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Fumigation Report

General Information

Vessel Name

Country of Loading
Country of Discharge

Estimated Voyage Time (in days)

Commodity

Specify

Gross Weight (in KG)

Quantity (in CTNS)

Holds or Tanks treated:
Hold/Tank

Depth

Cubic Capacity

Type & Quantity of Fumigation Formulation Used

Dosage of Exposure

Method of Application

Sign Off

Additional Observations

I certify that immediately following application of the fumigant formulation all openings to the fumigated space were closed and placarded with appropriate warning signs. I further certify that all openings to the fumigated space have been checked and no fumigant gas was leaking at the time of the vessel’s departure.

Certified Fumigant Applicator Name & Signature
Officer in Charge Name & Signature

Fumigation Report Template Checklist

Created by: SafetyCulture Staff | Industry: General | Downloads: 3

This fumigation report template can be used as a fumigation certificate when certified fumigant applicators have successfully performed fumigation in a vessel. Automatically generate and deliver a fumigation report with critical details like country of discharge, estimated voyage time, and holds or tanks treated using this template. Certified fumigators can efficiently add an unlimited number of holds or tanks treated, including specifications such as cubic capacity, type and quantity of fumigation formulation used, and method of application.

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Fumigation Report

General Information

Vessel Name

Country of Loading
Country of Discharge

Estimated Voyage Time (in days)

Commodity

Specify

Gross Weight (in KG)

Quantity (in CTNS)

Holds or Tanks treated:
Hold/Tank

Depth

Cubic Capacity

Type & Quantity of Fumigation Formulation Used

Dosage of Exposure

Method of Application

Sign Off

Additional Observations

I certify that immediately following application of the fumigant formulation all openings to the fumigated space were closed and placarded with appropriate warning signs. I further certify that all openings to the fumigated space have been checked and no fumigant gas was leaking at the time of the vessel’s departure.

Certified Fumigant Applicator Name & Signature
Officer in Charge Name & Signature