BASIC POLICY PROCEDURE TEMPLATE

Company Name	YOUR LOGO
123 Company Address Drive
Fourth Floor, Suite 412
Company City, NY 11101
321-654-9870
POLICY NAME	POLICY NO.
EFFECTIVE DATE	DATE OF LAST REVISION	VERSION NO.
ADMINISTRATOR RESPONSIBLE	CONTACT INFORMATION
APPLIES TO Apply group names to define applicable areas of staff.
GROUP 1	GROUP 2	GROUP 3
GROUP 4	GROUP 5	GROUP 6

VERSION HISTORY
VERSION	APPROVED BY	REVISION DATE	DESCRIPTION OF CHANGE	AUTHOR

APPROVAL AND REVIEW

ADDITIONAL NOTES

SCOPE

Describe to what and to whom this policy applies.

POLICY STATEMENT

Describe the policy and the reason for the policy.

TERMS AND DEFINITIONS

Define any acronyms, jargon, or terms that might have multiple meanings.

TERM	DEFINITION

POLICY SECTIONS

Policy intro:

POLICY SECTION ONE NAME

POLICY SECTION TWO NAME

POLICY SECTION THREE NAME

EXCEPTIONS

Describe exceptions here.

RELATED POLICIES AND OTHER REFERENCES

ROLES AND RESPONSIBILITIES

List the job titles and business offices directly responsible for the policy.

ROLE	RESPONSIBILITY

CONTACTS

List contacts in the table.

SUBJECT	CONTACT	PHONE	EMAIL

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