Guidelines and protocols for those students who wish to return to the

campus
Note: This protocol is based on the current government orders.
This is subject to change.
Contents:

1. Before entering the campus and during the journey

1.1. Items to be brought by the students while returning to the campus
1.2. During the journey

2. On the day of arrival

2.1. At Health Centre
2.2. At Allocated/Parent Hall

3. Quarantine / Isolation Facility

3.1. Quarantine Zone in VH-2
3.2. Isolation Zone in Yoga Hall

4. Protocol for Testing, Hospitalization and Post Hospitalization

4.1. Protocol for Testing
4.2. Protocol for hospitalization of a student who has tested positive for the coronavirus
4.3. Protocol for the post hospitalization period
4.4. Instructions for the student who is in the isolation zone after the hospitalization
4.5. Protocol for hospitalization of a student in NON COVID hospital.

5. Arrangements in VH-2 and Yoga Hall

6. Guidelines for students in the hall premises (after the quarantine period)
7. Guidelines for Mess Operations
8. Protocol/Guidelines in case a Hall is declared to be a containment zone
9. Challenges and Current Situation

Annexure 1: Undertaking form by Student and Parent/Guardian

Annexure 2: Entry form

Annexure 3: Consent form for RT-PCT Test

Annexure 4: Declaration form for health issue

Annexure 5: Frequently asked questions:

https://drive.google.com/file/d/1Qe51lV4lxel8sqsdzom7Ytd7aRVEwu_9/view?usp=sharing

Annexure 6: Students on campus want to go out and need re-entry to IITK campus

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 The Institute has allowed the return of all the students (except Y21 UG students) on the campus from
December end onwards. The returning to campus is voluntary for academic session 2021-22 2 nd
Semester. Students, who are interested to come, need to upload the undertaking form (see Annexure-
1) and vaccination certificate on Pingala portal. Once it will be verified and approved by DOSA
office the name shall appear in the Google Spreadsheet given in the link below along with details of
the Hall of residence (Halls will be allotted as per current policy and availability of rooms in a
particular hostel).

https://docs.google.com/spreadsheets/d/1547MAlOcQLx5y_e51InRcBWeuJjDQ4dx/edit?usp=shari
ng&ouid=103020175107799256329&rtpof=true&sd=true

The student, whose name appears in the Google spreadsheet, will ONLY be allowed to come on
campus.

Note:

⮚ Only those students will be allowed on campus who have taken both doses of COVID vaccine.
⮚ Based on the hostel allotment many students will stay in shared accommodation.
⮚ Student needs to bring a negative RT-PCR for a test taken within 72 hours prior to reaching the
IIT Kanpur campus. Student whose report is awaited will not be permitted to enter on campus.
⮚ Students need to directly report to Health Centre (HC) on arrival to campus.
⮚ At the HC, the final dose vaccination certificate and negative RTPCR report is to be shown at
the HC Reception.
⮚ After the screening at the Health Centre, student can proceed to their respective allocated/parent
hall.
⮚ During the stay on campus, as per the advice of the Health Centre, students may have to go for
quarantine followed by an RT-PCR test.
⮚ Those tested positive will go to COVID care medical facility available on campus or a dedicated
COVID hospital in the city for such period as may be advised by the Health Centre. It may be
followed by staying in quarantine facility in VH-2.
⮚ Once on campus, students going out of campus need to follow protocol given in Annexure-6

It is imperative that the students take adequate precautions during travel, on arrival, during the quarantine
period and also during their stay in the hostel, both for their safety and the safety of others. Necessary
guidelines and precautions for all these stages are given below. (Please note that it is mandatory to follow
them.)

