Handbook for Inspection of Ships & Ship Sanitation Certificate PDF

Part A: Inspection system requirements 19 Part A: Inspection system requirements 1. Overview of legal and policy framework When the International Health Regulations (IHR) (2005) came into force on 15 June 2007, competent authorities could require from international ships the I...

Part A: Inspection system requirements 19 Part A: Inspection system requirements 1. Overview of legal and policy framework When the International Health Regulations (IHR) (2005) came into force on 15 June 2007, competent authorities could require from international ships the IHR model ship sanitation certificate (SSC) (IHR Annex 3), which covers public health risks on board, and the necessary inspections and control measures taken in accordance with the IHR (2005). Competent authorities are required to use the Annex 3 SSC to identify and re- cord all evidence of contamination or infection and other risks to human health in diffe- rent areas, facilities or systems, together with any required control measures that must be applied (as authorized by the IHR) to control public health risks1. The SSCs may be required from all ships, whether seagoing or inland navigation ships, on international voyages that call at a port of a State Party. According to the IHR (2005), States Parties authorize certain ports to inspect ships and issue the certificates (or their extensions) and to provide related services and control measures, as referred to in Article 20.3 and Annex 1 of the IHR (2005). Any port authorized to issue the Ship Sanitation Control Certificate (SSCC) must have the capability to inspect ships, issue certificates and implement (or supervise the implementation of) necessary health control measures. States Parties can also authorize ports to issue the Ship Sanitation Control Exemption Certificate (SSCEC) or to grant extensions of up to one month to conveyance operators, if they are unable to carry out the necessary measures at the port in question. The IHR (2005) requires States Parties to ensure that all SSCs are issued according to IHR Article 39 and Annex 3. The States Parties must also send to the World Health Organization (WHO) the list of their ports authorized to: issue SSCCs and provide the related services referred to in IHR (2005) Annex 3 (Requirements for the SSC) and Annex 1B (Core capacity requirements for designa- ted ports); issue SSCECs only, and extend a valid SSCEC or SSCC for one month until the ship arrives in a port at which the certificate may be issued. Each State Party must inform WHO of any changes that occur in the status of the lis- ted ports. WHO publishes and updates a list of these authorized ports, with related information. This list is available on the WHO (IHR 2005) website (http://www.who.int/ ihr/ports_airports/en). According to the IHR (2005), the SSCs of each State Party must conform to the IHR model SSC in Annex 3. The use of the model certificate facilitates the international movement of shipping, minimizes unnecessary delays, helps to standardize the ins- pection process, and allows uniform and easily recognizable communication of risks. Certificates must have correct formatting and content as specified in the IHR (2005); 1. According to the IHR (2005), “public health risk” is defined as “a likelihood of an event that may affect adversely the health of human populations, with an emphasis on one which may spread internationally or may present a serious and direct danger”. This central concept underpins these guidelines and, together with other definitions, is important in understanding how the inspection process described here achieves the IHR (2005) goals. 20  Part A: Inspection system requirements certificates that do not conform to the model may be viewed by other competent authorities as invalid or may be invalid according to the IHR (2005). Use of the template does not impose any obligation on the ship, other than those prescribed by the IHR (2005). SSCs may be used as international communication tools and will usually be delivered in countries (or, sometimes, regions) other than the place of issue. Therefore, States Parties should usually issue and complete the certificates in English or in French. 2. Roles and responsibilities States Parties shall take all practical measures consistent with the IHR (2005) to ensure that conveyance operators permanently keep conveyances for which they are respon- sible free from infection or contamination, including vectors and vector reservoirs (IHR Article 24). The application of control measures may be required if evidence of sources of infection or contamination is found. These measures may be carried out by the conveyance operator (either by the crew or by a private company under contract) or by the competent authority. The control measures applied should always be agreed upon and supervised by the competent authority (usually the port health authority). The SSCs are designed to identify, assess and record any public health risks, and the consequent control measures that should be taken, while ships are in port. Public health risks are identified by epidemiological evidence, direct observation or measure- ment (or any combination of these). The competent authority should evaluate the risk in terms of the epidemiological situation and the severity of the risk. Control measures shall be applied at the point of entry, according to the conditions specified by the IHR (2005). If clinical signs or symptoms of illness or disease and factual