I always keep my blue-tooth & location for AAROGYA SETU App in the phone on and I have checked
that today and verify that’s it’s on
Status of AAROGYA SETU App is “YOU ARE SAFE”
None of my family members including myself have fever, cough & difficulty in breathing
I always use and will continue to use face mask, face shield & hand gloves without fail
I would strictly maintain hand hygiene, social distancing norms & respiratory etiquettes
I would ensure pillion riding is not done
I have read the guidelines and I confirm that I will immediately report to my reporting manager
and the field co-ordinator of any change in the one-time declaration form
EMPLOYEE WSFA COVID - 19 DECLARATION FORM
1 Does your place of present residence fall
under the category of a COVID-19 HOTSPOT as declared by the relevant authorities of the
state/centre or by the Company?
2 Do you happen to know any person diagnosed
with COVID 19 who resides in your building/vicinity?
3 Travel history (last one month) of any
International and/or domestic trip of you/family members/close relatives:
4 Whether any family member/close relatives
living with you put under quarantine by the relevant state/central health
authorities:
5 Did you/ any family member/close relatives
notice any symptoms of cough, fever, cold, congestion, breathlessness, weakness within the last
one month?
6 If any of question no 4 and 5 is yes, then
whether any physical contact/interaction/meeting with such family member/close
relatives?
7 Did you have any of the COVID-19 symptoms
and/or any other disease?
8 If Yes then did you visit a doctor/reported
to the authorities?