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1. Before entering the campus and during the journey

1.1 Items to be brought by the students while returning to the campus

⮚ Sufficient number of face masks

⮚ Hand sanitizer, soap/hand wash, Antiseptic wipes
⮚ Set of utensils (steel plate, tumbler, spoons, tiffin box)
⮚ Thermometer (mandatory)
⮚ Pulse oximeter (mandatory)
⮚ Nail cutter and scissors
⮚ Two fresh bedsheets and two fresh pillow covers.
⮚ Electric kettle (for making tea or coffee or warm water especially during the quarantine
period)
⮚ Aadhar card (mandatory)
⮚ Institute identity card/ Any government approved ID (if institute id is not issued)
⮚ Vaccination Certificate (Fully vaccinated student is only permitted)
⮚ Negative RT-PCR report taken in 72 hours prior to your arrival
⮚ Filled entry form (Annexure-2).
⮚ Consent form for RT-PCT Test (Annexure -3)
⮚ Declaration form for health issue (Annexure-4)

1.2 During the journey

⮚
⮚ Drink plenty of water to stay hydrated
⮚ Avoid touching surfaces in public places and maintain a safe distance from your fellow
passengers at all times
⮚ Keep your hands clean, by either using a sanitizer or by washing them frequently (at least
once an hour). Avoid touching your nose, eyes and mouth.

2. On the day of arrival

⮚ Entry into the Institute at the main gate will be as per the protocol which is applicable to all
the visitors to the campus.
⮚ The students will be allowed to enter the campus anytime.
⮚ Vehicles or accompanying person will be permitted till the hostel gate.
3
 ⮚ Guest, relatives, friends etc. are not permitted to stay inside the hall premises.
⮚ On arrival to campus, directly report to Health Centre.
⮚ The students should bring following document:
i. Institute identity card/ Any government approved ID (if institute id is not issued)
ii. Vaccination Certificate (Fully vaccinated student is only permitted)
iii. Negative RT-PCR report taken in 72 hours prior to your arrival
iv. Filled entry form (Annexure-2).
v. Consent form for RT-PCT Test (Annexure -3)
vi. Declaration form for health issue (Annexure-4)
vii. Photocopy of Aadhaar Card.
 If your RT-PCR report is awaited, you will not be permitted to stay on campus.

2.1 At Health Centre:

⮚ Students will report directly to Health Centre on arrival.
⮚ Students need to show Vaccination Certificate and Negative RT-PCR report.
⮚ Students will have to go through the necessary screening procedure conducted by Health
Centre. Health Centre screening slip will be issued.
⮚ Non-symptomatic students: After getting the HC clearance slip endorsed by a HC staff,
proceed to your allocated/parent Hall
⮚ Symptomatic students or those having some medical problem: After a medical check-up,
based on the doctor’s recommendations,
(a) in case of COVID 19 like symptoms, the student will be shifted to VH-2 (Quarantine
Zone) and COVID 19 testing- RT-PCR will be advised for the student. Health Centre
will co-ordinate with pathology lab for sample collection. Sample collection might take
about 2 to 3 days and it can take about 2 to 3 days for the report to come. During this
entire period, the student will remain under quarantine. The mobile no of the Lab
Technician, who will perform sample collection will be shared with the student. The
student can obtain his/her RTPCR report from CM Portal -
https://labreports.upcovid19tracks.in.

 RTPCR testing will be decided by the Medical Officer as per the assessment of the condition
of the student.
 All the above activities will be conducted with strict adherence to the norms of social
distancing.

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 2.2 At Allocated/Parent Hall

⮚ Student should produce following document at Hall Reception:

i. HC clearance slip.
ii. Institute identity card/ Any government approved ID (if institute id is not issued).
iii. Vaccination Certificate (Fully vaccinated student is only permitted) .
iv. Negative RT-PCR report taken in 72 hours prior to your arrival.
v. Filled entry form (Annexure-2).
vi. Consent form for RT-PCT Test (Annexure -3)
vii. Declaration form for health issue (Annexure-4)
viii. Photocopy of Aadhaar Card.