evidence of a public health risk (including sources of infection and contamination) are found on board a ship on an international voyage, the competent authority shall consider the ship as affected and may: (a) disinfect, decontaminate, disinsect or derat the conveyance, as appropriate, or cause these measures to be carried out under its supervision; and (b) decide in each case the technique employed to secure an adequate level of control of the public health risk as provided in these regulations. Where there are methods or materials advised by WHO for these procedures, these should be em- ployed, unless the competent authority determines that other methods are as safe and reliable (IHR Article 27.1). If the competent authority for the points of entry is not able to carry out the control measures required under IHR Article 27, the ship may nevertheless be allowed to de- part, subject to the following conditions: (a) the competent authority shall, at the time of departure, inform the competent authority of the next known port of entry of the type of information referred to under subparagraph (b); and 21 Part A: Inspection system requirements (b) in the case of a ship, the evidence found and the control measures shall be noted in the SSCC (IHR Article 27.2). Therefore, ports should have the capacity to support the control measures adopted to prevent the spread of disease and disease agents. Such measures include cleaning, disinfection, decontamination, deratting and disinsection. A port on the WHO list of ports authorized to issue SSCs should also have available trained personnel who can board ships, identify any significant risks to public health and take appropriate control measures. Thus, States should have nationally recogni- zed training and competency requirements for public health or environmental health officers assigned to issue SSCs. Subject to IHR (2005) Article 43, or as provided in applicable international agreements, ships shall not be refused free pratique by States Parties for public health reasons. In particular, they shall not be prevented from embarking or disembarking; discharging or loading cargo or stores; or taking on fuel, water, food and supplies. States Parties may subject the granting of free pratique to inspection and, if a source of infection or contamination is found on board, the carrying out of necessary disinfection, deconta- mination, disinsection or deratting, or other measures necessary to prevent the spread of the infection or contamination (IHR Article 28). If the public health risk appears significant or if evidence of potential international spread of disease exists, the National IHR Focal Point and community-level health authorities should be alerted immediately by the competent authority. 2.1 Role of Competent Authority The competent authority responsible for the implementation and application of health measures at points of entry is required, according to the IHR (2005) (Article 22), to: be responsible for monitoring baggage, cargo, containers, conveyances, goods, postal parcels and human remains departing and arriving from affected areas, so that they are maintained in such a condition that they are free from sources of infection or contamination, including vectors and reservoirs; ensure, as far as practicable, that facilities used by travellers at points of entry are maintained in a sanitary condition and are kept free from sources of infection or conta- mination, including vectors and reservoirs; be responsible for supervising any deratting, disinfection, disinsection or decontami- nation of baggage, cargo, containers, conveyances, goods, postal parcels and human remains, or sanitary measures for persons, as appropriate under these regulations; advise conveyance operators, as far in advance as possible, of their intent to apply control measures to a conveyance, and shall provide, where available, written informa- tion concerning the methods to be employed; be responsible for supervising the removal and safe disposal of any contaminated water or food, human or animal dejecta, wastewater and any other contaminated mat- ter from a conveyance; 22  Part A: Inspection system requirements take all practicable measures consistent with these regulations to monitor and control the discharge by ships of sewage, refuse, ballast water and other potentially disease- causing matter that might contaminate the waters of a port, river, canal, strait, lake or other international waterway; be responsible for supervising service providers for services concerning travellers, baggage, cargo, containers, conveyances, goods, postal parcels and human remains at points of entry, including the conduct of inspections and medical examinations as necessary; have effective contingency arrangements to deal with an unexpected public health event; communicate with the National IHR Focal Point on the relevant public health measures taken pursuant to these regulations. 