Worksheet

Title: The Working Title of the Policy

Action: What is being done, e.g. Major Revision, New Policy, Rescission, etc.

Reason for Action: Why the action is being taken, e.g. Change in State or Federal Law, Change in Regulations, Best Practice, Risk, Minor Edits, Department / Title Changes, etc.

Description of Reason: A brief description of what has happened to prompt this change.

Policy Editor: Who drafted or worked on the policy primarily (for contact and editing purposes).

Responsible Officer: Who is responsible for the policy in the long term (for record purposes).

Responsible Office: Who does the Officer work for, and who do they report to.

Affected Policies, Procedures, and/or Guidelines: What other Policies, Procedures, and/or Guidelines may be affected, along with any necessary or suggested steps to be taken with those Policies, Procedures, and/or Guidelines.

Implementation / Enforcement: What steps will be taken to implement the policy. What steps will be taken to ensure compliance.

Additional Information: Any further information or requests, for example, expedited review, interim approval, etc.