⮚ Student should submit following document at Hall Reception:

i. Vaccination Certificate
ii. Filled entry form (Annexure-2).
iii. Consent form for RT-PCT Test (Annexure -3)
iv. Declaration form for health issue (Annexure-4)

⮚ If you don’t have allocated room in hostel and visiting off office hours, please get in touch
with Hall office Manager in advance so that on your arrival, you get your room key.
⮚ Hall Office email ids are: hall1@iitk.ac.in for Hall-1; hall2@iitk.ac.in for hall-2 and so on.
For GH-1 it is gh1@iitk.ac.in.

3. Quarantine / Isolation Facility

3.1 Quarantine Zone in VH-2

⮚ Quarantine zone in VH-2 is meant for those students who

(a) have fever or flu like symptoms or any other COVID like symptoms.
(b) are suspected to be infected with the coronavirus or history of contact.
(c) have given their samples for testing and are awaiting the results of the testing.
(d) after discharge from hospitals as per recommendation of Health Centre.
(e) who will be required to be in isolation for 7 days or more after discharge from the
hospital following the treatment for COVID 19.

3.2 Isolation Zone in YOGA Hall

⮚ A small COVID care facility has been developed by the institute in YOGA hall to care mild
COVID symptomatic campus residents. The students who tested positive and having mild
5
 symptoms will be kept in this facility.

4. Protocol for Testing, Hospitalization and Post Hospitalization

4.1 Protocol for Testing:

⮚ Students with any of the following symptoms should contact the Health Centre:
● Loose motions
● Sore throat
● Fever
● Loss of smell and taste
● Persistent headache
● Bluish discoloration of lips and face
● Mental confusion
● Chest pain
● Difficulty in breathing
● SPO2 – less than 95 %

⮚ The attending doctor will decide, based on the symptoms, whether it is necessary to go ahead
with the testing.
 The student may be prescribed medicines and will be advised to undergo quarantine in VH-
2. During the quarantine period, the student will be asked to monitor his/her temperature and
the SPO2 measurements, using the thermometer and the oximeter which have been brought
by the students. Student will monitor his / her own health regularly. Monitoring of pulse,
temperature and SPO2 will be done by student and report the readings to HC, either by email
at HC reception (hcrecep@iitk.ac.in) or through a message at HC WhatsApp on 8765436535
during the following hours:

i. 6 am to 8 am
ii. 4 pm to 6 pm
iii. 8 pm to 10 pm
 Health Centre will call the student as per the requirement. If student does not report, the HC
can call student to get the information.
 In case of an EMERGENCY, call immediately on HC Mob. No. 8765436535 and
simultaneously inform any one of the following so that one attendant (a female attendant for
female) is send immediately to accompany the student for various needs.

Do not wait for WhatsApp message to be seen by HC.

Please note that during EMERGENCY situation do not rely on WhatsApp or SMS. It may delay the matters.

6
 ⮚ If the student’s sample has to be tested for the coronavirus, the HC will make arrangements
for the testing, and then the sample will be collected by the lab which may take 2-3 days. It
can take a further 2-3 days for the report to come. During this entire period, the student will
remain in quarantine in isolation zone of Hall-1.
⮚ The student has to make a payment as per the prevailing rate (which could be around Rs.
700 in cash, subject to change) for the RT PCR test which will be reimbursed by the Institute,
on filling up the reimbursement form and around Rs. 200 to 500 sample collection cost which
will be not reimbursed. The mobile (no of the Lab Technician, who will perform sample
collection will be shared with the student. The student can obtain his/her RTPCR report from
CM Portal - https://labreports.upcovid19tracks.in and inform HC accordingly.
⮚ The student will be provided an exclusive phone number for the purpose of consultation with
a doctor in the HC. This facility will be available 24/7.
⮚ The student will be asked to monitor their temperature and SPO2 levels. They will have to
report their readings, either by email at HC reception (hcrecep@iitk.ac.in) or through a
message at HC WhatsApp on 8765436535. HC will call the student as per the requirement.