2.2 Role of conveyance operators According to the IHR (2005) (Article 24), States Parties must take all practicable measures consistent with the IHR to ensure that conveyance operators: comply with the health measures recommended by WHO and adopted by the State Party; inform travellers of the health measures recommended by WHO and adopted by the State Party for application on board; permanently keep conveyances for which they are responsible free from sources of infection or contamination, including vectors and reservoirs. The application of measures to control sources of infection and contamination may be required if evidence is found. The ship’s master must ensure that any cases of illness that are indicative of an infec- tious disease or evidence of a public health risk on board are relayed to the competent authority at port on arrival, as required by Article 28 and Annex 3. The IHR (2005) (Annex 4) also requires that conveyance operators shall facilitate: inspections of the cargo, containers and conveyance; medical examinations of persons on board; application of other health measures under these regulations; provision of relevant public health information requested by the State Party. Conveyance operators shall also provide to the competent authority a valid SSCEC or SSCC and a Maritime Declaration of Health (IHR Articles 37 and 39; Annexes 3, 4 and 8). With regard to vector-borne diseases, the IHR (2005) Annex 5 provides specific measures applicable to conveyances and conveyance operators. 23 Part A: Inspection system requirements 2.3 Role of inspecting officers The role of the competent authority is to inspect areas, systems and services on board; verify the practical implementation of these systems and services; ascertain the sanita- ry condition of areas inspected; and recommend corrective actions or require measu- res to be taken when and where applicable. Any control measures required should be noted on the Evidence Report Form (see Annex 7) and will lead to the issue ance of an SSCC. The IHR (2005) Annex 3 identifies areas, systems and services to be inspected on a conveyance. The IHR (2005) Annex 1 requires that States Parties should provide trained personnel at points of entry to inspect conveyances, to conduct inspection program- mes and to ensure a safe environment for travellers using port facilities, as appropriate. In order to perform these duties, inspecting officers should demonstrate competency in the following areas before being assigned to inspection duties: Assessment of public health risks (including the effectiveness of systems implemen- ted to control risks) by direct observation and by measurement with testing and sam- pling equipment. The assessment should be based on the information received from conveyance operators, agents or the ship’s master, such as information from the Ma- ritime Declaration of Health2; communications to port before a ship’s arrival about public health events on board (IHR Article 28); traveller information; the disease status at port of origin, in transit and at the port of entry; and the application of perso- nal protective techniques and related equipment. An understanding of the manner in which public health risks from microbiological, chemical and radiological agents affect human health and can be transmitted to in- dividuals via other individuals, food, air, water, waste, vectors, fomites and the en- vironment; appropriate measures to restrict radiation exposure to levels as low as reasonably practicable, if radiation risks are identified; and the protocol for seeking professional help for management of radiation risks and their effects. Use of operational procedures for notification, assessment and response, equip- ment and medicines; knowledge of environmental requirements relating to the size and type of conveyance; and knowledge of related, applicable guidelines (e.g. WHO, International Labour Organization [ILO], International Maritime Organization [IMO]). 3. Pre-inspection planning and administrative arrangements for issuing ship sanitation certificates Before establishing an inspection programme, the inspection procedures and the administrative arrangements necessary for inspections and the issue of certificates should be in place. 2. The ship’s master must ascertain the health status on board before arrival at port. The master must also deliver to the competent authority a complete Maritime Declaration of Health, which should be countersigned by the ship’s surgeon (if one is on board), unless the competent authority does not require a declaration (include Article 37 and Annex 8; see WHO interim technical advice for case management of pandemics [H1N1] on ships). 24  Part A: Inspection system requirements 3.1 General preparation and administrative arrangements for inspection of ships and issue of ship sanitation certificates 3.1.1 Communication Develop procedures for notification, assessment and response with regard to public health events on board (e.g. disease outbreaks, sources of infection and contamina- tion, incidents and emergencies). Establish and maintain communication, reporting and tracking systems, in coopera- tion with other key agencies and departments such as the National IHR Focal Point and the national health surveillance system. Maintain an up-to-date, easily accessible list of ports authorized to issue SSCs; in- clude an up-to-date list of contact details for the ports. Ensure that inspectors are capable of clear communication with ships’ operators or agents and their crews. Determine and disseminate the correct information for communication to the com- petent authority, the conveyances and their operators or agents. Assess the volume, frequency and type of ship arrivals. 3.1.2 Training Develop and implement plans that identify training needs, qualification requirements and competency criteria. Ensure that inspectors can issue SSCs, including in English Familiarize inspectors with the checklists in this document. Familiarize inspectors with all necessary procedures for inspecting ships and issuing SSCs. Ensure that inspectors demonstrate appropriate knowledge of the types of certificates defined in this document and of the legal text of the IHR (2005). Train inspectors in the likely flow of inspections, according to the size and type of ships. 