FEU-NRMF HEALTH AND SAFETY DECLARATION AND COMMITMENT

I, __________________________,
Yman Gio Bauza Bumanglag commit to abide by the FEU-NRMF Health and Wellness
policy to safeguard my health and my family, FEU-NRMF students and employees.

1. Following the minimum health standards at school and wherever I may go such as:
• Wearing of mask
• Handwashing or sanitizing with alcohol frequently as the situation calls for
• Practicing physical distancing of 6 feet from others and avoiding congregation in
crowded places.

2. Help FEU-NRMF Administration trace my probable exposure to COVID positive patients

and/or their contracts by:
• Being truthful in my Health Declaration form and Health Declaration Survey
From.
• Subject myself to COVID-19 Contract Tracing System upon entry to the FEU-
NRMF and to any establishments that I may visit,
• Subject myself to the FEU-NRMF Internal Contract Tracing System by tapping
into the system whenever I go to another area in the hospital other than my
assigned work area.

3. Helping FEU-NRMF Administration keep tract of my physical condition by:

• Reporting any fever or respiratory symptoms
• Not reporting to school if sick
• Complying with stay home orders
• Complying with quarantine orders

I understand that failure to comply with health and safety protocols may result to exposing
myself and FEU-NRMF students and employees.

I understand that any violation may lead to disciplinary proceedings and sanctions by the
Discipline Committee after due process.

I acknowledge:
There is a heightened state of risk associated with engaging in Limited Face to face. I
agree:
o I will strictly adhere to infection-prevention strategies that may be implemented
by FEU-NRMF including in addition to those listed above for all students, using
other personal protective equipment as indicated by FEU-NRMF.
 o If I feel unsafe or have been exposed to a patient who later tests positive for
COVDI-19, I will notify the Department through the Subject coordinator for the
clinical experience of the condition which I believe is unsafe.

_____________________________
Yman Gio Bauza Bumanglag ____________________________
(Signature over printed name of (Signature over printed name of
Student) Parent/Guardian)

____________________________
Tita Y. Cruz, RN, MAN EdD Dr. Magdalena Florentina Natividad
_____________________________
Dean, School of _______________
Nursing Vice President for Academic Affairs

Atty. Antonio Henson Abad Jr.

______________________________
President