Ship Sanitation Control Exemption Certificate

Issued at (Port)
Date
Certificate No.
This is to certify that the vessel described below was inspected in accordance with the requirements of the International Health Regulations (IHR 2005).
Name of vessel
Registration/IMO number
Flag
Type of vessel
Gross Tonnage
Call Sign
Voyage From
To
Last Port of Call
Sanitary Conditions Found
Area/Item Findings Status (Satisfactory/Unsatisfactory) Remarks
Cargo Holds
Ship's Quarters
Galley
Water Supply
Other
Vectors of Diseases Investigated
Status of Control Measures
Additional Comments/Observations
This is to certify that the ship is exempted from control measures in accordance with the International Health Regulations (IHR 2005) for the period of validity of this Certificate.
Signature and seal of the competent authority
Date of Issue
This certificate is valid until: