(On the letter head of the establishment)
Date: ___/___/_____
                                   Declaration
              I, _________________________ Proprietor/ Authorized Signatory of
M/s     ________________________________________________        situated    at
__________________________________________. We are covered under following
categories as mentioned in the MHA guidelines dated 15.04.2020:
1. We          are         manufacturer/          service         provider         of
   _____________________________________________________________.                   I
   hereby declare that this unit produces essential goods/ provides essential
   services and is involved in the supply chain of the said essential goods/ services
   as stated in guidelines issued by Ministry of Home Affairs, Government of India
   from time to time.
2. We are a commercial establishment operating __________________________.
   The same is covered under sub clause _______ of clause 14 of MHA instructions.
3. We are an industrial establishment manufacturing _____________________. The
   same is covered under sub clause _______ of clause 15 of MHA instructions.
4. We are a builder/ construction company involved in construction of _______
   ____________________. The same is covered under sub clause _______ of clause
   16 of MHA instructions.
              I hereby declare that this industrial/ commercial establishment will
comply with the MHA guidelines as well as State Government guidelines and
directions received from the District Administration from time to time. In addition
to the above, it is also submitted that we have obtained all the required licenses/
permissions from various Govt. Authorities to operate the unit.
            I also declare that the unit will operate with the workforce as
mentioned in the application form and all the employees/ labour involved in the
operation of the unit will work with proper sanitization and social distancing
practices.
              If at a later stage, any of the above declared information is found to
be incorrect, I shall be liable for the same. I am also aware that I can be prosecuted
                       (On the letter head of the establishment)
u/s 188 of IPC & other laws enforced in India for providing any incorrect information
in this regard.
                                                     Authorized signatory with stamp
                      Name of the signatory: _______________________________
                      Designation: ________________________________________
                      Name of establishment: _______________________________
                                                                                                  Annexure II
      Standard Operating Procedure for Social Distancing for Officers, Workplace,
                            Factories and Establishments
Sr.     The following measures shall be implemented               Compliant    Relevant documents/proof to
No.     by     all   officers,  factories     and    other        with (Y/N)   be attached
        establishments: -
1.      All areas in the premises including the following                      No document is required to be
        shall be disinfected completely using user friendly                    submitted at application stage
        disinfectant mediums:
        a. Entrance Gate of building, office etc.
        b. Cafeteria and Canteens.
        c. Meeting room, Conference halls / open areas
           available / verandah / entrance gate of site,
           bunkers, porta cabins, building etc.
        d. Equipment and lifts
        e. Washroom, toilet, sink, water points etc.
        f.   Walls/ all other surfaces
2.      For workers coming from outside, special                               1. Passing capacity of the
        transportation facility will be arranged without any                      vehicle
        dependency on the public transport system. These                       2. No. of vehicles with regd.
        vehicles should be allowed to work only with 30-40                        no.
        % passenger capacity.                                                  3. Copy of RC of each vehicle
3.      All vehicles and machinery entering the premise
        should be disinfected by spray mandatorily.
4.      Mandatory thermal scanning of everyone entering                        No. of thermal scanners to be
        and exiting the work place to be done.                                 provided
5.      Medical insurance for the workers to be made                           Copy of ESI Certificate or copy
        mandatory.                                                             of any other medical insurance
                                                                               obtained.
6.      Provision for hand wash & sanitizer preferably with                    Total number of hand washes
        touch free mechanism will be made at all entry                         and sanitizers to be provided
        and exit points and common areas. Sufficient
        quantities of all the items should be available.
7.      Work places shall have a gap of one hour
        between shifts and will stagger the lunch breaks of                     S.   Timing    Shift   Shift   Shift
        staff, to ensure social distancing.                                     N.             A       B       C
                                                                                1    Opening
                                                                                2    Lunch
                                                                                3    Closing
8.      Large gatherings or meeting of 10 or more people
        to be discouraged. Seating at least 6 feet away
        from others on job sites and in gatherings,
        meetings and training sessions.
9.      Not more than 2/4 persons (depending on size)
        will be allowed to travel in lifts or hoists.