3.1.3 Equipment Ensure that the tools and equipment necessary for inspection and control measures, including personal protective equipment (PPE) and sampling equipment, are always available and in a good condition (see list of PPE and recommended equipment in Annexes 4 and 5). Ensure that the correct forms, the unique seals or stamps to authenticate certificates, and other administrative supplies are accessible and in good condition. 3.1.4 Administration Develop and implement a high-quality management scheme for monitoring, auditing and assessing the outcomes of inspections. Develop and implement a system for the administrative control and record manage- ment of issued SSCs; for example, establish and maintain a file system or secure database of inspections performed and certificates issued. The system should be able to identify previous deficiencies. 25 Part A: Inspection system requirements Establish a system for collecting the agreed inspection fees. Identify the port areas required for the safe inspection of ships; the adoption of control measures, when applicable; and the facilities and services as listed in IHR (2005) Annex 1B. 3.2 Planning for on-site inspection Request and record the pre-arrival information supplied by the ship’s operator or agent (i.e. confirm time of arrival, berth, request for inspection, previous and next port, health status on board, identity and contact details of conveyance operator or agent). Based on the received information, perform an assessment of public health risks; assemble the personnel and equipment necessary for the individual inspection. Prepare easy-to-understand information about the inspection procedures in a form that can be transmitted to the ship in advance (e.g. a leaflet). For unannounced inspec- tions, this information should not be transmitted in advance. The information should contain: - a list of the documents required for inspection; - advice that a contact person must be available on board; - advice that all areas must be accessible for inspection, in order that the inspection proceeds unhindered. 4. Measures and operational procedures for ship inspection and the issue of ship sanitation certificates Inspections are designed to confirm that ships are operating in accordance with ap- propriate practices for assessment and control of health risks on board. An inspection provides a snapshot of a ship’s operations and the manner in which its systems are implemented and maintained. The inspecting officer should typically identify risks that arise from the activities on the ship, and the effectiveness of the ship’s own assessment of risks and control measures. Both the quality of operating procedures and the extent of their implementation should be assessed. Specifically, the inspection should determine whether the ship’s operator and/or master have iden- tified relevant hazards, assessed health risks and identified suitable control measures to effectively manage those risks. With regard to the issue of SSCs, a port should have appropriately trained personnel available to board a ship, identify any significant public health risks and order control measures. Before boarding, inspectors need to comply with all necessary adminis- trative and technical procedures to ensure efficient and safe access to the ship. They should also follow procedures to ensure a reasonable level of safety while the ship is in dock, when boarding and during onboard inspections. If a new certificate is to be issued, all areas must be inspected. The areas must be in a condition that prevents cross-contamination by the inspection process (e.g. as descri- bed in Annex 3). 26  Part A: Inspection system requirements Before an inspection begins, the ship’s master should, if possible, be informed of the purpose of the inspection, be advised to prepare all the required documentation and be instructed to provide a contact person on board to facilitate the inspection. An inspection usually includes a preliminary discussion with the ship’s operator or agent and the master on matters relating to the ship’s sanitation systems and procedu- res. Additionally, the relevant documentation sent to the master or representative by the competent authority before the inspection should be reviewed. If a ship’s risk assessment and risk management systems are unsatisfactory, evidence of implementation is inadequate, or unforeseen potential hazards are identified, the inspection officer should discuss these matters with the master at the conclusion of the visit. The discussion may include previous inspection reports, relevant current docu- mentation and all food- and water-related activities undertaken on the ship. Subsequently, a summary of the matters that do not comply with this document or with other associated technical documents (e.g. the WHO Guide to ship sanitation) should be confirmed in writing by the officer on the Evidence Report Form (see Annex 7). The officer should also note the relevant advice given, including an expected timeframe for any corrective action. If control measures are noted on the existing SSCC or on an existing Evidence Report Form (see Annex 7), the inspection shall verify that these measures have been succes- sfully implemented. If the conditions under which the inspection and/or control measures are performed are incompatible with obtaining satisfactory