Consolidated form for Health and Hygiene and availability of
Media facilities
Consolidated details of General Health and Hygiene of persons living together in
single house collected for safety reasons.
Name of the Student Teacher / Employee
Class:
Section:
Name Relationship Age
Sex Details of illness, if not well.
1. Anyone in your family affected by
Covid 19? Yes/No
2. If any member of your family is suffering from illness, it should be informed
to the school immediately.
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