Covid Self Declaration Form

Self-declaration form to be mandatorily filled by the traveller.

Please fill up this form, which will require you to declare any illness and provide information that will aid in contact tracing, should the need arise.

Be sure that the information you give us accurate and complete. All the information submitted shall be encrypted, and strictly used only in compliance with state government guidelines, and ordinances, in relation to business operation in light of COVID-19 response.

Personal Information
Personal Info.
Contact Details
Your Contact Details
Your Current Address
Emergency Contact Details
Emergency Contact Details

As the same as your current address?

COVID-19 Preventive Questions
Thank you for being vaccinated! ❤️😊

"Close Contact" Definition

Defines close contact as anyone who was within 6 feet of an infected person for at least 15 minutes starting two days before the onset of symptoms until the time the patient is isolated.

Healthcare-associated exposure, including providing direct care for COVID-19 patients, working with health care workers infected with COVID-19, visiting patients, or staying in the same close environment as a COVID-19 patient. Working together in close proximity or sharing the same classroom environment with a COVID19 patient.

Travelling together with COVID-19 patients in any kind of conveyance.

FYI: People they have been in close contact with (such as those living in the same household or extended household) may pick up the virus but not show any symptoms for up to 14 days. These people are asked to isolate for 14 days so that they are sure they are not going to get ill and pass the illness on to others outside the household.

Declaration

Self Declaration

I am not suppressing any relevant/ material facts and all the above-stated information is correct to the best of my knowledge. Non-disclosure/ suppression of information may attract the penal provision.

I undertake this journey at my own risk of contracting any disease including COVID 19 and any member of the organizing committee is not be liable for any costs incurred or damages suffered upon, either direct or indirect, as a result of or incidental to such illness and I release organizing committee members from any liability of any kind arising therefrom.

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Private Data Protection Notice

We do this as preventive measures for our community to mitigate the risk of a novel Coronavirus disease (COVID-19) outbreak.

This data sheet will be stored safely and is not shared with any third party unless there will be an official request by the local authorities for reasons of public interest in the area of public health.

The datasheet will be deleted one month after collection unless a longer period is required by the public authorities.

Thank you for your cooperation!

In case you develop symptoms such as fever and cough within 14 days of the trip ends restrict your outdoor movement and contact 24 hours helpline number 011-23978046. The Helpline Numbers of States & Union Territories for corona-virus

  • Central Govt. Helpline: 011-23978043/46
  • Maharashtra Helpline: 020-26127394
  • Police: 100
  • Ambulance: 108
  • Fire Brigade: 104
  • PMC: 1800-1030-222
  • Disaster Mana. Control Room: 1077
  • Child Helpline: 1098
  • Women Helpline: 1091
The Helpline Email ID for corona-virus: ncov2019@gov.in
Information Source: https://www.pmc.gov.in
  
STAY SAFE! STAY HEALTHY!

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(+91) 99 2345 0044
Mon-Fri, 08:00-21:00 hrs. (IST)

contact@sgtrekkers.in

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