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SELF DECLARATION

Note: Proceed with this Self -declaration only if you are a Registered Nurse or a Doctor

For the purposes of being considered eligible to undertake the ‘Essential Upskilling for Nurses on COVID-19 Pandemic Management’ provided by Trained Nursing Association of India and Columbia Asia [•] (herein referred to as the Course), I confirm and declare that:

  1. I:
    1. am a (i) qualified, trained and registered Nurse or (ii) a qualified, trained, registered & practicing Medical Doctor, and
    2. I have never been disqualified by authority or court of law under any applicable law or regulation from pursuing the vocation/profession of Nursing or the profession of Medicine.
    3. am of sound mind and am above 18 years of age as on the date of making this declaration.
    4. am not currently undergoing or under notice or assertion of any criminal prosecution or other criminal or professional misconduct investigation
  2. I understand clearly that every effort has been made by the Curators of this Course to ensure that the content thereof is factually correct and is reasonably updated to current dates and is based on and aligned with the advisories issued by World Health Organisation (WHO), Indian Council of Medical Research (ICMR) and Centres for Disease Control (CDC).
  3. I understand clearly that the application or use of this knowledge by me must (i) conform to the highest standards of care and professionalism ensuring always and uncompromisingly the adherence to the professional requirements attaching to the profession of Nursing and as appropriate to the profession of Medicine (ii) be used by me with utmost care in conjunction with knowledge gained by me during my degree, experience and knowledge gained during the profession.
  4. I understand and appreciate that the Course has been designed and is offered without any monetary consideration or participation fee on a good faith basis in public interest.

I hereby solemnly and truthfully declare that the statements/disclosures made, and information submitted herein (collectively Information) and undertakings provided herein are individually and collectively true and accurate to the best of my knowledge and belief. I understand if the Information shared by me is found to be incorrect or false or not fully true at any stage, my candidature in the course will be cancelled with immediate effect. I hereby indemnify and shall keep indemnified and held harmless at all times in future and without limitation as to time and amount, Columbia Asia, Trained Nurses Association of India, Generation India Foundation and all other Partners and persons who have played any part or role in creating the Course against any cost, liability, reputational damages or any other consequence whatsoever as may directly or indirectly arise to or be asserted against them either individually or collectively on account of any act of omission or commission taken by me in my personal or professional capacity whether in course of my work or otherwise and whether related to COVID 19 or otherwise.

Agreeing to this statement is legal consent to all statements mentioned on this page and shall be enforceable against me under the law of contract or other applicable law in India.

SELF DECLARATION

Note: Proceed with this Self -declaration only if you are a Nursing Student

For the purposes of being considered eligible to undertake the ‘Essential Upskilling for Nurses on COVID-19 Pandemic Management’ (herein referred to as the ‘Course’) provided by The Trained Nursing Association of India and Columbia Asia Hospital [•], I confirm and declare that:

  1. I:
    1. am a 3rd or 4th year Nursing college student and;
    2. am not currently undergoing or under notice or assertion of any criminal prosecution or other criminal or professional misconduct investigation.
    3. am not subject to or under any investigation or other proceeding for the purpose of professional negligence or for the purpose of determining any professional lapse or negligence or professional incapacity.
  2. I understand clearly that every effort has been made by the Curators of this Course to ensure that the content thereof is factually correct and is reasonably updated to 10th May 2020 and is based on and aligned with the advisories issued by World Health Organisation (WHO), Indian Council of Medical Research (ICMR) and Centres for Disease Control (CDC).
  3. I also understand that this course & knowledge is for academic purposes only and does not enable me to handle treatment of COVID 19 patients. Only Nurses with experience and expertise should be handling such patients.
  4. I understand clearly that (i) the course is only for academic knowledge purpose (ii)Handling COVID patients requires the experience and further knowledge that registered and qualified Nurses must necessarily have/possess (iii)to use this knowledge, if I am a final year student and have been enlisted by government body or by Government hospital or other approved Hospital or COVID Care Centre or Facility approved by the Government of India and the Government of the respective State to work in such Hospital or Centre or Facility under properly established protocols and the guidance and supervision of concerned Hospital/Centre/Facility with utmost care and fully in accordance and in conjunction with professional knowledge gained by me during my course of study in the Course being pursued by me.
  5. I understand and appreciate that the Course has been designed and is offered without any monetary consideration or participation fee on a good faith basis in public interest.

I hereby solemnly and truthfully declare that the statements/disclosures made, and information submitted herein (collectively Information) and undertakings provided herein are individually and collectively true and accurate to the best of my knowledge and belief. I understand if the Information shared by me is found to be incorrect or false or not fully true at any stage, my candidature in the course is liable to be cancelled with immediate effect.

I hereby indemnify and shall keep indemnified and hold harmless at all times in future and without limitation as to time and amount, Columbia Asia Hospital, The Trained Nurses Association of India, Generation India Foundation and all other Partners and persons who have played any part or role in creating this Course against any cost, liability, reputational damages or any other consequence whatsoever as may directly or indirectly arise to or be asserted against them either individually or collectively on account of any act of omission or commission taken by me in my personal or professional capacity whether in course of my work or otherwise and whether related to COVID 19 or otherwise.


Agreeing to this statement is legal consent to all statements mentioned in this document and shall be enforceable against me under the law of contract or other applicable law in India.