Undertaking by the Student

I, Mr/Ms…………………………......................................, having Roll

No……………………………, enrolled on ……………. (month), ……………… (year) in

the (Department/ Centre/ School) ………………………………………………..in the

academic program ........................................................................................................ hereby

declare the following:

A. That my stay in the campus is required to carry out academic tasks;

B. That before I start for the campus, I will undergo a medical check-up and RT PCR
COVID19 Test as latest as possible to the date of journey (96 hours for train journey/
72 hours for flight) and forward the COVID 19 Test report with this undertaking;
C. That I will do RT-PCR test in my home town from Government approved centers
and before starting my journey towards IIT Kharagpur and not do RT-PCR test
upon arriving to Kharagpur or nearby areas.
D. That I will inform the details of my travel itinerary in advance and observe all
protocols for safe journey recommended by B. C. Roy Technology Hospital, IIT
Kharagpur;
E. That I will undertake the journey from Kolkata Airport, and/or Kharagpur Rail Station
following all the protocol
F. That on reaching the campus, I will report to B. C. Roy Technology Hospital, IIT
Kharagpur and on their recommendation move to the allotted quarantine facility in the
campus;
G. That based on the health condition I will undergo necessary quarantine for 14 days or
more in the designated facility;
H. That during the quarantine, I will not engage in any socialization in any form and
maintain complete isolation;
I. That if infected with COVID-19, I will abide and follow all the medical procedures
as may be prescribed by B. C. Roy Technology Hospital, IIT Kharagpur;
J. That I am mindful of the fact that the B. C. Roy Technology Hospital, IIT Kharagpur
provides only primary health care, and there is no advanced medical treatment facility
within the campus or Kharagpur township;
K. That I am aware of the difficulties in availing advanced medical facility at Kolkata
hospitals;
L. I completely understand that while the Institute will try to provide me with the best
possible health care, I will not hold the institute liable for any health emergencies;
M. In case of violation/failure to follow any of the rules and regulations imposed by the
institute, I will be liable for the disciplinary action of the Institute including
withdrawal of my hostel facilities and I may be asked to return to home.
N. That I am consciously using my discretion to travel to the IIT Kharagpur campus at
my own risk;
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 O. That as of the date of signing this undertaking, my COVID-19 vaccination status is
fully vaccinated.

I hereby declare that the above provided information is true to my knowledge and sign this

undertaking being fully aware of the consequences of my action in a conscious state of mind

and body.

Date: Signature of the student

Place:
Hall of Residence:

I, Mr/Mrs/Dr/Prof……………………………………….......................... … … … …, as a

legal guardian/parent endorse the undertaking of my ward/son/daughter in conscious mind

after understanding the health risks and consequences.

Date: Signature of Legal Guardian/Parent

Place:

Special note: Covid cases are continuously being reported in our campus. Hence, you are requested
to strictly maintain the protocols advised, when in campus. If any violation of these mandatory
rules is noticed, like not wearing a mask in public spaces (inside or outside the Halls) or irregular
wearing of mask, would lead to issuing of notices to Supervisor, Faculty Advisor, Head of
Department and Guardian and sent back home at the earliest opportunity. We would wish you to
share the onus of maintaining the campus as much a covid-safe zone, as other campus community
members.

It is emphasized that during the quarantine as well as post quarantine, you should strictly avoid any
kind of socializing. Post quarantine, you will be allotted different Hall and obligation to maintain
COVID-19 safety protocol will continue throughout your stay.

Also note that unauthorized visits without intimation and permission outside the campus are strictly
prohibited, including week-end visits to Kolkata or any place beyond the campus periphery, unless
absolutely necessary. Please be warned that if anyone is found or reported indulging in such an
activity, s/he would immediately be asked to vacate the hostel room and return home.

D. Sen
Dean (SA)
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