DEPARTMENT OF HOMELAND SECURITY U.S. COAST GUARDU.S. COAST GUARD DECLARATION OF HEALTH Port Name:To be completed and submitted to the competent authority by the Captain of the ship entering a foreign.
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How to fill out the DHS CG-5100 online
The DHS CG-5100 is an essential declaration of health form required by the U.S. Coast Guard for ships entering foreign ports. This guide will provide you with clear, step-by-step instructions to help you complete this form accurately and efficiently.
Follow the steps to complete the DHS CG-5100 online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by entering the port name where the ship is docking. Ensure that the name reflects the exact port destination.
- Fill in the date in the format MMDDYYYY, representing the date of submission.
- Input the ship name carefully, as it should match the name registered with the shipping authority.
- Enter the hull number, which is a unique identifier for the vessel.
- Specify the gross tonnage of the ship, which indicates its size and volume.
- Indicate the name of the captain, ensuring correct spelling and details.
- Enter the nationality of the captain.
- Answer whether a valid sanitation control exemption or control certificate is on board by selecting 'Yes' or 'No'.
- If you selected 'Yes', provide the details of the certificate and where it was issued.
- Indicate whether the ship has visited an affected area as per the World Health Organization by answering 'Yes' or 'No'.
- If 'Yes', specify the port name from where the ship is arriving.
- Provide the date of issuance of the health declaration in the format MMDDYYYY.
- Answer whether a re-inspection is required by selecting 'Yes' or 'No'.
- If 'Yes', indicate the date of visit in the format MMDDYYYY.
- List all ports of call from the commencement of the voyage, including departure dates.
- Enter the total number of crew members currently on board.
- Indicate the number of persons on board who are not part of the crew.
- Respond to the health questions honestly, selecting 'Yes' or 'No' for each question. If applicable, provide particulars in the attached schedule.
- Complete the declaration statement confirming the accuracy of the information provided.
- The captain should sign the form and date it in the provided sections. If applicable, a senior medical department representative should also sign and date their section.
- Finally, you can save changes, download, print, or share the filled-out form as required.
Complete your DHS CG-5100 online today to ensure timely processing.
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