Form FNS-57 "Report of Shipment Received Over, Short and/or Damaged"

Form FNS-57 or the "Report Of Shipment Received Over, Short And/or Damaged" is a form issued by the U.S. Department of Agriculture - Food and Nutrition Service.

The form was last revised in July 1, 2008 and is available for digital filing. Download an up-to-date Form FNS-57 in PDF-format down below or look it up on the U.S. Department of Agriculture - Food and Nutrition Service Forms website.

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Download Form FNS-57 "Report of Shipment Received Over, Short and/or Damaged"

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FORM APPROVED OMB NO. 0584-0293
Expiration Date: 09/30/2016
U.S. DEPARTMENT OF AGRICULTURE- FOOD AND NUTRITION SERVICE
REPORT OF SHIPMENT RECEIVED OVER, SHORT AND/OR DAMAGED
SEE INSTRUCTIONS ON REVERSE
Public reporting burden for this collection of information is estimated to average 5 minutes 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. An agency may not conduct or
sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments
regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture,
Food and Nutrition Services, Office of Research and Analysis (0584-0293), Alexandria, VA 22302. Do not return the completed form to this address.
SECTION A - SHIPMENT IDENTIFICATION AND UNLOADING INFORMATION
3. CONTRACT NO.
4. DESTINATION CITY AND STATE
1. NAME OF COMM ODITY
2. TYPE OF PACK
5. DELIVERY ORDER NO.
7. M ETHOD OF DELIVERY
6. NOTICE TO DELIVER NO.
8. RR CAR, TRUCK, OR PIG NO.
RAIL
TRUCK
PIGGYBACK
10. OCEAN BILL OF LADING NO.
9. UNLOADED
(Overseas Shipment Only)
STARTED (Date and Time)
COMPLETED (Date and Time)
SECTION B - OVERAGE, SHORTAGE, AND/OR DAMAGE
11. QUANTITY
D. SHORT
B. AMOUNT RECEIVED IN GOOD
C. OVER
A. REPORTED SHIPPED
E. DAMAGED
F. HIDDEN DAMAGE
CONDITION
13. CARRIER'S AGENT PRESENT DURING
12A. DAMAGE/OVERAGE/SHORTAGE
12B. HOW DISCOVERED
UNLOADING
WHEN DISCOVERED
DURING
BEFORE
AFTER
UNLOADING
PHYSICAL
OTHER
YES
NO
UNLOADING
UNLOADING
UNLOADING
TALLY
RECOUNT
14. DOOR SEAL NUMBERS
B. OUTBOUND SEAL NUMBERS (If Applicable)
A. INBOUND NUMBERS AND CONDITION OF SEALS
15. CARRIER'S AGENT NOTIFICATION
16. DID CARRIER'S AGENT RESPOND TO NOTIFICATION?
A. NAME OF AGENT
C. HOW NOTIFIED
YES (in what way)
NO (Explain)
IN PERSON
FAX
B. DATE NOTIFIED
TELEPHONE
E-MAIL
17. COMPLETE IF APPLICABLE
A. WAS MECHANICAL REFRIGERATION, EQUIPMENT OPERATING
B. TEMPERATURE OF REFRIGERATION UNIT/INTERIOR TEMP/COMMODITY
YES
NO
CONSIGNEE CERTIFICATION
I CERTIFY the information and statements above are, to the best of my knowledge and belief, true and correct.
DATE
SIGNATURE OF CONSIGNEE OR REPRESENTATIVE
CARRIER CERTIFICATION
Receipt of a copy of this report is hereby acknowledged and the facts contained herein are verified.
SIGNATURE OF CARRIER'S AGENT
NAME AND ADDRESS OF CARRIER
CARRIER REMARKS
DATE
REMARKS (IF DAMAGED, PLEASE INDICATE NATURE AND DISPOSITION OF THE DAMAGE)
SBU
ORIGINAL - Send to Kansas City Commodity Office,
FORM FNS-57 (07/08) Previous editions obsolete
(Include all supporting Documentation)
Electronic Form Version Designed in Adobe 8.1.0 Version
FORM APPROVED OMB NO. 0584-0293
Expiration Date: 09/30/2016
U.S. DEPARTMENT OF AGRICULTURE- FOOD AND NUTRITION SERVICE
REPORT OF SHIPMENT RECEIVED OVER, SHORT AND/OR DAMAGED
SEE INSTRUCTIONS ON REVERSE
Public reporting burden for this collection of information is estimated to average 5 minutes 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. An agency may not conduct or
sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments
regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture,
Food and Nutrition Services, Office of Research and Analysis (0584-0293), Alexandria, VA 22302. Do not return the completed form to this address.
SECTION A - SHIPMENT IDENTIFICATION AND UNLOADING INFORMATION
3. CONTRACT NO.
4. DESTINATION CITY AND STATE
1. NAME OF COMM ODITY
2. TYPE OF PACK
5. DELIVERY ORDER NO.
7. M ETHOD OF DELIVERY
6. NOTICE TO DELIVER NO.
8. RR CAR, TRUCK, OR PIG NO.
RAIL
TRUCK
PIGGYBACK
10. OCEAN BILL OF LADING NO.
9. UNLOADED
(Overseas Shipment Only)
STARTED (Date and Time)
COMPLETED (Date and Time)
SECTION B - OVERAGE, SHORTAGE, AND/OR DAMAGE
11. QUANTITY
D. SHORT
B. AMOUNT RECEIVED IN GOOD
C. OVER
A. REPORTED SHIPPED
E. DAMAGED
F. HIDDEN DAMAGE
CONDITION
13. CARRIER'S AGENT PRESENT DURING
12A. DAMAGE/OVERAGE/SHORTAGE
12B. HOW DISCOVERED
UNLOADING
WHEN DISCOVERED
DURING
BEFORE
AFTER
UNLOADING
PHYSICAL
OTHER
YES
NO
UNLOADING
UNLOADING
UNLOADING
TALLY
RECOUNT
14. DOOR SEAL NUMBERS
B. OUTBOUND SEAL NUMBERS (If Applicable)
