SOP_NUMBER: 103.67-att-1
TITLE: Interpreter Designation Form
WORD_COUNT: 207
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/290224
URL: https://gps.press/sop-data/103.67-att-1/

ATTACHMENTS:
  1. Interpreter Designation Form
     URL: https://gps.press/sop-data/103.67-att-1/
  2. Department of Justice Complaint and Consent Form
     URL: https://gps.press/sop-data/103.67-att-2/
  3. Department of Justice Complainant Consent_Release Form
     URL: https://gps.press/sop-data/103.67-att-3/

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FULL TEXT:
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SOP 103.67
Attachment 1

12/3/20


Timothy C. Ward

_Commissioner_



Brian P. Kemp
_Governor_


# **GEORGIA DEPARTMENT OF CORRECTIONS** **_Office of Professional Standards_**

_**State Offices South at Tift College**_

_**P. O. Box 1529**_
_**Forsyth, Georgia 31029**_

_**Phone: (478) 992-5374**_

_**Fax: (478) 994-7752**_


**Limited English Proficiency (LEP) Plan**
**Language Interpreter Designation Form**



I, __________________________, (Employee Name) hereby give my permission for the
Georgia Department of Corrections to use a language interpreter other than an appointed
representative from within the agency for the purposes of communicating medical, personnel, or
legal information on the date of service indicated. I understand that the interpreter will have
access to my medical and personnel information, only through the interpretation of oral and/or
written communications.

Language Required: __________________________________

**_____________________________________________________________________**
Employee Signature Date:

**_____________________________________________________________________**
Witness/Title Date:


**To be completed by Interpreter:**
**______________________________________________________________________________**

I, _________________________, (Interpreter Name), agree to accurately interpret written and/or
verbal communications from the above referenced employee for appropriate Georgia Department
of Corrections staff, agents, or representatives. I understand that my interpretation will remain
confidential with all parties involved and that my official translation may be used in accordance
with Georgia Department of Corrections internal investigations or third-party legal
representation.

**_____________________________________________________________________**
Interpreter Signature Date:


_Equal Opportunity Employer_

Retention Schedule: Upon completion, this form shall be retained permanently in the employee’s official
and local personnel files.