| DATE OF INSPECTION OR CONDEMNATION: |
| OWNER: |
| I hereby certify that the following |
| Weight | Animal | Quantity | Origin | Reason |
| | | | |
| were examined and condemned by the Department of Environmental Health on the above date, as unfit for human consumption in accordance with the Public Health Act and the Public Health (Slaughterhouse) Regulations. |
| These goods were condemned at: |
| Owned by: |
| Disposed at: |
| Disposal supervised by: |
| Date of Disposal: |
| |
| Environmental Health Officer |
| CONDEMNATION CERTIFICATE |
| I am satisfied that the above statement is correct and the [ …..] |
| have been satisfactorily disposed of being supervised by the Environmental Health Officer in accordance with the Public Health Act and the Public Health (Slaughterhouse) Regulations. |
| |
| Medical Officer of Health /
Environmental Health Officer |