number(s) of the inspection personnel who assigned the final grade.

35. Final grade as it will appear on the official certificate.
FORM FGIS-921, INSPECTION LOG

An inspection log provides a record of sampling, inspection, and significant or unusual events occurring during the loading or unloading of grain offered for inspection as a shiplot, unit train lot, lash barge lot, 

or combined lot. Inspection logs are the source document for preparing official certificates and any other report used to document the loading of the lot.

Record shiplot, unit train lot, lash barge lot, and combined-lot inspection information on Form FGIS-921, “Inspection Log,” and, if necessary, print additional pages of this sheet for continuation of the loading. 

Inspection logs are used to record information obtained from original inspections, reinspections, or appeal inspections performed on samples drawn during loading or unloading or on the basis of file samples. 

Use of an inspection log does not preclude the use or maintenance of other records (e.g., sample tickets).

The FGIS field office or official agency conducting the inspection shall retain the original copy of the form. If the inspection is conducted by an official agency, one copy shall be sent to the supervising field 

office. If requested, one or more copies shall be given to the applicant or to an interested person.

CONTACT INFORMATION: 

Contact the field office responsible for the geographic area in which the service will be provided. Details for these locations can be found at FGIS Field Offices.

The signed form should also be mailed to this location. 

For further information on the Warehouse Sample-Lot Inspection Service Contract contact:

Field Management Division 

Policy, Procedures, and Market Analysis Branch 

FGISPoliciesProceduresMarketAnalysisBranch@usda.gov