results, the competent authority shall make a note to that effect on the SSCC. 4.1 Documentation review For inspection purposes, information on the ship, its cargo and possible public health risks is needed, but the requested information and documents from conveyance ope- rators need to be public health information necessary for these public health purpo- ses. With regard to health documents, the practice should follow the requirements in the IHR (2005) and documents listed in other international agreements, such as IMO conventions that relate to environmental protection and sanitation in general (e.g. the International Convention for the Prevention of Pollution from Ships 1973, as modified by the 1978 protocol [MARPOL]; and the Convention on Facilitation of International Maritime Traffic 1965, as amended 2006). To help the ship’s master prepare for the inspection, a list of all required documents should be sent in advance by the national authority (e.g. to the maritime agent) before the port health officer boards the ship for inspection. 27 Part A: Inspection system requirements The Maritime Declaration of Health (see model provided in IHR Annex 8) contains basic data relating to the state of health of crew and passengers during the voyage and on arrival at the port, and provides valuable information on: identification of the ship; ports of call within past 30 days (to be listed); all crew members and travellers within past 30 days (to be listed); validity of the existing SSC and whether re-inspection is required; affected areas visited. The SSC (see model provided in IHR Annex 3) identifies all areas of public health risks and any required control measures to be applied. The International Certificate of Vaccination or Prophylaxis (see model provided in IHR Annex 6) verifies that crew members and passengers have been vaccinated ac- cording to entry requirements. The following documents, according to the document list in the Convention on Facili- tation of International Maritime Traffic 1965 (as amended 2006), may be requested by the competent authority to assess public health risk: a General Declaration, to ascertain the ship’s name, type and flag State; it also pro- vides valuable information on the ship’s requirements in terms of waste and residues, reception facilities and brief particulars of voyage; a Cargo Declaration and Ship’s Stores Declaration, for information on the cargo (e.g. port of loading and discharge, description of goods); a Dangerous Goods Manifest, which details information on dangerous goods (e.g. subsidiary risk(s), mass, stowage position on board). The following additional sources of information may be required, if appropriate, for assessment of public health risk: management plans concerning, for example, water bunkering, food safety, pest control, sewage or waste; an IMO Ballast Water Reporting Form; a medical log, for information on incidents on board the ship that may constitute health events under the IHR (2005); a list of medicines, providing information on the kinds and amounts of medicines carried in the medical chest; a Potable Water Analysis Report, which provides the results of any microbiological examinations or chemical analyses of potable water on board. The competent authority should develop protocols and procedures for the transmis- sion of pre-arrival and pre-departure information, to effectively process the required information. 4.2 Inspection process Inspection is undertaken by observing areas of the ship. When a ship requests a new certificate, all areas as listed in this document (see Annex 3) should be inspected. The main purpose of the inspection is to confirm that all points of control have been cor- rectly identified, and that any appropriate control measures have been implemented or corrective actions taken. 28  Part A: Inspection system requirements While performing inspections on board or in port areas, inspectors must wear appropriate identification, clothing and PPE, including, but not limited to, life jackets, safety helmets, safety boots, high-visibility clothing, respiratory and noise (ear) protection, rubber glo- ves, protection goggles, face masks (FFP3) and single-use overalls, as required. Previous identification and security clearance of port authorities and ship operators should be granted before starting the inspection. Generally, the inspector starts the inspection by introducing the team and outlining the objective of the inspection to the master. The inspector then receives information about operating conditions and safety rules on board from the master. This exchange should occur in a private space, if available. The inspection process is then outlined to the master, and the documentation in place is reviewed. The order of inspection (see Annex 3) is at the inspector’s discretion. However, cross- contamination from inspection activities should be avoided. Therefore, personal hy- giene, cleanliness of clothes and the inspector’s health status should be considered. If a new certificate is to be issued, all areas have to be inspected. If the ship’s holds are in use, the cargo should also be inspected, if applicable, especially for presence of vec- tors. If enough personnel are available in the inspection team, team members can be assigned different areas for inspection. The aim is to achieve all the objectives of the inspection, taking into consideration the availability of time, the number of inspectors, and the size and type of the ship. The areas for inspection, the kind of evidence sought, the potential sources of informa- tion and the appropriate control measures to be taken are identified in the checklists of this handbook. This handbook can help identify deficiencies and non-compliance before completing the certificate. 