AGENCY: Tooele County (Utah). Department of Health
SERIES: 5519
TITLE: Preschool immunization survey
DATES: 1975-
ARRANGEMENT: Chronological, thereunder alphabetical by name of school
DESCRIPTION: This is a survey taken by local health departments of children entering kindergarten in Tooele County. Copies of the forms are sent to the State Department of Health. It includes two forms, School Immunization survey form (form A) and Students needing follow-up action form (form B). Form A includes names of school and school district, phone number and location of school (city and county), name of responsible person, number enrolled in kindergarten, number of children with immunization cards or records turned in to the school, number of children with no record of immunization turned in, number of children adequately immunized, number of exemptions (medical, religious, personal) and total of exemptions.__Form B includes name of school and school district, phone number, location of school (city and county), responsible person, student's name, telephone number and address, indication of which immunizations were not completed (DPT, polio, measles, rubella), indication whether in compliance but inadequate, and any comments.
RETENTION
Retain for 2 year(s)
DISPOSITION
Destroy.
RETENTION AND DISPOSITION AUTHORIZATION
These records are in Archives' permanent custody.
APPROVED: 03/1991
FORMAT MANAGEMENT
Paper: Retain in Office for 2 years and then destroy.
APPRAISAL
Administrative
This disposition is based on the primary administrative needs expressed by the office. The Utah Health Department maintains these surveys as part of the Immunization program files (series 83013). Those files are maintained permanently.