10.     Use for staircase        of      climbing   should   be
        encouraged.
11.     There should be strict ban of gutka, tobacco etc.
        and spitting should be strictly prohibited.
12.     There should be total ban on non-essential visitors
        at sites.
13.     Hospitals/clinics in the nearby areas, which are                       Attach the list of such hospitals
        authorized to treat COVID-19 patients, should be                       along with their emergency
        identified and list should be available at workplace                   contact numbers.
        all the times.
I hereby declare that we shall comply with the Standard Operating Procedure given above for Social
Distancing for Officers, Workplace, Factories and Establishments. In case any of the above information is
found to be incorrect/ false, I shall be liable for criminal proceedings as per the guidelines.
                                                                                      (Signature with Stamp of
                                                                         Industrial/Commercial Establishment)
        Implementation of Consolidated revised guidelines with regard to industry and other
                                     establishments w.e.f. 20.04.2020
Govt. of India has issued a set of guidelines vide letter dated 15 th April 2020 where in select
additional activities can be operational in the State in view of the economic hardship being
observed throughout the country. There are three key contours of guidelines provide by GoI: 1)
Demarcation of Areas as Containment Zones, 2) Permissible Activities within and outside
Containment Zone, and 3) the Implementation mechanism finalized by State of Haryana:
   1) Demarcation of areas as Containment Zone shall be determined by Health Department,
       Govt. of Haryana from time to time and will be published on onemapggm.gmda.gov.in
       and through press intimation.
   2) Activities permitted in and outside containment zones will be strictly regulated as per
       MHA guidelines dated 15.04.2020 (Copy Attached).
   3) Implementation Process
       1. Applicant shall apply on SARAL Haryana Portal (https://saralharyana.gov.in/) to obtain
           permission to resume operations and apply for passes. Further, passes for interstate
           movement of vehicles shall be applied on Govt of India portal for e-pass
           (https://covidpass.egovernments.org/requester-dashboard/)
       2. As a part of application, the applicant will give an undertaking of SoPs mentioned in
           annexure I & II of MHA order issued on 15th Apr, 2020.
       3. In order to scrutinize and approve the application committee shall be constituted at
           Block level, Town level, and City level comprising following members:
           Approval for passes up-to 25 people:
                    Sl.No    Rural Areas                 Urban Areas
                       1     SDM of the area             SDM
                       2     DSP of the area             DSP of the area
                       3     BDPO of the area            EO/ Secretary of the MC
                             Assistant Labour            Assistant Labour
                      4.
                             Commissioner                Commissioner
           Approval for passes for more than 25 but up-to 200 people
                    Sl.No    Rural and Urban areas       Municipal Corporation
                             (except MC areas)           (MC) Area
                       1     ADC of the area             Commissioner MC
                                                1 of 4
                2     DSP of the area             DSP of the area
                3     BDPO of the area            EO/ Secretary of the MC
                      Assistant Labour            Assistant Labour
                4.
                      Commissioner                Commissioner
   Approval for passes for more than 200 people
                          Sl.No    District
                             1     DC of the area
                             2     SP / CP of the area
                             3     GM DIC
                                   Dy Labour
                             4.
                                   Commissioner
   Assistant Director Industrial Safety will provide its full cooperation and assistance to
   these committees. Further, Chairman of the committee may coopt any additional
   member as required.
4. Applications received from Industries / Industrial establishments / Commercial and
   Private Establishments having employed up to 25 people shall be scrutinized and
   approved by the Block Level Committee.
5. Applications received from Industries / Industrial establishments / Commercial and
   Private Establishments having employed more than 25 people but up to 200 people
   shall be scrutinized and approved by the Committee headed by Addl DC /
   Commissioner, Municipal Corporation - MC, as applicable.
6. Applications received from Industries / Industrial establishments / Commercial and
   Private Establishments having employed more than 200 people shall be scrutinized
   and approved by the Committee headed by DC.