A. INBOUND NUMBERS AND CONDITION OF SEALS
15. CARRIER'S AGENT NOTIFICATION
16. DID CARRIER'S AGENT RESPOND TO NOTIFICATION?
A. NAME OF AGENT
C. HOW NOTIFIED
YES (in what way)
NO (Explain)
IN PERSON
FAX
B. DATE NOTIFIED
TELEPHONE
E-MAIL
17. COMPLETE IF APPLICABLE
A. WAS MECHANICAL REFRIGERATION, EQUIPMENT OPERATING
B. TEMPERATURE OF REFRIGERATION UNIT/INTERIOR TEMP/COMMODITY
YES
NO
CONSIGNEE CERTIFICATION
I CERTIFY the information and statements above are, to the best of my knowledge and belief, true and correct.
DATE
SIGNATURE OF CONSIGNEE OR REPRESENTATIVE
CARRIER CERTIFICATION
Receipt of a copy of this report is hereby acknowledged and the facts contained herein are verified.
SIGNATURE OF CARRIER'S AGENT
NAME AND ADDRESS OF CARRIER
CARRIER REMARKS
DATE
REMARKS (IF DAMAGED, PLEASE INDICATE NATURE AND DISPOSITION OF THE DAMAGE)
SBU
ORIGINAL - Send to Kansas City Commodity Office,
FORM FNS-57 (07/08) Previous editions obsolete
(Include all supporting Documentation)
Electronic Form Version Designed in Adobe 8.1.0 Version
INSTRUCTIONS
This report is to be prepared whenever a shipment is
11E. Record the number of units received damaged of the
received over, short, and/or damaged.
quantity reported shipped on the 269A.
SECTION A - SHIPMENT IDENTIFICATION/
11F. Record the number of units received damaged of the
UNLOADING INFORMATION
quantity reported shipped on the 269A.
This section will be completed at all times to identify
12A. Check applicable box.
the shipment being reported as over, short and/or
12B. Show the information that shipment was actually over,
damaged.
short, and/or damaged.
ITEM
13. Check applicable box to show whether or not
carrier's agent was present from time car or truck
1. Self-explanatory.
was opened until unloading was completed.
2. Show type of pack, such as case 6/10' s, case
14A. Record the inbound seal numbers on all doors and the
12/No. 3 cylinders, 50# bag, etc.
condition of the seals. If shipment was made and
3. Self-explanatory.
not sealed, show "no seals."
4. Self-explanatory.
14B. If applicable, intermediate consignees on split ship-
ments shall record the seal numbers placed on all
5. Record Delivery Order No including Commodity
doors.
Code.
15A,B, C. Complete all three items.
6. Record the Notice to Deliver No. show n in the
16. If the " yes" box is checked, explain how the agent
space marked " N/D No." in the upper right on
responded (for example: made personal inspection;
the KCCO 269A.
advised that they would not be available; advised
7. Check applicable box.
consignee's inspection would suffice, etc.)
8. Record railroad car number, truck, or piggyback
If the carrier' s agent did not respond, explain why
number.
(for example: no agent available; refused to
9. Record date and time unloading started, and date
inspect; did not acknowledge, etc.)
and time unloading w as completed.
17A.Check applicable boxes.
10. When applicable, record the ocean bill of lading
number, (For Overseas Shipments ONLY)
17B. Record the temperature of the refrigeration unit
located on the outside of the trailer, interior temp/
SECTION B - OVERAGE, SHORTAGE, AND/
commodity.
OR DAMAGE
When a shipment is received over, short, and/or
CONSIGNEE' S CERTIFICATION
damaged, items 11 through 16 should be completed.
Self-explanatory.
11A. Record the number of units shown on the (KCCO)
CARRIER' S CERTIFICATION
269A, Forwarding Notice.
Request that the carrier' s agent complete these items, if
11B. Record the number of units received.
the agent refuses, and if available, request a copy of the
carriers )S&D report. If the carrier does not have a report
11C. Record the number of units received over the
make the following notation "Agent (insert name of driver)
quantity reported shipped on the 279A.
of (insert name of carrier) did not agree with this report.
The reason for the dispute is (give brief explanation). A
11D. Record the number of units received short of
copy of the report was given to him/her on (insert date)."
the quantity reported shipped on the 269A.
If the carrier's signature cannot be obtained within 10 days
or if the carrier is not avaible, make the following notation
"carrier did not respond" or carrier is not available."
NOTE: Only one form needs to be completed for a consolidation shipment. Make sure all overages, shortages and
damages are fully explained. If necessary please attach a separate sheet. Item 6 - please list the consolidation
number rather than the ND.
COPY 1 - To agent of the delivering carrier.
COPY 2 - For use of the dist ributing agency.
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