Dooly County, GA · Dooly County
School Symptom Screening Checklist and Parent/Guardian Attestation
This bilingual checklist and attestation record COVID-19 symptom screening information for students and are completed by school screeners or a student’s parent or guardian.
At a glance
- Issued by
- City of Dooly County · Dooly County, Dooly County, Georgia
- Notarization
- Not required: file this form without a notary.
- Official source
- doolycountyga.com
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
This bilingual document includes screening checklists for elementary students and people entering school buildings, plus a K-12 parent/guardian attestation. It asks about close contact, symptoms, and prior COVID-19 diagnosis, and the attestation provides spaces for the child’s and parent or guardian’s names, the date and time, and a signature. The document explains when children should stay home or may return to school.
Who needs it
School screeners use the checklists, while a parent or guardian completes the K-12 attestation for a child.
How to submit it
Submit it to the county department named on the form; check the county website for current contact details.
About notarization
This checklist is signed and dated without a notary; the parent/guardian attestation includes a signature and date, with no sworn or notarized attachment stated.
How to submit this form
- 1
Download the Checklist
Download the PDF containing the school screening checklists and parent/guardian attestation.
- 2
Complete the Screening
Answer the questions about close contact, symptoms, and prior COVID-19 diagnosis.
- 3
Sign and Date the Attestation
For the K-12 attestation, provide the requested names, date and time, and parent/guardian signature.
- 4
Submit to the County
Submit it to the county department named on the form; check the county website for current contact details.
Frequently asked questions
- What does the school symptom screening checklist ask?
- It asks about close contact with someone diagnosed with COVID-19, symptoms such as fever or cough, and whether the student has been diagnosed.
- Who completes the parent/guardian attestation?
- A parent or guardian provides the child’s and their own names, answers the screening questions, and signs and dates the attestation.
- Do I need a notary for the school symptom screening checklist?
- No. The document has no notary block; the parent or guardian simply signs and dates the attestation.
- How do I submit the school symptom screening checklist?
- The document does not give submission instructions. Submit it to the county department named on the form; check the county website for current contact details.