4.3 Taking samples The model SSC in IHR (2005) Annex 3 contains columns for recording “sample results” as part of the inspection and related information; however, such samples may not be required in all inspections according to the IHR. Whether a sample should be taken and analysed depends on factors such as the particular circumstances described in the checklists; the evidence found by the inspectors; the nature of any potential public health risks; and the adequacy, in a particular context, of the usual inspection techniques that do not involve taking samples. For example, if the cold potable water system shows temperatures above 25 °C, the risk of Legionella contamination increases. Therefore, this temperature is a trigger for taking a water sample. Harmful contamination other than microbial contamination (e.g. from chemical or radioactive sources) may also be found on ships. Methods of sampling for these contaminants are described in the WHO Guide to ship sanitation. If sample results are pending, issue an SSCC and note “Results are pending” on the certificate. 29 Part A: Inspection system requirements In general, when clinical signs or symptoms of illness or disease are present, evidence of a public health risk (including sources of infection and contamination) is found on board, or a public health risk is definitively identified, the competent authority deter- mines the appropriate public health measures to be applied for an adequate level of control. Methods or materials advised by WHO for these measures should be em- ployed, unless the competent authority determines that other methods are similarly safe and reliable. 4.4 Issue of certificates SSCECs and SSCCs consist of two parts: (a) the model certificate, which outlines the key physical areas of the ship for inspection; and (b) the attached references to the sys- tems for management of food, water, waste, swimming pools and spas, and medical and other facilities that may require closer inspection, according to the size and type of the ship. The Evidence Report Form can be used to list the evidence found and measures indicated. After the inspection, the inspecting officer should debrief the master before issuing an SSC. The master or representative must be allowed sufficient time to address any deficiencies and to retrieve the necessary documentation before completing the cer- tificate. According to the evidence of the adequacy of sanitary measures detected during the inspection, either an SSCEC or an SSCC is issued (see the flow chart in IHR Article 39, Appendix 2). Instructions for completing the certificate are as follows: Strike through the non-applicable certificate in the heading (either SSCEC or SSCC). Fill in the required information in the two tables (name of ship, flag, etc.). Choose the applicable table (left: SSCEC, right: SSCC). Complete every box in all the columns. Write legibly and use consistent wording from the checklists of this handbook. Use the Evidence Report Form if there is insufficient space on the SSC. Note areas not applicable by marking “NA”. Use the wording “None” or “Nil” in areas in which no evidence is found. List the documents reviewed. Use the wording “None” or “Nil” if no documents were reviewed. Clearly indicate if sample results were reviewed by noting “Yes” or “No”. Indicate if sample results are not yet available by noting “Sample results pending”. Sign (identifying the inspecting officer), date and stamp the certificate. Ensure that all certificates are legible. Ensure that English is at least one of the languages on the certificate. If a re-inspection is performed on a ship holding a valid certificate, an Evidence Report Form should be attached to the original certificate to record further information. The attachment must be referenced on the original certificate, preferably with a stamp as shown in Section 4.4.4, with the signature of the inspector. The attachment should also refer to the original document. 30  Part A: Inspection system requirements 4.4.1 Ship Sanitation Control Certificate An SSCC is issued when evidence of a public health risk, including sources of infec- tion and contamination, was detected on board and the required control measures have been satisfactorily completed. The SSCC records the evidence found, the control measures taken, and the samples taken and corresponding results (if applicable); if necessary, an Evidence Report Form can be attached. If the conditions under which control measures are taken are such that, in the opinion of the competent authority, a satisfactory result cannot be achieved at the port where the operation was performed, the competent authority shall make a note to this effect on the certificate. The note identifies all evidence of ship-borne public health risks and any required control measures to be applied at the next port of call. If the ship is al- lowed to depart, at the time of departure the competent authority shall inform the next known port of call by a rapid means of communication (e.g. e-mail, fax, telephone) of the type of evidence and the requisite control measures. These procedures particularly apply in contexts in which the public health risk could spread internationally or could present a serious and direct danger to the health of human populations. Any evidence of public health risks identified, required control measures or notation of sample results pending that could lead to the issue of an SSCC should be documented on the certificate, when applicable. 