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1.maritime Declaration of Health
1.maritime Declaration of Health
(To be rendered by the masters of ships arriving from ports outside the territory)
2 Has Plague occurred or been suspected among the rats or mice on board during
the voyage * or has been an abnormal mortality among them? NO
3 Has any person died on board during the voyage * otherwise than as a result of
an accident? NO
4 Is there on board or has there been during the voyage *any case of disease
which you suspect to be of an infectious nature? Give me particulars in Schedule NO
6 Are you aware of any other condition on board which may lead to infection
or the spread of a disease? NO
7 Has any sanitary measure (e.q. quarantine, isolation, desinfection or
decontamination) been applied on board? NO
Note.- In the absence of surgeon, the Master should regard the following symptoms as
ground for suspecting the existence of disease of an infections nature
(a) fever, persisting for several days or accompanied by (i) prostration; (ii) decreased
consciousness; (iii) glandular swelling; (iv) juandice; (v) cough or shortness of breath;
(vi) unusual bleeding; or (vii) paralysis.
(b) with or without fever; (i) any acute skin rash or eruption, (ii) severe vomiting
(other than sea sickness); (iii) severe diarrhoea; or (iv) recurrent convulsions.
I hereby declare that the particulars and answers to the questions given in this Declaration of Health
(including the Schedule are true and correct to the best of my knowledge and belief.)
Signed :
Capt. LOBOV, Vladimir
Counter signed : N/A
Date 03-Mar-24 Ship's Surgeon
* If more than four weeks have elapsed since the voyage began, it will suffice to give particulars for the last four weeks.