7. This entire process of scrutinizing and grant of permission / passes shall be issued in a
   phased manner through SARAL Haryana Portal https://saralharyana.gov.in/) by the
   aforementioned committee. The phasing will be done in each district as per social
   distancing norms and strict containment requirements in their district. Accordingly,
   approvals will be given in a phased manner strictly on first come first serve basis.
8. Guidelines for phased approval are as following:
        ● For Industries / Industrial establishments / Commercial and Private
            Establishments (other than IT and ITeS units)
                                         2 of 4
               a) In case of Pass requirement for up to 20 people, approve 100% of the
                   requirement
               b) In case of Pass requirement for more than 20 people, approve 50% of
                   the requirement or 20 passes, whichever is higher
        ● For IT and ITeS units
               c) In case of Pass requirement for up to 20 people, approve 50% of the
                   requirement
               d) In case of Pass requirement for more than 20 people, approve 33% of
                   the requirement or 10 passes, whichever is higher
        ● For Construction projects
               e) In case of in situ construction projects, allowed in 16.iii of MHA
                   guidelines, operations shall be allowed with 50% of the total
                   workforce. However, no passes will be issued
               f) In case of non in situ projects, allowed in 16.i, 16.ii, of MHA guidelines,
                   operations shall be allowed with 50% of the total workforce with
                   issuance of Blue passes
   It is clarified that opening of shops / dhabas on highways/movement of Self Employed
   individuals shall be strictly governed by MHA guidelines, and will be regulated by the
   Block / Town / City level Committee, as applicable, outside of this mechanism in
   consultation with Department of Labour by strictly adhering to the containment zone
   restrictions issued by MHA guidelines.
   In view of the approaching summer season and new academic session, distribution of
   books by book shops to school and college students and sale of Air Conditioners, Air
   coolers, Fans and their repair shops may be treated as essential goods / services and
   allowed to remain open and operate outside containment zone.
These guidelines are to be strictly implemented without any dilution. The District
Magistrates can, however, in exercise of the powers vested vide para 4(2) of the MHA
guidelines, fix the timings of various establishments, industries, and other permitted
activities depending upon the local requirements and norms of social distancing.
9. Passes shall be issued with the following distinction:
       a. Red Special Pass: Triangular passes in Red color shall be issued only to
           “Essential Service Providers” and Special pass holder will be allowed to enter
           the containment area (as defined by District Administration from time to time)
           or outside containment area both to provide essential services.
       b. Ordinary Pass: Rectangular passes (in Green color for Industries / Commercial
           Establishments and Blue color for Construction Projects) shall be issued to
                                       3 of 4
           other than “Essential service providers” eligible for “as per guidelines issued
           by MHA, GoI”. Ordinary Pass holder shall not be allowed to enter containment
           area (as defined by District Administration from time to time).
    Further, for in situ labour i.e labour residing within the factory unit / site, no separate
    passes shall be required.
10. Process Review Committee: A committee shall be formed under the chairmanship of
   the Special Secretary, Home Department and including Secretary Industries and
   Special Secretary Labour to oversee / monitor the issuance of passes.
11. The committee headed by the DC will oversee and monitor the functioning of other
   committees at district level.
12. Oversight Committee at State level under the Chairmanship of ACS (I&C) including
   administrative secretaries or their representation of departments such as Department
   of Health and Family Welfare, Department of Labour, Department of Food and
   Supplies, Home Department etc. shall be formed for the purpose of oversight and
   guidance to various departments of the Govt of Haryana. MD HSIIDC will be the Nodal
   Officer to co-ordinate the operations of this committee.
13. Grievance Redressal Mechanism: Industrial undertakings can submit their
   queries/grievances      pertaining    to      their   operations   on   Grievance    portal
   https://grs.hartron.io/#/ (available on Haryana Enterprise Promotion Centre portal)
   developed by Department of Industries & Commerce. HSIIDC, Department of
   Industries & Commerce, and Labour Department will act as Nodal Offices to co-
   ordinate the operations of this mechanism
14. It shall be noted that the State Government instructions are subject to MHA
   amendment to guidelines from time to time
                                        4 of 4