4.2 Protocol for hospitalization of a student who has tested positive for the coronavirus:

⮚ If a student’s sample tests positive for the coronavirus, the parents/guardians of the student
will be informed by the warden/DOSA office.
⮚ The student with mild symptoms will be sent to Covid Care facility of institute in Yoga Hall.
⮚ The student with moderate or critical symptoms will be sent to an Institute empanelled
COVID dedicated hospital. The mode of payment (cashless) to the above-mentioned
empanelled hospitals is through the insurance company, The New India Assurance Co. Ltd
(Raksha TPA).
⮚ The HC with support from the DOSA office will coordinate all the activities related to
hospitalization.
⮚ The student will remain in the hospital for the entire period as is advised by the hospital. (If
a student leaves the hospital without medical approval, then the student will not be allowed
to enter the campus).

4.3 Protocol for the post hospitalization period:

⮚ Once the student is discharged, the HC ambulance will be provided to bring back the student
7
 back to the campus. (In case, the student wishes to go home with his/her parents/guardians,
then the student may do so. However, the student should inform the
supervisor/warden/DOSA.) She/he will be kept in quarantine zone of VH-2.

4.4 Instructions for the student who is in the isolation zone after the hospitalization
⮚ The student will have to monitor his/her temperature, pulse and SPO2 levels regularly. The
student will also have to monitor own health and inform the health status at the HC reception
daily.
⮚ The student should use a triple layer medical mask all times. The mask should be discarded
after 8 hours of use or earlier in case it becomes wet or visibly soiled.
⮚ The student must stay only in the allotted room and use only that bathroom/ washroom
allotted to him/her. Nobody else should use this bathroom or washroom.
⮚ The student must take sufficient rest and drink sufficient water to be adequately hydrated.
⮚ Hands should be washed often with soap and water for at least 40 seconds or cleaned with
an alcohol-based sanitizer.
⮚ The student must strictly adhere to the doctor’s instructions and follow the medical advice.
⮚ In case the student’s health starts deteriorating, the/she will report the same to the HC
reception attendant in VH-2 immediately. The attendant will also inform HC and concerned
wardens immediately.

4.5 Protocol for hospitalization of a student in Non COVID Hospital:

⮚ The student referred to a Non COVID hospital for hospitalization will be required to undergo
RTPCR test prior to admission in any ward.
⮚ The student will be kept in the Holding area of the referred hospital till the arrival of RTPCR
report.
⮚ No attendant will be allowed with the student.

In case of an EMERGENCY, call immediately on HC Mob. No. 8765436535 and simultaneously

inform any one of the following:

Do not wait for WhatsApp msg to be seen by HC.

Please note that during EMERGENCY situation do not rely on WhatsApp or SMS. It may delay the matters.

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5. Arrangements in VH-2 and Yoga Hall

5.1 VH-2 (Quarantine Zone)

VH-2 is institute guest house facility. It is equipped with all the necessary facility which is
required to host any guest/student.

5.2 Yoga Hall (Isolation Zone)

⮚ Yoga Hall will be furnished with the following items:

● Cot with mattress, pillow, bedsheet, pillow cover, bucket, mug, dust pan, dustbin,
broom, etc.
● An instruction sheet containing all the necessary details of persons who can be
contacted.
⮚ Students will be assigned a shared washroom and bathroom.
⮚ Students will not permitted to go out without clearance of Health Centre.
⮚ Students have to wear a mask at all times.
⮚ Packed food will be served in Yoga Hall.
⮚ The student should be regularly (at least once in a day) in touch with his/her supervisor(s)
and his/her parents.
⮚ The student has to monitor the temperature and SPO2, using the thermometer and oximeter
brought by the students. Students who are feeling unwell should contact the HC reception
immediately.
⮚ Students will be provided an exclusive phone number which can be used to consult the HC
doctor through video conferencing. This facility is available 24/7.