4.4.2 Ship Sanitation Control Exemption Certificate According to the IHR (2005), an SSCEC is issued when no evidence of a public health risk is found on board and the competent authority is satisfied that the ship is free from infection and contamination, including vectors and reservoirs. This certificate is usually issued, as far as practicable, only if the inspection has been performed when the ship and the holds are empty, or when the holds contain only ballast or other material of similar nature and a thorough inspection of the holds is possible (IHR Article 39). Despite the presence of a valid SSCEC or an extension, according to the IHR (2005), inspections may nonetheless be required in various circumstances, as stated in IHR (2005) Articles 23 and 27 and Annex 4 (e.g. if the pre-assessment indicates evidence of a public health risk). 4.4.3 Extension of ship sanitation certificates SSCECs and SSCCs are valid for a maximum of six months. This period may be ex- tended by one month if the inspection or control measures required cannot be ac- complished at the port. However, if a ship constitutes a serious risk for the spread of disease, the necessary disinfection, decontamination, disinsection, deratting or other measures to prevent the spread of the infection or contamination must be performed at the next point of entry. At the time of departure, the competent authority shall in- form the competent authority of the next point of entry of the evidence found and the control measures required. 31 Part A: Inspection system requirements An extension allows a ship to reach a port at which the inspection and necessary control measures can be performed, without the necessity to travel with an expired certificate. An extension may be granted up to 30 days before the expiry date of the existing SSC. However, the SSC cannot be extended for longer than 30 days after the expiry date (IHR Article 39). Use of an “extension stamp” similar to that shown below is recommended to ensure a common standard among competent authorities. Place the stamp on the existing certificate. 4.4.4 Evidence Report Form The Evidence Report Form (see Annex 7) can be used to document evidence of public health risks found during an inspection, and also the prescribed control measures or corrective actions. The words “required” and “recommended” are used, according to the evidence found, samples tested and documents reviewed. The inspecting officer then submits the SSC and attached Evidence Report Form to the ship’s master. If a re- port form is used, a note is made on the SSC. Use of an “attachment stamp” similar to that shown below is recommended to ensure a common standard among competent authorities. 32  Part A: Inspection system requirements Some control measures required to avoid dissemination of disease and to control an existing serious and direct danger should be adopted immediately. Any required control measure automatically results in the issue of an SSCC. According to the risk assessment performed by the competent authority during the inspection, the crew and conveyance operator should follow any other recommenda- tions for preventive measures to avoid potential risks. Existing international standards and regulations are used as a baseline for defining the control measures advised as “required” or “recommended” measures. When “shall” is used to address a measure in the relevant articles and accounts of the international conventions, standards and regulations, the measure is deemed as a required measure. For example, the ILO (No. 68) Food and Catering (Ships’ Crews) Convention specifies matters of food supply and catering arrangements designed to secure the health and well-being of ships’ crews. This measure is addressed by “shall”, and thus leads to a “required” designation. Articles published in scientific journals provide evidence of public health risks that trigger public health emergencies at points of entry or in conveyances. The effects of such events justify specified measures to control contamination and infection. These articles provide a scientific basis to determine which measures should be required. For example, huge outbreaks of foodborne diseases that are often caused by pathogens resulting from improper temperature control in the food chain have been documented. Therefore, preventive measures concerning temperature control in food source, preparation, processing and service are crucial. Such measures are therefore identified as required measures. Some measures draw on international best practices to achieve the goal of controlling infection and contamination in an effective and efficient manner. 4.4.5 Affected conveyances and ship sanitation certificates According to IHR (2005) Articles 27 and 39, a conveyance shall be considered affected: if a valid SSCEC or SSCC cannot be produced; if clinical signs or symptoms of illness or disease are present and information based on fact or evidence of a public health risk exists, including sources of infection and contamination. In these circumstances, a conveyance is considered infected even if it possesses an SSCEC or an SSCC. If the competent authority is unable to carry out the required control measures, or the results of control measures are ineffective, this should be clearly stated on an attachment to the certificate (e.g. an Evidence Report Form as in Annex 7). The attachment should detail the facts or evidence of public health risks and the required control measures. The attachment should be clearly marked as an attachment to the original certificate and cross-referenced by, for example, the date and port of issue (see Annex 2). 