Ship Sanitation Exemption Certificate
Issued to (vessel name):
IMO Number:
Call Sign:
Flag:
Port of Registry:
Gross Tonnage:
Voyage (from - to):
Inspection Information
Date of Inspection:
Place of Inspection:
Reason for Inspection:
Findings
Area Inspected
Result/Remark
Water Supply
Food Stores
Galley
Accommodation
Medical Facilities
Hold(s)/Cargo
Machinery Spaces
Other
Evidence of infection or contamination found:
Rodents or vectors found:
Control measures required:
Conclusion:
This is to certify that a thorough inspection was made and that the above vessel is exempt from control measures at the time of inspection.
Date of Issue:
Authorized Officer (Name, Signature, Official Stamp):