Asymptomatic Confirmed COVID-19 Individuals

I (as named above) hereby declare I do not have any respiratory symptoms, high temperature or any other COVID-19 symptoms. I will commit to continuing my health quarantine at home for the specified period (10 days) from the date of the positive swab result, or until I am no longer symptomatic. I also declare the following:

1. Reading, agreeing to and complying with the Ministry of Health Home Isolation guidelines which are as follows:

• Specify my location using Tetamman application within 8 hours after I receive my permission. Otherwise, the concerned governmental authority will be notified after 24 hours to take necessary actions.

• Staying at home during all my home isolation period and never leaving unless to seek medical care.

• Staying in an isolated room away from other household members and to refrain from sharing food and drinks with them, especially high-risk members like the elderly, people with chronic conditions, and pregnant women. I will also stay away from pets

• Wearing a face mask when I have to leave the room or the house for any necessary reason (e.g. going to the hospital), or when I need to pass by or stay in a shared space. I will keep a distance of one meter and a half or more between myself and others.

• Covering my mouth and nose with tissue when I cough or sneeze and will appropriately dispose of the used tissue right away. After that, I will thoroughly wash my hands with soap and water for at least 40 seconds or I will use an alcoholic hand sanitizer.

• Refrain from sharing personal amenities with others (e.g. towel and utensils). I will disinfect with alcohol or chlorine-containing sterilizers all surfaces (regularly touched) like doorknobs, keyboards, light switches, mobile phones etc.).

• Ensuring that shared spaces at the house has good ventilation like an open window and if possible, allocate a toilet at home for my private use and always keeping the toilet cleaned and sanitized after every time it is used in case I have to share it with others.

• Monitoring symptoms like a dry cough, high temperature and difficulty breathing and to immediately call 937 in case any of the previously mentioned symptoms occur, or to immediately head to an emergency room if I start to have chest pains and difficulty breathing.

2. I have been registered in Tetammen and Tawakkalna applications. I was oriented on how to deal with the applications, follow ups and how to perform daily health evaluations.

3. Log in to Tetamman application to perform daily health evaluations.

4. Currently, I do not have any symptoms.

5. I agree to the Ministry of Health (MOH) taking any necessary preventive or curative measures, performing medical and laboratory tests and any other procedures that MOH deem necessary to my health and to the public health. I will report back to the hospital when I am contacted via the above stated numbers.

6. I pledge to adhere to the above instructions and other instructions issued later by concerned authorities in regards to dealing with COVID-19 pandemic and that not adhering to these instructions and guidelines will result in penalties such as a monetary fine that can reach SAR 500,000 or imprisonment for up to two years or to both penalties.