Continuation of the annex 6
Category Name Note
C Management plan for
Other vector control
management Medical log
plans c oncerning
onboard hygiene IMO ballast water
reporting form
Ballast Water Manage- http://www.imo.org/about/conventions/listofconventions/
ment Certificate pages/international-convention-for-the-control-and-mana-
gement-of-ships'-ballast-water-and-sediments-(bwm).aspx
Ballast-water record http://www.imo.org/about/conventions/listofconventions/
book pages/international-convention-for-the-control-and-mana-
gement-of-ships'-ballast-water-and-sediments-(bwm).aspx
Other
ภาคผนวก
140
300 คู่มือการตรวจและการออกเอกสารรบั รองสุขาภิบาลเรือ
Handbook for Inspection of Ships and Issuance of Ship Sanitation Certificates
Annex 7 Evidence Report Form
Table A7.1 is a sample of an Evidence Report Form. This form lists the evidence found,
samples and documents reviewed, and control measures or corrective actions to be
performed after a ship inspection, and supports the ship sanitation certificate (SSC).
When attached to the SSC, each page of this attachment needs to be signed, stamped
and dated by the issuing authority. If this form is used as an attachment to a pre-
existing SSC, this attachment must be noted in the SSC (e.g. by using a stamp).
Table A7.1
Sample Evidence Report Form
Evidence Report Form
This form supports the ship sanitation certificate (SSC), and provides a list of evidence found and control measures to be perfor-
med.
When attached to the SSC, each page of this attachment needs to be signed, stamped and dated by the competent authority. If this
document is used as an attachment to a pre-existing SSC, this attachment must be noted in the SSC (e.g. by using a stamp).
Ship’s name and IMO no. or registration: Name and signature of responsible onboard ship officer :
Name of issuing authority: Actual inspection date (dd/mm/yyyy):
Date of referred SSC (dd/mm/yyyy): SSC issued in the port of:
Indicate areas that have not been inspected:
o Quarters o Galley, pantry, service area o Stores o Child-care facilities
o Medical care facilities o Swimming pools/spas o Solid and medical waste o Engine room
o Potable water o Sewage o Ballast water o Cargo holds
o Other (e.g. laundry and washing machine)
Detected heath events on board o yes o No
evidence code
required
recommended
Evidence found Measure to be applied Measure
(brief description according to successfully
WHO checklist; draw a line under performed (stamp
each item of evidence to ensure and signature
items are clearly separated) of re-inspecting
authority)
ภาคผนวก
Name of issuing inspector: Signature of issuing inspector: Stamp of issuing authority: Page...........................................
of...........................................
IMO, International Maritime Organization; SSC, ship sanitation certificate; WHO, World Health Organization.
141
คมู่ ือการตรวจและการออกเอกสารรับรองสขุ าภบิ าลเรอื 301
Handbook for Inspection of Ships and Issuance of Ship Sanitation Certificates
Annex 8 Instructions for completing the Evidence Report Form
1. At the top of the form, the following information should be documented:
• ship name and International Marine Organization (IMO) or registration number
• name and signature of the responsible ship officer
• name of issuing authority
• date of actual inspection
• date of the ship sanitation certificate (SSC) that the Evidence Report Form refers to
• port where the SSC was issued.
2. The areas that have not been inspected are indicated by the checklist.
3. Further information in the form:
1st column, Evidence code Code of evidence as described in the
2nd column, Evidence found checklist
3rd column, Measures to be applied
Brief description of the evidence found
4th column, Required based on the checklist
5th column, Recommended
Description of the control measure(s) that
should be applied (use simple words as in
checklist)
Note an “X” here if the measure should be a
“requirement”
Note an “X” here if the measure should be a
“recommendation”
6th column, Measures successfully performed This column is reserved for the re-inspec-
ting authority. Only successfully performed
measures should be stamped and signed
by the re-inspecting issuing authority. If no
stamp or signature is applied, the success
of the measure should be verified in a new
inspection. To differentiate between each
piece of evidence and the corresponding
measures, horizontal lines should be drawn
to separate different evidence.
ภาคผนวก At the bottom of each page of the form, the name and signature of the inspecting officer, the
stamp of the issuing authority, the page number and any comments should be noted.
