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This inspection must be completed and documented on all containers/trailers/conveyances bound for the USA.

Printed name of person who conducted security inspection upon arrival: ______________________ Signature: _______________
Inspection was completed: Date: ______________ Time: ______________
Printed name of person who conducted follow up security inspection: ________________________ Signature: _______________
Seal number(s) that was on container when it arrived at this facility: ___________________________________
Seal number(s) that was on container when it departed this facility: ____________________________________
Printed name of person who affixed seal(s): ________________________ Signature: ___________________
Printed name of person who verified physical integrity of seal(s): ________________________ Signature: ___________________

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