6. Guidelines for Students in the Hall Premises:-

⮚ Students should wear masks properly at all times when they are not in their rooms. It is also
advised that protective gears also be used by those students involved in mess activities or
those involved in activities which require close interaction with others.
⮚ Rooms will not be cleaned by the sanitation workers. The students will have to clean their
rooms themselves.
9
 ⮚ The students should try to avoid physical interaction as much as possible and are advised to
use mobile phones/email etc to interact with others (instead of one to one or group
discussions).
⮚ Students should maintain adequate distances amongst themselves, in accordance with the
social distancing norms (necessitated by the severity of the situation). They should use only
the washrooms and bathrooms their respective wings, as far as possible.
⮚ Proper and adequate physical distancing should be maintained by the students.
⮚ Students are strongly advised not to gather both in the hall premises and also in their rooms.
⮚ The exit-entry guidelines are given in Annexure-6.
⮚ A group of student volunteers may be formed to monitor the health of their fellow students.
The group may be selected by the Wardens in consultation with the HECs.
⮚ Apart from the residents of the hostel, only the office staff and the sanitization workers will
be allowed inside the residential part of the hall.
⮚ Horticulture workers will have limited access to the constructed portions of the halls.
⮚ Laundry services will be available. Washing machines, if available, may be used for washing
clothes.
⮚ No external/exchange students/guests/project staff/postdoctoral fellows / interns/ are
permitted to stay in the hall.
⮚ Students having flu like symptoms, (for e.g. a slight fever, cough, cold, etc.) or any other
COVID like symptoms, should consult a doctor in the Heath Centre immediately by phone.
a. Such students shall be shifted to the quarantine zone of VH-2.
b. In the case of a scarcity of rooms in VH-2, the student will be allowed to self-quarantine
in his/her room. However, it is mandatory for the student to follow all the quarantine
protocols strictly.
c. They will be served food in their room by the mess staff.
⮚ The wardens and other HEC members shall enforce these rules in their halls. Services of
student volunteers may be taken for the smooth functioning of both the messes and the halls.
⮚ The student is also required to follow the guidelines, which can be issued from time to time
by the Institute authority/Govt. of India, due to spread of COVID 19 in the country.

7. Guidelines for Mess Operation:

⮚ The interaction amongst the students in the mess premises should be minimized as much as
possible. This can be handled in the following ways:-
● To avoid/reduce interaction amongst the students within the mess premises, batch
(wing) wise dining can be introduced. The students of a particular wing of the hall shall
10
 take their food at the particular time allotted to them.
● Dining hours will be according to the schedule given below:-
(i) Breakfast : 7:30 A.M. to 10:30 A.M.
(ii) Lunch : 12:00 P.M. to 3:00 P.M.
(iii) Dinner : 07.00 P.M. to 10:00 P.M.
⮚ Each table should not have more than 50% occupancy (between two persons, there should
be at least one empty chair).
⮚ Serving will be done only at the counter. Only the mess workers will serve the food and
touch the utensils. Students will only touch their plates and nothing else. Even the plates,
glasses and spoons will be handed to the student by a mess worker.
⮚ Sanitizers will be placed in the mess and the kitchen.

