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    Covid19 - Employee Declaration Form-2798

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    Veerendra Reddy Vintha
    V. Veerendra Reddy completed a COVID-19 employee self-declaration form for his employer. He indicated that he had traveled to his native place DIDUGU(V),(NATIVE PLACE) from June 7-October 12 and obtained prior permission. He answered no to all questions regarding COVID-19 symptoms or exposure. He declared the information as true and understood he would be responsible for any false declarations.

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    Covid19 - Employee Declaration Form-2798

    Uploaded by

    Veerendra Reddy Vintha
    33 views2 pages
    V. Veerendra Reddy completed a COVID-19 employee self-declaration form for his employer. He indicated that he had traveled to his native place DIDUGU(V),(NATIVE PLACE) from June 7-October 12 and obtained prior permission. He answered no to all questions regarding COVID-19 symptoms or exposure. He declared the information as true and understood he would be responsible for any false declarations.

    Original Title

    Covid19_Employee Declaration Form-2798

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    V. Veerendra Reddy completed a COVID-19 employee self-declaration form for his employer. He indicated that he had traveled to his native place DIDUGU(V),(NATIVE PLACE) from June 7-October 12 and obtained prior permission. He answered no to all questions regarding COVID-19 symptoms or exposure. He declared the information as true and understood he would be responsible for any false declarations.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    33 views2 pages

    Covid19 - Employee Declaration Form-2798

    Uploaded by

    Veerendra Reddy Vintha
    V. Veerendra Reddy completed a COVID-19 employee self-declaration form for his employer. He indicated that he had traveled to his native place DIDUGU(V),(NATIVE PLACE) from June 7-October 12 and obtained prior permission. He answered no to all questions regarding COVID-19 symptoms or exposure. He declared the information as true and understood he would be responsible for any false declarations.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    COVID-19 EMPLOYEE SELF DECLARATION FORM

    1. Do you live in a containment zone? No


    2. Have you been outside Hyderabad in the past 2 YES
    weeks?
    If Yes, please furnish details below:
    06/07/2020
    i) Date of leaving station
    ii) Place(s) visited/stayed DIDUGU(V),(NATIVE PLACE)
    iii) Mode of Travel
    PERSONNEL CAR
    iv) Date of return 12/10/2020
    v) Was prior permission obtained from Manager /
    YES
    Team Lead

    3a. Did you attend any social/religious/neighborhood No


    gathering with more than 10 people in the past 2
    weeks week? If yes, furnish the details (date &
    occasion)
    3b. Are any such events planned in the next If yes, furnish No
    the details (date & occasion)
    4. Do you have any family member who is working in No
    Essential Services such as Police/ Hospitals / Retail
    Store?
    5. In the last 14 days/currently are you experiencing any
    of the following symptoms?
    No
    Fever, Cough, Sore Throat
    No
    Shortness of Breath/Difficulty in Breathing No
    Persistent Pain in the Chest No
    Loss in Taste and Smell No

    If yes, date when the symptoms first appeared. No

    6. Have you been in contact with anyone who is No


    suspected or diagnosed positive of COVID-19?
    If yes, when and how? Have you been screened for
    COVID-19?

    7. Is anyone in your Residential vicinity infected with No


    COVID-19?

    I, VEERENDRA REDDY VINTHA hereby declare that the above information is true and factual. I also
    understand that if any of the above declarations are found to be false, I am personally responsible for the
    consequences. However, Aarvee can take any action deemed fit as per prevailing government issued
    guidelines or acts.
    (Signature & Date)
    Name & E. Code: V.VEERENDRA REDDY,2798
    Mobile No.: 9700420317
    Current Address: MIG-3,BALAJI NAGAR,KUKATPALLY-500072
    If any of the above are Yes, bring it to the notice of your division head, and you should not come to the
    office.
    If any of the above are Yes, bring it to the notice of your division head, and you should not come to the
    office.

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