Indian Oil Corporation Limited

Haldia Refinery

Date: 01.06.2020
A D V I S O R Y on COVID - 19
ABROAD, INTER-STATE AND INTRA-STATE TAVELLERS

I. All travelers arriving at Haldia Refinery from ABROAD and INTER-STATE shall contact
Haldia Refinery Hospital (Intercom – 4310 / 4326 / 4313). Health screening of all such
travelers will be arranged by Haldia Refinery Hospital.
II. All asymptomatic travelers shall go for home quarantined for 14 days based on advice of
HR hospital Doctors. In case they develop any symptom they will inform the same to HR
hospital for necessary medical intervention. They will be allowed to join with a Medical
Certificate from HR hospital after 14 days.
III. All symptomatic travelers, will have to undergo COIVD-19 Test from Nominated Hospital
at Kolkata or Durgachak Sub-Divisional Hospital with prior information to HR hospital.
Further course of action in such cases would be advised by Haldia Refinery Hospital
based on Test Result. They would be allowed to join based on a Medical Certificate
issued by HR hospital, as and when deemed fit by the Hospital.
IV. All INTRA-STATE travelers should undergo Medical checkup at HR hospital and obtain a
medical fitness certificate for their joining. They will need to give an UNDERTAKING that
they have not travelled to or from any CONTAINMENT zone in last 14 days. In case any
INTRA-STATE traveler has visited a CONTAINMENT zone, they will have to undergo
COIVD-19 Test from Nominated Hospital at Kolkata or Durgachak Sub-Divisional Hospital
with prior information to HR hospital. Further course of action in such cases would be
advised by Haldia Refinery Hospital based on Test Result. They would be allowed to join
based on a Medical Certificate issued by HR hospital, as and when deemed fit by the
Hospital.
Format of Undertakings to be submitted – (A) For IOCL Employees & Dependents and (B) For
other than IOCL employees is enclosed
V. Besides the above guidelines , The following shall continue to be ensured by all
employees, their dependents & all other stakeholders:
 Indian Oil Corporation Limited
Haldia Refinery

I. Any person arriving at Haldia Refinery from any location will have to download Arogya
Setu App and keep Bluetooth activated.
II. He should also Compulsory wear of Face Masks at public / work place, maintain norms
of social distancing at work place, ensure hand hygiene at all times by frequent washing
of hands with soap and water or use of alcohol based hand sanitizers.
III. He should also ensure compliance of various advisories pertaining to COVID -19 issued
by IOCL / Govt authorities from time to time
***
 Indian Oil Corporation Limited
Haldia Refinery

F O R M A T – A (ABROAD, INTRA-STATE AND INTER-STATE TAVELERS)

U N D E R T A K I N G (For Employees and Dependents)

I, Shri / Smt. ___________________________________________, EMP No. ______________________,

Designation ______________________________________________, Grade _____________________,
Section _______________ _____________________Department _______________________ hereby
undertake that;

1. I have traveled from _________________________________________________________,

District _______________________________,
State____________________________________, Country
_________________________________ on Date ___________________.

2. The above location IS / IS NOT (delete whichever is not applicable) a CONTAINTMENT ZONE (As
declared by Govt of India or Govt of Concerned State or Govt of West Bengal.
3. I have travelled / not travelled to or from any containment zone in last 14 days (delete
whichever is not applicable )
4. I have reached Haldia on Date _________________________.

5. I have NO Symptoms / MILD Symptoms (for COVID-19) (delete whichever is not applicable)

6. I have given my sample / my sample & my dependents’ sample travelling with me at

________________________________ Hospital on ___________________. (To be filled up only
in applicable cases)
7. It has been intimated by ___________________________________ Hospital that my /our test
results will be available on _______________________.___________________. Immediately
after availability of test result I will contact Haldia Refinery Hospital for further advice .(To be
filled up only in applicable cases)
8. I have reported for medical checkup at Haldia Refinery Hospital on _______________________ .

9. Myself & my family members have been advised Home quarantine from _______(Date) to
______ (Date) . I shall intimate Haldia Refinery Hospital immediately if I or my family members
develop severe symptoms of COVID – 19 during the quarantine period . .(To be filled up only in
applicable cases)

10. I / I and My dependents have downloaded and installed Arogya Setu App on my / our mobile
phones and my / our Bluetooth is activated.

11. I shall obtain Medical fitness Certificate before joining duties at Haldia Refinery.
I hereby understand and Undertake that the information provided as above are true to the best of my
knowledge. I Undertake that at any time, if I am found to have concealed any fact on the above, Haldia
Refinery Management will institute suitable disciplinary action against me.

Date: ______________________ Signature: ______________________________

Name: _______________________________
EMP No: _____________ Desgn___________
Address _____________________________
Phone / Mobile _______________________
 Indian Oil Corporation Limited
Haldia Refinery

F O R M A T – B (ABROAD, INTRA-STATE AND INTER-STATE TAVELERS)

U N D E R T A K I N G (For other than IOCL Employees)

I, Shri / Smt. _________________________________, Designation _____________________________,

Company _________________________________________________________________________,
hereby undertake that;

1. I have traveled from _________________________________________________________,

District _______________________________,
State____________________________________, Country
_________________________________ on Date ___________________.

2. The above location IS / IS NOT (delete whichever is not applicable) a CONTAINTMENT ZONE (As
declared by Govt of India or Govt of Concerned State or Govt of West Bengal.

3. I have travelled / not travelled to or from any containment zone in last 14 days (delete
whichever is not applicable )
4. I have reached Haldia on Date _________________________.
5. I have NO Symptoms / MILD Symptoms (for COVID-19) (delete whichever is not applicable)
6. I have given my sample / my sample & my dependents’ sample travelling with me at
________________________________ Hospital on ___________________. (To be filled up only
in applicable cases)
7. It has been intimated by ___________________________________ Hospital that my /our test
results will be available on _______________________.___________________. Immediately
after availability of test result I will contact Haldia Refinery Hospital for further advice .(To be
filled up only in applicable cases)

8. I have reported for medical checkup at Haldia Refinery Hospital on _______________________ .

9. Myself & my family members have been advised Home quarantine from _______(Date) to
______ (Date) . I shall intimate Haldia Refinery Hospital immediately if I or my family members
develop severe symptoms of COVID – 19 during the quarantine period . .(To be filled up only in
applicable cases)
10. I / I and My dependents have downloaded and installed Arogya Setu App on my / our mobile
phones and my / our Bluetooth is activated.
11. I shall obtain Medical fitness Certificate before visiting Haldia Refinery
I hereby understand and Undertake that the information provided as above are true to the best of my
knowledge. I undertake that at any time, if I am found to have concealed any fact on the above, IOCL,
Haldia Refinery Management will institute suitable punitive actions against me and my Company /
Organization.

Date: ______________________ Signature: ______________________________

Name: _______________________________
Designation____________________________

Address ______________________________
Phone / Mobile _______________________