8. Protocol/Guidelines in case a Hall is declared to be a containment zone

⮚ Each hall should have a hall executive committee (HEC). If an elected HEC is not already
available, then a temporary one may be constituted by the warden. The HEC should have a
plan, in case a Hall is declared to be a containment zone, in line with the following.
⮚ A hall staff member may be asked to stay inside the hall during the period, the hall is sealed,
in order to facilitate the coordination of the various tasks.
⮚ Each wing will need to have a team of two or three residents, one of whom is the coordinator,
for the distributing of the food, cleaning and dissemination of information/instruction. In
case, the coordinator falls ill, another person in the group can take over.
⮚ Each wing must also have a WhatsApp group to make announcements such as the arrival of
meals and also to communicate any other information necessary for the smooth functioning
of the hostel.
⮚ The following information must be collected from all the residents: contact details including
emergency contact numbers, blood group, and any known medical conditions/co-
morbidities.
⮚ Each wing will need to create its own roster of cleaning duties to be shared equally by all its
residents. Such a roster needs to be created soon after the return of the residents to the hall.
⮚ Non-wing spaces such as toilets, wash basins, and corridors will be cleaned by an external
team of sanitation workers during a fixed 2-3 hour slot every day, if permitted. During this
slot, the residents will be required to stay in their rooms to avoid any possibility of contact
with the sanitation workers. The sanitation workers must be provided with all the necessary
protective equipment.
⮚ A large trash can will be placed in each wing. The wing coordinator will be supplied pre-
treated garbage bags. Residents have to dispose their trash in this bag and the wing
11
 coordinator will remove the bag each day and place it at a designated place, from where it
will be collected by the sanitation workers. Each wing will be given a designated time slot
for placing the garbage at the collection point.
⮚ The packed food which will be supplied during this period will be handed over by the HEC
to the wing coordinators. The team of wing volunteers will then oversee its distribution.
⮚ Each hall should have an SOP for handling such a situation. The same should be sent to all
the residents and a copy should be made available with the Hall office.

9. Challenges and Current Situation:

The challenges that the Institute is facing as a consequence of the pandemic are huge. However,
despite all the constraints forced by the prevailing situation, the Institute is sparing no effort in
confronting these challenges. It is taking adequate measures to ensure that the return of the
students to the campus is both smooth and safe. Many of the measures have been listed above.
Some measures, challenges and the prevailing situations in both the city and the campus are also
listed below.

⮚ During the quarantine period, the students have to be in isolation. They are not permitted to
go beyond the wing in which they are residing. Further, they should not visit any other
student and should avoid any meetings in common areas. All interaction with their fellow
students should take place in a virtual medium. The institute is making all the necessary
arrangements so that basic needs of the students can be attended to. But there are limitations
due to prevailing situations. Engaging employees/workers to take care of the various
activities is not easy as the situation is not normal and everybody's life is at risk. We are
aware that being in isolation is difficult. It has to be done to ensure both your safety and that
of your fellow inmates.

⮚ If a student tests positive for the coronavirus, the student will be admitted to an empanelled
COVID 19 dedicated hospital or a Government hospital. The student may not have the
choice of doing isolation in the Hostel as a dedicated care giver is necessary for each such
student as per the protocol. If no bed is available in any of the hospitals, then the student will
be accommodated in the (transit) isolation zone as a temporary arrangement and will then be
shifted to a hospital.

12
 ⮚ As no visitors are allowed inside the COVID 19 dedicated hospital, the admitted students
will have to handle their hospitalization on their own. It is important for the students to be
mentally prepared for this.

⮚ It is very important that the students practice social distancing strictly and take a lot of
precautions, so that they are safe.

⮚ Running a mess and serving food to the students is indeed a very big challenge. Though, the
Institute is ready to meet a lot of exigencies, it cannot anticipate all the challenges and
problems beforehand. In this regard, the students' cooperation is expected and is also
imperative.

⮚ If there is an outbreak or the hostel is declared to be a containment zone, managing the hostel
and mess will be a major challenge. The residents of the halls have to play a major role in
managing the hostel, providing food to the students and taking care of their own health and
that of their fellow students.

Students are required to follow all the guidelines/protocols mentioned in this document. Any violation
may attract severe action including eviction from the hall by the wardens.

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 Annexure-1
Undertaking by the Student

I………………………………………….……….RollNo……………………………………..., am returning to the campus from

……………..………………………………………………… (City and State).

