Ship Sanitation Control Certificate Form

Name of Ship

IMO Number

Flag

Port of Registry

Gross Tonnage

Net Tonnage

Valid Until

Issued At (Port)

Date of Inspection

Inspected By

Areas/Facilities/Equipment Inspected

Evidence Found Indicating Infection or Contamination (if any)

Reasons for Control Measures (if applicable)

Control Measures Applied

Remarks

Place and Date of Issue

Signature