(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