Click to enter the Policy # and Title

Administrative Responsibility:   [REQUIRED: Click here to enter the POSITION, not name of the individual, responsible for interpreting and revising the policy]

PURPOSE

[REQUIRED: Click here to enter a statement describing the purpose of this policy.]

SCOPE

[REQUIRED: Click here to enter a statement indicating the employee groups that are impacted by this policy.]

DEFINITIONS

1. [Click here to list terms and definitions related to this policy or enter "N/A" if not applicable]

POLICY

[Click here to enter a formal statement outlining the ways in which the organization intends to conduct its affairs and act in specific circumstances.]

PROCEDURE

1. [Click here to list steps by which the policy can be accomplished.

Effective Date: REQUIRED: Click here to enter the date the policy was first put into effect

Revised Date: Click here to enter the date the policy was last revised.

Reviewed Date: Click here to enter the last date the policy was reviewed without revisions.

To be reviewed, at minimum, every three years and/or revised as needed by:  REQUIRED: Click here to enter the POSITION, not name of the individual, responsible for reviewing the policy.

Next Review Date: Click here to enter the date the policy will next be reviewed

SUPERSEDES POLICY

1. [Click here to enter superseded Policy # and title or "N/A" if not applicable]

HISTORICAL DATES