Ship Sanitation Declaration

Name of Ship: Flag: Port of Arrival: Arrived from (port): Date of Arrival: Gross Tonnage: Net Tonnage: Agent: Last port and date of departure:

Ship Sanitation Control Exemption/Ship Sanitation Control Certificate

Date and place of issue: Issued by: Expires on:

Questions (answered by the Master of the ship)

No.	Question	Yes	No	Details (if “yes”)
1	Has there been a case of illness or death on board during the voyage?
2	Any evidence of infection/contamination?
3	Are vectors of disease present or suspected on board?
4	Is sanitary condition of ship satisfactory?

Date: Name and signature of Master:

For Official Use Only

Ship Sanitation Control Certificate/Exemption granted/refused (strike out which not applicable). Comments: Inspected by (name and signature): Date: