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Annexure 2 (PHD Students)

1) The document is a self-declaration form for PhD students returning to campus during the COVID-19 pandemic. 2) It requires students to declare that they do not have COVID-19 symptoms, have not been exposed to the virus, and will follow safety protocols like wearing a mask and social distancing. 3) It also confirms the student's research requires them to return to campus and cannot be done remotely, and that their supervisor did not pressure them to return but agrees the work cannot be delayed.

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Bin Desh
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49 views2 pages

Annexure 2 (PHD Students)

1) The document is a self-declaration form for PhD students returning to campus during the COVID-19 pandemic. 2) It requires students to declare that they do not have COVID-19 symptoms, have not been exposed to the virus, and will follow safety protocols like wearing a mask and social distancing. 3) It also confirms the student's research requires them to return to campus and cannot be done remotely, and that their supervisor did not pressure them to return but agrees the work cannot be delayed.

Uploaded by

Bin Desh
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
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Annexure-2

Self-Declaration/Undertaking Form (for PhD Students)


Date:
Respected Sir/Madam
I, Mr./Ms./Mrs. ………………………………………….……………………………………….
with ID no. …………………………………. type of ID…………..……..…………… PhD
scholar of ………………………………..….. Dept. withRegn.No. ………….......………… and
boarder of Hostel No. …………………………………………………..have gone through and
understood the guidelines and protocols of the institute pertaining to resumption of
study/research. I state that I am aware that it is entirely voluntary for me to return to the institute
and that I am doing so of my own free will, having understood the risks inherent in commuting
to, and doing laboratory work at the institute in the current COVID-19 pandemic scenario. I am
returning from ……………………………… on…../…./2020.
In my opinion, which has been affirmed by my supervisor, it is completely essential for me to
come to research lab/computation facility at NIT Silchar and the nature and/or stage of my
research is such that it cannot be done from home and that any further delay would jeopardize
my research work.
I declare that,
1) I am not having fever, cough and breathing problem from last two weeks.
2) None of my family members where I was living is suffering from fever, cough and
breathing problem past 2 weeks.
3) I am not having any disease like diabetes, hypertension or heart/lung/kidney related
diseases etc.
4) I will wear face mask as well as other protective gear and maintain physical social
distancing in my class rooms/laboratories/academic area/hostels and in NIT Silchar
campus.
5) I will regularly wash my hands with soap and water for at least 40 seconds or clean
them with alcohol based sanitizer.
6) I will use ArogyaSetu app on my mobile and they will remain active at all times
(through Bluetooth and Wi-Fi).
7) I will self-monitor my health every day after I return to the institute. In case, I develop
fever, cough, flu like symptoms and/or breathing problem then I will inform about it to
my Supervisor/Associate Warden/Head of the Department etc. Also I will consult one
health centre doctor and follow medical advice.
8) I understand that there is always a possibility of getting infected by the virus. My
parents/guardians are also fully aware of my wish to return to the campus to start
working in the laboratories and other offices for my research related activities.
9) I declare that I had a prior intimation to my supervisor(s) about my return. I also
want to declare that my supervisor has not put any pressure on me to resume the research
activities at NIT Silchar.
10) I understand that in case of COVID-19 infection I may require isolation, treatment
and/or hospitalization outside the campus for which I will follow government laid
down protocols.
11) I also understand that in case I am identified as SYMPTOMATICPOSITIVE COVID patient, I
will be transferred to the COVID Care facility of the District/Govt. Authority.

Registration no. and signature of student:

Emergency contact 1: Emergency contact 2:


Signature of parents/guardians:

I agree with the above request made by the research scholar that the nature and/or stage of the
research being conducted by him/her is such that it cannot be subjected to any further delay, nor
can it be done from home. I affirm that I have not exerted any pressure in making the research
scholar decide to return to the institute. I shall coordinate the wellbeing of the research scholar
with the help of available institute facilities in case of any COVID-19 related emergency.

………………………………………………………………
Name(s) and signature of the Research Supervisor(s)/P.I(s)
………………………………………………………………
Signature of the Head of the Department .

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