I declare the following:

 My parents/guardians/family and I are aware that the COVID-19 pandemic continues in the country and that waves
of surging cases could affect Kanpur and the country in the near future.
 I am returning to the Institute voluntarily to resume my research activity.
 I am not being forced or coerced by anyone to return to the Institute and I will not hold the Institute or any member
of the Institute responsible if I face any problems/mishaps arising as a consequence of the pandemic.
 I understand that there is a possibility of my catching the coronavirus infection, both during my travel and also
during my stay in the campus. My parents/ guardians/family and I are fully aware of the above fact and it is with
this knowledge that I agree to return to the campus to reside in the hostel and start working in my
department/laboratory to pursue my research related activities.
 I am aware that persons with co-morbidities like asthma/hypertension/any respiratory
illness/diabetes/dyslipidemia/obesity/psychiatric conditions/heart diseases/thyroid disease or any condition of
decreased immunity are particularly at a serious risk of severe illness due to COVID-19 infection.
 If I have co-morbidities, I will inform the Health Centre upon arrival.
 I will adhere to the COVID-19 compliance behavior and protocols in the campus. I am aware that non-compliance
would attract disciplinary action which might lead to revocation of the stay in the campus.
 I will wear a face mask (as advised medically) and any other prescribed protective gear at all times in public
(outside my hostel room in IITK). I will also maintain social distancing in public and will not participate in
gatherings of any kind.
 I will cooperate with all Institute personnel (e.g. the Health Centre personnel, the security personnel, the Hall office
personnel, the Departmental Committees), in the discharge of their duties. I am aware that lack of cooperation
could attract disciplinary action.
 I will install Arogya Setu App on my phone and keep it active.
 I will monitor my health myself during the prescribed quarantine period of my stay on campus. In the event that I
develop a fever, cough/COVID-19 like symptoms during my stay, then I will intimate the same to both my
supervisor and the Health Center immediately. I agree to follow the recommendations of the Health Center.
 I understand that Health Center in IIT Kanpur is a primary healthcare centre with limited facilities and in the event
that I am tested to be COVID-19 positive (asymptomatic or symptomatic), I will have to use the COVID care
medical facility available on campus or in the city and get admitted to a COVID care facility on campus or a
dedicated hospital in the city for such period as may be advised by the Health Centre. It may be followed by stay
in isolation facility in one of the halls or at my home. I will provide my complete cooperation to the Institute and
the Health Center in this regard. I am aware that the medical expenses towards COVID care will be covered by the
14
 student’s health insurance policy.
 I understand that for any non-COVID-19 medical issue, on referral to the city Hospital, I will have to remain
initially for a few days in the waiting area of the hospital till my RTPCR report shows negative results (as per
COVID-19 protocol).
 I will not go out of campus for any reason except for any emergency or medical requirements as permitted.
 In case due to some medical emergency and/or family reasons, if I need to go out, I shall follow all the guidelines
as prescribed by the authorities from time to time.
 If asked by the Institute to leave the campus within a specified time period on account of rising COVID-19 cases,
I will do so willingly and I will cooperate with the Institute authorities in this regard.
 I am ready to stay in the same hostel room in which I was staying before the pandemic and in case institute decides
to move me to another hostel, I will move.
 I understand that my request to change my hostel/room allotted to me may not be entertained.
 I will fully comply with any other measures/ guidelines prescribed by the Institute from time to time in this regard.

I willingly agree to the above declaration.

Signature of Student: Date:

Undertaking by Parent/Guardian

I……………………………………..,parent/guardian of Mr./Ms.………………………….………., am aware of the

prevailing situation in the country and am aware that my ward is not being forced or coerced by anyone (including
myself) to return to the Institute, and that he/she is returning to the Institute voluntarily to resume his/her research
work. I will not hold the Institute or any member of the Institute responsible, if my ward faces any problems/mishaps
as a consequence of the pandemic.

Name of Parent/Guardian…………………………………. Signature ………………………….

