[Insert title of Policy Instrument]

[Division], [Branch]

Version: 1.0

Approved by: [Insert person and title, or committee name]	Owner: [Insert person and title or group?]
Approval date: [insert date policy made effective]	Last reviewed: [insert last reviewed date]	Review date: [insert next review date]
Contact: [Who can be contacted about this? Could be generic/shared email.]	Policy Instrument type: [Is this a policy, standard, guideline, etc.]

Contents

Contents	2

[Policy Instrument] Statement	3

Authority	3

Scope	3

[Policy Instrument] Description	3

[Policy Instrument] Specification	3

Definitions	3

Roles and Responsibilities	3

Compliance	3

References and Supporting Resources	4

[Policy Instrument] Statement

At a high leve,l what does this policy establish, enable or prevent?

Authority

From where does this policy receive its authority? From an act or regulation? How does it link back?

Scope

Does this policy apply to all departments? Does it apply to only one department? What about agencies, boards and commissions?

[Policy Instrument] Description

What does it mean? Why is it important to the GoA to have a policy about this?

[Policy Instrument] Specification

Describe the specifications of this policy instrument

[Note: Diagrams and visuals may be attached as an appendix.]

Definitions

[to be included when publishing] Definitions to be used in the interpretation of this policy instrument are in Appendix A.

Roles and Responsibilities

Deputy Heads will:

List responsibilities of a Deputy Head if it applies, if it does not then please remove this sub-header.

IMT Professionals (including contracted resources) will:

List responsibilities of an IMT professional if it applies, if it does not then please remove this sub-header.

GoA Employees will:

List responsibilities of a GoA Employee if it applies, if it does not then please remove this sub-header.

Compliance

[to be included when publishing] Consequences of non-compliance with this policy could result in damage to Government of Alberta’s reputation, expose Albertans to harm and/or incur unnecessary costs.

This section may be used for documenting risks and how this policy instrument mitigates risks.

If there are further compliance requirements, please add them here. For example, what are the consequences for non-compliance? Which office(s) are responsible for following up on compliance? What actions might be taken if someone is not compliant?

References and Supporting Resources

Do other policy instruments fall under or relate to this policy? Are there guidelines or other documents that can support the material? Has a determination been made that a “new” policy is actually required, and not an enhancement or update (i.e. reuse) of an “existing” policy?