302 1ค4่มู 2อื การตรวจและการออกเอกสารรบั รองสุขาภิบาลเรือ
Handbook for Inspection of Ships and Issuance of Ship Sanitation Certificates
references and resources ภาคผนวก
CAC (Codex Alimentarius Commission) (2003)., Recommended international code of practice—
general principles of food hygiene (incorporates Hazard Analysis and Critical Control point
[HACCP] system and guidelines for its application), CAC/RCP 1-1969, Rev. 4-2003. Rome, CAC.
CAC (Codex Alimentarius Commission) (2004).Code of hygienic practice for milk and milk
products, CAC/RCP 57. Rome, CAC.
CDC (Centers for Disease Control and Prevention). Vessel Sanitation Program. National Center
for Environmental Health. Atlanta, CDC
(http://www.cdc.gov/nceh/vsp).
Helsinki Commission (1990). HELCOM Recommendation 11/10: Guidelines for capacity
calculation of sewage system on board passenger ships. Helsinki, Helsinki Commission.
ILO (International Labour Organization) (2006). Maritime Labour Convention 2006. Geneva, ILO.
IMO (International Maritime Organization) (1978). Annex IV: Prevention of pollution by sewage
from ships and corresponding resolutions MEPC.2(VI) and MEPC.115(51). In: International
Convention for the Prevention of Pollution from Ships 1973 (amended 1978) (MARPOL 73/78).
London, IMO.
IMO (International Maritime Organization) (1978). Annex V: Prevention of pollution by garbage
from ships. In: International Convention for the Prevention of Pollution from Ships 1973
(amended 1978) (MARPOL 73/78). London, IMO.
IMO (International Maritime Organization) (1982). Medical first aid guide for use in accidents
involving dangerous goods (MFAG). London, IMO.
IMO (International Maritime Organization) (1995). Emergency, occupational safety, medical
care and survival functions. In: International Convention on Standards, Certification and
Watchkeeping for Seafarers 1978 (amended 1995). London, IMO.
IMO (International Maritime Organization) (1996). Resolution MEPC.70(38) Guidelines for the
development of garbage management plans. London, IMO.
IMO (International Maritime Organization) (1997). Resolution A.868(20) Guidelines for the control
and management of ships’ ballast water to minimize the transfer of harmful aquatic organisms
and pathogens. London, IMO.
IMO (International Maritime Organization) (1997). Resolution MEPC.76(40) Standard
specification for shipboard incinerators. London, IMO.
IMO (International Maritime Organization) (2000). Guidelines for ensuring the adequacy of port
waste reception facilities. London, IMO.
IMO (International Maritime Organization) (2004). International Convention for the Control and
Management of Ships’ Ballast Water and Sediments. London, IMO.
IMO (International Maritime Organization) (2006). Annex 5: Certificates and documents required
to be carried on board ships. In: Convention on Facilitation of International Maritime Traffic 1965
(2006 ed.). London, IMO.
IMO (International Maritime Organization) (2008). Guidelines for the uniform implementation of
the BWM convention. London, IMO.
คู่มือการตรวจและการออกเอกสารรับรองสุขาภิบา1ล4เร3ือ 303
Handbook for Inspection of Ships and Issuance of Ship Sanitation Certificates
ISO (International Organization of Standardization) (2002). ISO 15748-1:2002 Ships and marine
technology—potable water supply on ships and marine structures. Geneva, ISO.
ISO (International Organization of Standardization) (2006). ISO 19458:2006 Water quality—
sampling for microbiological analysis. Geneva, ISO.
ISO (International Organization of Standardization) (2008). ISO 14726:2008 Ships and marine
technology—identification colours for the content of piping systems. Geneva, ISO.
ISO (International Organization of Standardization), IEC (International Electrotechnical
Commission) (2005). ISO/IEC 17025:2005 General requirements for the competence of testing
and calibration laboratories. Geneva, ISO/IEC.
WHO (World Health Organization) (1999). Safe management of wastes from health-care
activities. Geneva, WHO.
WHO (World Health Organization) (2007). International medical guide for ships, 3rd ed. Geneva,
WHO.
WHO (World Health Organization) (2008). Guidelines for drinking-water quality. Geneva, WHO.
WHO (World Health Organization) (2011). Guide to ship sanitation, 3rd ed. Geneva, WHO.
ภาคผนวก
304 คมู่ 1อื 4ก4ารตรวจและการออกเอกสารรับรองสขุ าภิบาลเรอื
Handbook for Inspection of Ships and Issuance of Ship Sanitation Certificates
กรมควบคุมโรค
Department of Disease Control