COVID-19 Screening Self Declaration Form

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The safety of our employees, supplier partners, customers, families, and visitors remains the Catalyst group’s utmost priority. As the coronavirus disease 2019 (COVID-19) outbreak continues to evolve and spread globally, we are following the current recommendations from the World Health Organization and Government of India. To prevent the spread of COVID-19 and reduce the potential risk of exposure to our workforce and visitors, we are conducting a simple screening questionnaire. Your participation is important to help us take precautionary measures to protect you and everyone around you. Thank you for your time.

Your Name *

Phone number *

Which of the statements below is applicable to you *

I have undertaken an inter-state of inter-district travel

I reside in a containment zone

I have had close contact or cared for someone diagnosed with COVID-19 within the last 21 days

I/family member have experienced any cold or flu-like symptoms in the last 21 days

None of the above

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