Sample Policy Template

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Company

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Sample Workplace Policy Template

Disclaimer: This is a sample policy and can be adapted for your workplace needs. Suggestions are given

about what to include. However, items can be added or removed to suit your workplace.

Policy:

Policy #

Approved by:

Effective:

Revised:

PURPOSE:

POLICY STATEMENT:

SCOPE:

PROCEDURE:

CONTRAVENTIONS: Non-compliance of this policy will be brought to the attention of

the appropriate supervisor or manager for further action

Developed by the Middlesex-London Health Unit and adapted with permission. Material can be reproduced

provided source is acknowledged (Middlesex-London Health Unit and Ottawa Public Health).

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Parent category: Legal