Maritime Sanitation Control Self-Declaration

Vessel Information

Name of Vessel IMO Number Flag State Voyage (From - To) Last Port of Call Date of Arrival

Sanitation Control Details

Area/Item	Status	Comments
Potable Water Quality
Food Sanitation
Solid Waste Management
Wastewater/ Sewage
Vector Control Measures
Medical Facilities

Additional Remarks

Declaration

Name and Title of Declarant Date Signature