SRI LANKA TECHNOLOGICAL CAMPUS

SLTC FACILITY UTILIZATION APPLICATION

How to apply *

1. Before you complete this form please ensure you have read all the information at the end of this
document on the covid19 management or refer the notice on our website https://sltc.ac.lk
2. Either fill out this form directly in your web browser, then save a copy to your computer OR download
the form, print and fill in manually, then scan a copy.
3. Attach the completed and saved form to an email along with copies of any required and supporting
documents. Email to susanthak@sltc.ac.lk with the subject “Application for Utilizing SLTC Facilities”. *
4. Your applications will be acknowledged.

* Upload the completed form in pdf format together with your confirmation of participation using the
Google the Fill out Form

Please do not proceed unless you are granted permission.

SECTION 1: Your contact information

(Please provide the details of the person applying to utilize the facilities)

1. Full name:
2. NIC / PP No:
2. Staff/Student No: N/A
2. Phone number:
3. Email:
4. Facility/Premises that you request to use: SLMCC 2020 Competition Venue at SLTC, No07, Hector
Kobbekaduwa Mawatha, Colombo 07

SECTION 2: Reason and dat e for utilising the facility

4. I am requesting permission to utilise the facility (please select your reason(s))

 (Other reasons) Participant SLMCC 2020

5. Please provide details supporting your request:

Arranged by SLOMF .
.
.
.

6. Is there a date you need to travel? (please tick to confirm) Yes 󠆴

a. If yes, please provide the date (dd/mm/yy): 3rd July 2020 Tentative Timings: 8.00am – 2.00pm

SECTION 3: Support ing documents if any: N/A

7. Include copies of all documents supporting your application.

a. Please attach or scan documets relevant to your request to the email application.
 b. Please make sure all copies are readable and, where possible are dated and on a document.

SECTION 4: Your movement s and living arrangement s (Mandatory)

8. Current self-isolation address (house/unit number, street address, suburb and city you have occupied
during the lockdown period):

9. Organisation Address/es you will be going to:


SLTC – Colombo 7

10. Is your request one-way or return (use of hostel facilities etc.? Return

11. Are you travelling alone or with others? Alone  With others 
If with others, please provide details (full name and relationship to you):

N/A

12.. Please select how you will be travelling. (Select every travel method you will be using) : N/A

Met hod Out going t rip Ret urn t rip

a) Personal car Please provide registration make of car Please provide registration make of car
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

If you are not the driver, please provide t he following details:

1. Full name:
2. NIC No:
3. Current self-isolation address (house/unit number, street address, suburb and city):
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
4. Phone number:
5. Email:

c) Bus/ Train/taxi Please provide details (day/time/route) Please provide details (day/time/route)
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
13. Have you travelled domestically or internationally since the beginning of lockdown (16/03/2020)? (please tick
to confirm) Yes  No 
If YES, please provide details:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

14. Is there anything else you would like us to know? (please tick to confirm) Yes  No 
If YES, please provide details:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

SECTION 5: Your COVID-19 declarat ion (please tick to confirm)

I 󠆴confirm 󠆴the 󠆴following:
 have not been diagnosed with COVID-19,
 do not have symptoms consistent with COVID-19
 have not been tested for COVID-19 and are awaiting results
 not 󠆴a 󠆴close 󠆴contact 󠆴of 󠆴a 󠆴suspected/probable/confirmed 󠆴case 󠆴of 󠆴COVID-19
 have not travelled or been into a lockdown/ COVID-19 prevelant area within the last 14 days
 have not been instructed to refrain from traveling for medical reasons related to COVID-19

I 󠆴confirm 󠆴all 󠆴the 󠆴information 󠆴provided 󠆴in 󠆴this 󠆴form 󠆴and 󠆴supporting 󠆴documentation 󠆴is 󠆴correct. 󠆴
(Please sign confirm, electronic signature/typing will be accepted)
HOW TO MANAGE COVID-19 RISK WHEN YOU WANT TO USE THE FACILITIES & PREMISES

POINTS TO TAKE INTO CONCIDERATION WHEN YOU TRAVEL

1. Before traveling

1.1 Make sure you have the latest information on areas where COVID-19 is spreading and the current
status.
1.2 Based on the latest information make your application. Assess the benefits and risks related to your
activity.
1.3 Avoid traveling if you are t high risk (e.g. older employees and those with medical conditions such
as diabetes, heart and lung disease).
1.5 Consider carrying a small bottles of alcohol-based hand rub. This can facilitate regular hand-washing
and sanitising.
1.6 Use a standard 3ply face mask to ensure respiratory hygiene.

2. WHILE traveling:

2.1 Wash hands regularly and stay at least 1 m away from people maintain social distancing especialy those
who are coughing or sneezing.
2.2 Know what to do and whom to contact if you feel ill while traveling.
2.3 Ensure that you comply with instructions from local authorities and any local restrictions on travel,
movement, or large gatherings where you are travelling.

3. RETURNING from traveling:

3.1 Once you have returned you should monitor yourselves for symptoms.
3.2 If you develop even a mild cough or low-grade fever (i.e. a temperature of 37.3 C or more) they
should stay at home and self-isolate. Avoiding close contact (less than 1 m) with other people, including
family members. Call the local local public health department, giving them details of your recent travel
and symptoms.
POINTS TO TAKE INTO CONCIDERATION WHEN YOU UTILISE FACILITIES

1. BEFORE Entering the Premises:

1.1. Follow advice/instructions given by the mangemnet at all times.

1.2. Adhere to preparedness plan to prevent infection.
1.3 Make sure you have a mask on at all times.
1.4 Make sure you sanitise your hands before you enter the facility. Use your own pens etc for
documentation purposes.
1.5 Minimise/ avoid contact with surfaces that you do not need contact with.
1.6 Repeat the procedure if you have leave the premises and return at a later time for any reason.

2. DURING Utilisation of Premises

2.1 Proceed directlty to the location you wish to utilise once you confirm it is ready for use.
2.2 Confirm that the facility you are using has been cleaned and sanitised before you use it.
2.2 Practice respiratory hygeine by keeping your mask on and covering your face if you cough or
sneeze.
2.3 Clear your work area of any paper/ material that you have used and dispose of it safely before
you leave the work station.
2.4 Keep the work area safe for the next person to utilise.
2.5 Use the of alcohol-based hand rub dispensers provided around the venue.
2.6 If there ae others, ensure that you are least 1 meter apart.
2.7 If you or anyone within the facility feels unwell, follow our preparedness plan inform the
mangement or call our hotline.

3. AFTER Utilisation of Premises

3.1 Make sure you document your departue from the premises.
3.2 Retain the details of all actions/ locations utilized for at least one month. This will help public
health authorities trace people who may have been exposed to COVID-19 if anyone becomes ill.
3.4 If someone is isolated as a suspected COVID-19 case, we will inform you. You will be advised to
monitor yourselves for symptoms for 14 days and take temperature twice a day.
3.5 If you develop even a mild cough or low-grade fever (i.e. a temperature of 37.3 C or more) you
should stay at home and self-isolate. This means avoiding close contact (less than 1 meter) with other
people, including family members. Call the local public health department, giving them details of your
recent travel and symptoms.