Health Check Record

Vendor Name Sonex auto Industries Limited

Name Mohit Kumar Location Bahadurgarh

Anyone in Family Any COVID 19 positive

SL Date Body Temp. °F Cough/Sneezing with COVID case in your Remark
(Yes/No) symptoms neighbourhood
(Yes/No) (Yes/No)

1 7/21/2021 97.8 *F No No No

2 7/22/2021 98.8 *F No No No

3 7/23/2021 97.9 *F No No No

4 7/24/2021 98.9 *F No No No

5 7/25/2021 98.6 *F No No No

6 7/26/2021 97.7 *F No No No

7 7/27/2021 98.7 *F No No No

9 7/28/2021 98.1 *F No No No

10 7/29/2021 97.8 *F No No No

11 7/30/2021 97.8 *F No No No

12 7/31/2021 98.8 *F No No No

13 8/1/2021 97.9 *F No No No

14 8/2/2021 98.9 *F No No No

15 8/3/2021 98.6 *F No No No

16 8/4/2021 97.7 *F No No No

17 8/5/2021 98.7 *F No No No

18 8/6/2021 98.1 *F No No No

19 8/7/2021 97.8 *F No No No

20 8/8/2021 98.6 *F No No No

21 8/9/2021 97.7 *F No No No

22 8/10/2021 98.7 *F No No No

Temperature more than 98.6F is not OK

Format may change based on final criteria
IMPORTANT NOTE (Mandatory) :- 1)
2) During cross-Verification if found NG, will do penalized as per ROKI MINDA guidelines
3) Driver and Co-Driver Separate Sheet to be filled.
 Covid19 Check sheet - Annx 1 Driver Temprature and Health

Driver Name: Date दिनांक:

Currently Staying State: Time समय:

Currently Staying City/ Village: Currently Staying Location:

S. No. Not
Points to be checked चेक किये जाने वाले बिंदु Temprature Ok Ok Remark
कृ . F ठीक है ठीक नहीं है टिप्पणी

1 Temprature Day 1

2 Temprature Day 2

3 Temprature Day 3

4 Temprature Day 4

5 Temprature Day 5

6 Temprature Day 6

7 Temprature Day 7

8 Temprature Day 8

9 Temprature Day 9

10 Temprature Day 10

11 Temprature Day 11

12 Temprature Day 12

13 Temprature Day 13

14 Temprature Day 14

Do you have any other suspected symptoms such as cough,

15 difficulity in breathing

16 Any family member or close contact have any other suspected

symptoms such as fever, cough, difficulity in breathing

17 Do you have Covid-19 positive case in your neighbourhood

Truck Driver Codriver Signature ड्राइवर के हस्ताक्षर

Vigilance/ Safety Co-coordinator Signature

सेफ्टी कोऑर्डिनेटर के हस्ताक्षर

Logistics Manager Signature मैनेजर के हस्ताक्षर

 Covid19 Check sheet - Annx 1 Co-Driver Temprature and Health

Driver Name: Date दिनांक:

Currently Staying State: Time समय:

Currently Staying City/ Village: Currently Staying Location:

S. No. Not
Points to be checked चेक किये जाने वाले बिंदु Temprature Ok Ok Remark
कृ . F ठीक है ठीक नहीं है टिप्पणी

1 Temprature Day 1

2 Temprature Day 2

3 Temprature Day 3

4 Temprature Day 4

5 Temprature Day 5

6 Temprature Day 6

7 Temprature Day 7

8 Temprature Day 8

9 Temprature Day 9

10 Temprature Day 10

11 Temprature Day 11

12 Temprature Day 12

13 Temprature Day 13

14 Temprature Day 14

Do you have any other suspected symptoms such as cough,

15 difficulity in breathing

16 Any family member or close contact have any other suspected

symptoms such as fever, cough, difficulity in breathing

17 Do you have Covid-19 positive case in your neighbourhood

Truck Driver Codriver Signature ड्राइवर के हस्ताक्षर

Vigilance/ Safety Co-coordinator Signature

सेफ्टी कोऑर्डिनेटर के हस्ताक्षर

Logistics Manager Signature मैनेजर के हस्ताक्षर