Self-Declaration by Students / Post Docs/ Project Staff (Day Scholars)

returning to do Research work in IITD laboratories

Undertaking prepared : 29/12/2020

Date: ……/……/………..
Respected Sir / Madam,
I have gone through and understood the guidelines and protocols of the Institute, pertaining to
resumption of research. I state that I am aware that it is entirely voluntary for me to return to
the Institute and that I am doing so of my own free will, having understood the risks inherent in
commuting to, and doing laboratory work at the Institute in the current Covid-19 Pandemic. I
have applied for permission to continue with my research at the Institute.

I (………………………….........…………………), am returning from, .……………………………………………

……………………………………………………………...…………………………………………………….………………………… …….
(Mobile number ………………………….), on …./…../2021. After return I am living at following address:
…………………………………………………………….. …………………. ……………………………….………………..……………….

In my opinion, which has been affirmed by my research supervisor, it is completely essential for
me to come to research lab/computation facility in IIT Campus and the nature and/or stage of my
research is such that it cannot be done from home and that any further delay wouldjeopardise
the entire project.
I understand that if I am found to have given wrong information in the declaration below or not
following protocols after onboarding at the institute I will be liable for disciplinary action.

I declare that

 I am not having fever, cough and breathing problem ( 14 days prior to date of my travel).
 None of my family members where I was living (.......................... ), is suffering from fever, cough
and breathing problem 14 days prior to my travel date..
 I am not having any disease like diabetes, hypertension or heart/ lung /kidney related disease, etc.
 I will wear face mask as well as any other prescribed protective gear and maintain physical social
distancing in my class room/ Laboratories/ academic area/ hostels and in IITD campus.
 I will regularly wash my hands with soap and water for at least 40 seconds or clean them with
alcohol based sanitizer.
 I will use Aarogya Setu App on my mobile and it will remain active at all times (through Bluetooth
and Wi-Fi)
 I will self-monitor my health every day after I return to the Institute. In case, I develop fever, cough,
flu-like symptoms and/or breathing problem then I will inform about it to my supervisor / in charge/
Head of department, unit, etc. Also I will consult a doctor and follow medical advice. In
 such eventuality, I shall not return to the Institute until such time that I have been free of Covid- 19
symptoms for a minimum period as stipulated by the Govt.
 I understand that there is always a possibility of getting infected by the virus due to the number
of cases in Delhi and in the country. My parents/ guardians are also fully aware of my wish to return
to the campus to start working in the laboratories and other offices for my research related
activities.
 I also want to declare that my supervisor has not put any pressure on me to resume the research
activities at IIT Delhi.
 I also understand that IIT Delhi has a Primary Health Care Centre only and it will extend all available
facilities in case of a medical emergency. However in case of CoViD-19 infection I may require
isolation, treatment and/or hospitalization outside the campus, for which government laid down
protocols and costs apply. It is highly possible that for Covid positive cases State/central Govt
administration may insist on shifting to Govt isolation facility.

 Signature of student / Post Doc / Project staff :

 Name of student / Post Doc / Project staff :
 Student entry number / Employee Code: Department/ Centre :
 Date of Joining : - Contact Mobile number: -
 Name of Parent/Guardian : contact number of parent/Guardian:
 Emergency contact number 1: Emergency Contact No 2 :
 Vaccination date (Dose 1) Vaccination Date ( Dose 2) 

* I agree with the above request made by the research scholar that the nature and/or stage of the research
being conducted by him/her is such that it cannot be subjected to any further delay, nor can it be done from
home. I affirm that I have not exerted any pressure in making the research scholar decide to return to the
Institute. I shall coordinate the well-being of the research scholar with the help of available Institute facilities
in case of any covid related emergency.

Name(s) and signature of the Research Supervisor(s) / P.I (s) / Program Coordinator

Signature of the Head of the Academic Unit

Scan and send to : ddsp@admin.iitd.ac.in; cc: deanacad@admin.iitd.ac.in (for PhD students and post docs)
deanrnd@admin.iitd.ac.in ( for project staff) cc : Sec_officer@admin.iitd.ac.in; cc:
deansa@admin.iitd.ac.in