Scribd
Upload
4 views1 page

Self Declaration

The document is a Self-Health Declaration Form for individuals arriving at IIMA, requiring personal details such as name, arrival date, and contact information. It includes declarations regarding the individual's health status, including symptoms and COVID-19 testing history, and outlines adherence to health protocols. The form emphasizes the importance of self-isolation and minimal interaction with the community for a week after arrival.

Uploaded by

rahulpandey8007
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
4 views1 page

Self Declaration

The document is a Self-Health Declaration Form for individuals arriving at IIMA, requiring personal details such as name, arrival date, and contact information. It includes declarations regarding the individual's health status, including symptoms and COVID-19 testing history, and outlines adherence to health protocols. The form emphasizes the importance of self-isolation and minimal interaction with the community for a week after arrival.

Uploaded by

rahulpandey8007
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Please e-mail this page to- security@[Link]& estatemngr@[Link].

in

Self-Health declaration form


Name of the arriving person:

Arrived on (Date):

Mobile no

Email Id

Age

House/ Dorm/ MSH No.


(where staying on
Campus)

Arriving From (Give


complete address)

I declare that:
 I was not residing in any containment zone.
 I am not suffering from any fever, cough, or any respiratory distress.
 I am not under quarantine.
 If I ever develop any of the above-mentioned symptoms, I will immediately contact the
dispensary of the institute.. (Ext. 4777)/ Mobile : 9825022796
 I have not tested COVID19 positive in the past / I have tested Covid-19 positive on
____________and recovered completely thereafter.
 I will adhere to the health protocol prescribed by the Gujarat state.
 I will self-isolate & restrict my interaction with the IIMA community to bare minimum for a week.

You might also like