SELF DECLARATION

To be submitted by Faculty / Student / Non-teaching Staff

at the time of rejoining the College / University /School

 I, ___________________________________, age : _____ yrs., faculty /

non-teaching staff / student of ___________________________________
__________________________________________________________________
(Department / Semester / College / School) will wear mask,
maintain social distancing norms and follow all government
guidelines during this pandemic and also outside office hours /
college timing.
 I am aware that anyone - staff / student can be an asymptomatic
carrier of COVID-19.
 I am aware that I can be an asymptomatic carrier of COVID-19.
 I was not in contact with any COVID-19 positive case. If
I come in contact with a positive COVID case, I will inform the
concerned authorities immediately with all the details.
 I am aware that the University / College / School / Organization is
taking all the measures required to keep me safe from COVID-19.
 I will also follow all guidelines when I go out for my personal work.
 I am aware that in spite of following all precautions I may get
infected with COVID-19 and I will not hold the College / University
/ School / Students / Staff responsible for it.
 If I suffer from fever / cold / cough / loss of smell or any other
Influenza like (COVID-19) like symptom, I will immediately report
to Doctor / Hospital and also inform the College / University/
School authorities.
 I will follow all the rules and regulations stipulated from time to
time by University / College / School and the Government in this
pandemic.

Signature :

Date :

Name :

Designation / Programme :

Mobile Number :