33 Part A: Inspection system requirements After a re-inspection of the ship in the next port to check that the control measures required by the previous competent authority have been performed, and that the measures have been verified as effective, notes to that effect must be made on the attachment. The ship shall then cease to be regarded as an affected conveyance under IHR (2005) Article 27, unless other public health risks were discovered on the re- inspection. The original validity date of the exemption certificate remains unaffected, unless a full inspection is performed and a new certificate issued, with the agreement of the master of the ship. 5. Control measures Once the public health risks have been identified based on the information or evidence found, the competent authority should determine appropriate control measures and consider the adequacy of existing control measures. Public health risks can be controlled by a variety of means. The competent authority should enforce reasonable and practicable control measures, according to the risk assessment. Unnecessary or excessive measures should be avoided. In addition, the availability of technical resources and reasonable costs should be considered when assessing options for control. When a public health risk exists, control measures that will reduce the risk to an acceptable level should be identified. The conveyance operator is responsible for controlling any onboard risks. Nevertheless, the competent authority should provide reasonable assistance to identify suitable and relevant control options. Control measures for public health risks on ships should be applied only after all key parties (i.e. the master, the conveyance operator or agent and the port authorities involved in this activity) have been fully informed of the intended methods. Critical activities, such as the designation of port areas for quarantine of ships suspected of carrying a public health risk, should be identified well in advance, in cooperation with the port operator for ship movement. The schedule of work to be performed should be confirmed with the ship’s supervisory crew members and noted in any corrective actions. The methods suggested for detecting and measuring public health risks on ships (in Part B of this document) are based on information from existing guidelines, WHO State Party experts, international organizations and the shipping industry. Disinsection, decontamination, deratting, disinfection and other sanitary procedures taken pursuant to the IHR (2005) shall be performed in a manner that avoids injury and, as far as possible, discomfort to persons. Also, environmental damage that affects public health, baggage, cargo, containers, conveyances, goods or postal parcels should be avoided (IHR Annex 4B.1). As far as practicable, facilities used by travellers at points of entry should be maintained in a sanitary condition and kept free from sources of infection or contamination, including vectors and reservoirs (IHR Article 22.2). These measures shall be initiated and completed without delay, and applied in a transparent and non-discriminatory manner (IHR Article 42). 34  Part A: Inspection system requirements 6. Other relevant international agreements and instruments While this document focuses on specific provisions of the IHR (2005), other international instruments and agreements also address related issues, such as crew safety and comfort, and some operational aspects such as facilitation, communication, maritime pollution, and safety and security of ships and ports. Such instruments and agreements include those adopted under the auspices of the ILO and the IMO. These international instruments should be compatible and, indeed, synergistic, with the IHR (2005). In any event, the IHR (2005) provides that the IHR and other instruments be interpreted in a compatible manner. A number of these instruments and agreements are referred to, where applicable, in parts of this document. As provided in the IHR (2005) and subject to the preceding paragraph, the regulations do not prevent States Parties having certain common interests in terms of their health, geographical, social or economic conditions. States Parties are also not precluded from concluding special treaties or arrangements to facilitate the application of the regulations, with particular regard to: direct and rapid exchange of public health information between neighbouring terri- tories of different States Parties; health measures to be applied to international coastal traffic and to international traffic in waters within their jurisdiction; health measures to be applied in contiguous territories of different States Parties at their common frontier; arrangements for carrying affected crew and passengers or affected human remains by means of transport specially adapted for the purpose; deratting, disinsection, disinfection, decontamination or other treatment designed to render goods free from disease-causing agents. The IHR (2005) also provides that, without prejudice to their obligations under the regulations, States Parties that are members of a regional economic integration organization shall apply in their mutual relations the common rules in force in that organization. 35