Relation:……………………………… Date: …………………

15
 Annexure 2
Form to be submitted by Student on Arrival (Entry Form)
S. Details
No.

1 Name of the Student

2 Roll No.

3 Department/Program

4 Mobile No.

5 Hostel and Room No.

6 Staring Destination
(City/Town and Full Address)

7 Date and time of Departure

8 Date and time of Arrival at IIT

Kanpur

9 Name and Contact Number of

Parents/guardian/ Relatives

10 Name and Contact Number of

local guardian (if applicable)

11 Mode of transport Train No Name

Coach/Seat

Flight No Carrier Seat no Bus No Bus

Name Seat No

Car/Taxi No Service

12 Details of member(s) Name Relationship Mobile Number

accompanied, if any

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 13 Whether you were Yes No
tested positive for
COVID?

Are you primary contact of Yes No

a COVID positive patient

14 Have you downloaded Yes No

Aarogya Setu App ?

I have brought the following:

Items YES (Tick) NO (Tick)

1 Thermometer

2 Pulse Oximeter

3 Aadhar Card

Undertaking
1. I have not been ill with either a fever or a cough and have not had a breathing problem at least
for the last 2 weeks.
2. No member in my residence (where I am currently residing, at least for the last two weeks)
………………....………. (city, state), has been ill with a fever or a cough or has had a breathing
problem for at least the last 2 weeks.
3. If the HC recommends COVID test at any point of time, I shall agree for the same/
4. If there is a need for further quarantine at any point of time, I shall agree for the same.
5. I will not leave the campus without prior permission of the hostel Wardens/DOSA.

Date:

Signature:

Name:

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 Annexure 3

UNDERTAKING FOR CONSENT TO UNDERGO RT-PCR TEST

Date: Place:

I hereby give my consent to undergo RT-PCR Test on the day as per the advice of IIT
Kanpur Health Centre.
If the RT-RCR Test’s results are positive, I agree to go to COVID dedicated hospital for
my effective treatment.

Student’s signature

Student’s Name

Roll Number
Aadhar Card No.

*A Clear copy of Aadhar to be submitted with this form.

Mobile No.
Email Address
Parent’s Name &
Mobile Number
Supervisor’s
Name & Mobile
Number
Department
On Campus
Residential Hall &
Room No.

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 Annexure 4
DECLARATION Form for Health Issue

I, Mr/Ms..................................................Roll No.......................................of............... programme, is

hereby declare about the comorbidities as under:-

(Please tick)

1. Asthma / Respiratory disease (Yes/No)

2. Hypertension (Yes/No)

3. Diabetes (Yes/No)

4. Obesity (Yes/No)

5. Dyslipidemia (Yes/No)

6. Heart Disease (Yes/No)

7. Thyroid Disease (Yes/No)

8. Decreased immunity due to any illness or medication (Yes/No)

(eg. Steroids)

9. Any other (please mention) :...............................................................................

I further declare that I understand that all health-related issues shall be handled by the Health
Centre of the Institute as per rules.

Signature of Students

Roll No. : .........................

Date: ….............................

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 Annexure 5
Frequently Asked Questions

Frequently asked questions are available at the following link:

https://drive.google.com/file/d/1Qe51lV4lxel8sqsdzom7Ytd7aRVEwu_9/view?usp=sharing

This will be revised periodically.

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 Annexure-6

Students on campus want to go out and need re-entry to IITK campus

Case Mechanism
Case-1: Make entry on the registers kept at Hall Office and IITK Main Gate while
Few hours visit going out.
completing within
a day (No night After coming back, make entry on both the registers again.
stays allowed)
This information may be helpful in case of contact tracing.
Case-2 For Exit:
More than a day Apply on Entry-Exit Portal. It will be approved by ARHA.
Visit Make entry on the registers kept at Hall Office and IITK Main Gate while
leaving campus.

For Entry:
Apply on Entry-Exit Portal. It will be approved by ARHA.
Make entry on the register kept at IITK Main Gate on arrival.
Come with Negative RT-PCR report. Get screening done at Health Centre
and go to parent Hall.
Make entry on the register kept at Hall Office on arrival.

Note: Separate registers should be maintained by Hall Office and IITK Main Gate Security for
Case-1 and Case-2.
The Hall Office registers should be kept at Hall Main Gate after office hours.

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