This two-page document is a policy template that provides guidance for writing new policies. It includes sections for the purpose and scope of policies, the main policy statement, employee responsibilities, exceptions, related information like other policies and procedures, definitions of key terms, and contacts. The template also has spaces for a table of contents, revision history, and headers and subsections to structure the different parts of a policy document.

1. Page 1 of 2
Policy Template/ Policy Name
Policy #:
Section: HR
Effective Date:
Policy Sections
Table of Contents & Page #
Purpose
Write a high level over view of the Policy and what it is for: Scope (towho or whatdoesthe policyapply?), Policy
Statement, and Reason…
Policy
Policy Name
1. Section Head
2.
2.1.
2.1.1.
3. Employee Responsibilities
3.1. Management EE’s
3.1.1.
3.2. Those that are under CBA
3.2.1. need to see the CBA
Special Situations/Exceptions
Exceptions to policy
Related Information
Policy Name: (A policy related to this policy.)
Procedure Name: Provide Procedure Name and map to find in …. (“Upcoming Procedure
(forthcoming)- If the document does not exist, forthcoming should follow this format.” )
Section Reference (e.g. 1.1) - Name of an exhibit related to the policy.
Form Name (e.g. ABC) - Name of a form related to the policy.
Definitions
Key Word/Term/Concept Definition
Contacts

2. Page 2 of 2
Subject Contact Phone
Revision History
Date Name Change Description and Justification
10/23/2015 HR – Lucianne Template Development