1. Have you visited any countries in the last 14 days ?
2. Has anyone crew/passengers away onboard during the voyage not due to an accident?
3. During the voyage, were any crew/passengers members evacuated due to illness or passing away?
4. Were there any suspected cases of contagious diseases onboard during the voyage?
5. Was there any crew/passengers member with a body temperature equal to or greater than 37.5°C (fever, decreased consciousness, swollen glands, yellowing of the skin, cough or shortness of breath, unusual bleeding, paralysis, acute skin rash or blistering, severe vomiting, severe diarrhea, repeated seizures, food poisoning)?
6. Was the number of sick crew/passengers members during the voyage greater than usual/estimated?
7. Is there any crew/passengers ill onboard now??
8. If there is a sick crew/passengers, have you consulted a physician?
9. Are you aware of any conditions inside the ship that could lead to infection or spread of disease?
10. Is food processing and storage carried out properly and hygienically?
11. Are spoiled/expired food items separated?
12. Has the supply of clean water been inspected and certified?
13. Is the water being used odorless, tasteless, and colorless?
14. Are the trash bins always covered?
15. Is hazardous waste on the ship managed properly?
16. Are there any rats/cockroaches/other disease-carrying animals on the ship?
17. Have sanitation measures (such as quarantine, isolation, pest control, or decontamination) been conducted on the ship for the last month?
18. Are there any stowaways/crew members not listed on the crew list?
19. Are there any sick animals or pets on the ship?
1. Maritime Declaration of Health in line with the actual conditions on the ship.
2. Sanitation Certificate document available and still valid?
3. First Aid Kit/Medication Certificate available and still valid?
4. Health Book available.
5. There is the last port clearance from the previous port.
6. Do the ship's crew members have Vaccination Documents and still valid?
7. Crew list with body temperature measurement results available.
I, Captain of the Ship: [Ship Name], declare that the above entries are in accordance with the actual conditions on the ship [Ship Name]. If there are any difference, I am responsible according to the applicable regulations in Indonesia.