Policy Retirement Request Form

To initiate a policy retirement, please complete the form below. Upon submission, it will be sent to the policy library coordinator, who may follow up for clarification. You’ll receive confirmation once the policy is retired.

If you need to retire multiple policies at once, the coordinator can help streamline the process. For assistance or questions, email: policylibrarycoordinator@wisc.edu.

"*" indicates required fields

Company

This field is for validation purposes and should be left unchanged.

Policy number and title*

Target/effective date for retirement*

Reason for policy retirement

The policy content of the policy is no longer relevant.

The policy is being consolidated with another policy (or policies).

The policy content is duplicated in another policy (or policies).

The policy content is being moved to a procedure.

Other:

List policy (or policies) being consolidated

List policy (or policies) that are duplicated

You have selected "other;" please describe the reason for policy retirement

Provide a message about the policy retirement

You may include a brief message about the policy retirement to be displayed in the Notes field in the policy library. This may include information on where to find other relevant materials and/or directing individuals to other policies relevant to the subject matter.

Provide a list of other policies/documents affected by the retirement of this policy

Name of person submitting this form*

First Last

Email of person submitting this form*

Are you the approval authority for this policy?*

Yes

Approval authority name*

First Last

Approval authority email*

Attestation statement*

I attest that this policy retirement request has been approved by the authority named above.

Submission date*