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    Tick/circle The Appropriate Answers For All Listed

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    Riya Singla
    This document is a self-declaration form for hotel guests regarding COVID-19. It requests guests provide their personal details, health status, and recent travel history. Guests must confirm they are not experiencing COVID-19 symptoms and have not been exposed to the virus through contact with infected individuals or travel to contaminated areas within the last 14 days. The form aims to screen guests and allow only asymptomatic individuals on hotel premises to protect guest and staff health and safety during the pandemic.

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    Tick/circle The Appropriate Answers For All Listed

    Uploaded by

    Riya Singla
    26 views1 page
    This document is a self-declaration form for hotel guests regarding COVID-19. It requests guests provide their personal details, health status, and recent travel history. Guests must confirm they are not experiencing COVID-19 symptoms and have not been exposed to the virus through contact with infected individuals or travel to contaminated areas within the last 14 days. The form aims to screen guests and allow only asymptomatic individuals on hotel premises to protect guest and staff health and safety during the pandemic.

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    Self Declaration Form.docx

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    This document is a self-declaration form for hotel guests regarding COVID-19. It requests guests provide their personal details, health status, and recent travel history. Guests must confirm they are not experiencing COVID-19 symptoms and have not been exposed to the virus through contact with infected individuals or travel to contaminated areas within the last 14 days. The form aims to screen guests and allow only asymptomatic individuals on hotel premises to protect guest and staff health and safety during the pandemic.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    26 views1 page

    Tick/circle The Appropriate Answers For All Listed

    Uploaded by

    Riya Singla
    This document is a self-declaration form for hotel guests regarding COVID-19. It requests guests provide their personal details, health status, and recent travel history. Guests must confirm they are not experiencing COVID-19 symptoms and have not been exposed to the virus through contact with infected individuals or travel to contaminated areas within the last 14 days. The form aims to screen guests and allow only asymptomatic individuals on hotel premises to protect guest and staff health and safety during the pandemic.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    SELF-DECLARATION FORM FOR GUESTS (COVID-19)

    Dear Valued Guest,

    The outbreak of COVID-19 (Novel Coronavirus) requires early and effective detection of suspected cases to
    limit the risk of exposure to others. The Ministry of Health and Family Welfare has directed the Hotels to
    obtain personnel particulars requested in this form, conducting temperature screenings, and ensuring that
    only asymptomatic persons are allowed into hotel premises.

    Accordingly, we seek your cooperation in completing this form before you Check-In. We are grateful for your
    support and apologize for any inconvenience caused. Please be rest assured that the information collected in
    this questionnaire shall be disclosed and used solely for determining whether it is permissible for guests to
    stay or use services at the Hotel, to ensure that we provide a safe and healthy environment for everyone
    during this period, and as may be permitted by applicable law or required by government and regulatory
    authorities.

    Name: Place of residence:

    Telephone No.: Mobile No.:

    Travelling from: Proceeding to:

    Check in date: Check out date:

    Tick/circle the appropriate answers for all listed

    1. Do you currently have any of the following symptoms?

    Fever/Chills YES / NO Cough YES / NO

    Shortness of Breath YES / NO Difficulty breathing YES / NO

    Sore Throat YES / NO Diarrhoea YES / NO

    Others YES / NO

    2. Within the pa st 1 4 da ys ha ve you,

    (i) Expe r ie nce d a ny of the ab ove symptoms ? YES / NO

    YES / NO
    (ii)Come in contact with any person/s who was tested COVID-19 Positive on or within 14
    days of your contact with them?

    (iii)Travelled outside India in the last 14 days? YES / NO

    YES / NO
    (iv)Visited any area within India / State / City, in a contamination zone or in any place
    which was declared contaminated during or after your visit?
    4. Are you currently on medication for any of the below: YES / NO
    Hypertension, Diabetes, Asthma, Cancer

    or any other illness or condition, please indicate

    I hereby confirm that the information contained in this Self-Declaration Form is accurate and complete.

    Name: Signature & Date:

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