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Health Declaration Form

The document is a declaration form for students staying at VIT Hostel, confirming their COVID-19 status and adherence to health protocols. Students must declare they are not COVID-19 positive, have not been in a containment zone, and will follow safety guidelines during their stay. Non-compliance with the protocols may result in penal action.

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abhishekbartan94
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82 views1 page

Health Declaration Form

The document is a declaration form for students staying at VIT Hostel, confirming their COVID-19 status and adherence to health protocols. Students must declare they are not COVID-19 positive, have not been in a containment zone, and will follow safety guidelines during their stay. Non-compliance with the protocols may result in penal action.

Uploaded by

abhishekbartan94
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

NAME:

Registration No:

Mobile No:

Email Id:
Reporting Date:

Proctor Name:

COVID Status: I am not COVID-19 positive.

I have declared that:

• I am/was not residing in any containment zone.


• I am not suffering from any fever, cough, or any respiratory distress.
• I am/was not under quarantine.
• If I ever develop any of the above-mentioned symptoms, I will immediately contact the concerned health authorities.
• I have not tested COVID-19 positive in the last three weeks.
• I am eligible to stay in hostel as per the extant norms.
• I will make my mobile number/ contact details available to VIT hostel authorities, whenever required by them.
• I understand that if I avail the VIT hostel accommodation without meeting the eligibility criteria, I would be liable to penal
action.
• I will adhere to the health protocol prescribed by the state.

VIT Hostel stay advisory: Safety during COVID-19

We seek your kind assistance to safeguard your well-being, as well as that of your fellow residents and our staff at VIT
Hostel, by following the guidelines set out below:
All students should wear a mask and frequently sanitize their hands.
be removed only
while eating and drinking.
Please maintain appropriate social distancing while on campus.
Kindly adhere to all the announcements and other directives issued by our VIT staff and/or authorities at all points of time during
your stay at VIT Hostel.
Caution: Students are advised to strictly follow all COVID-19 protocols. Failure to comply with these guidelines and the
directions of our VIT Hostel staff and/or authorities may attract penal action against the concerned individual.

Date:

Place: Signature of Student

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