Policy Maintenance Form

The North Dallas Community Bible Fellowship (NDCBF) Policy Maintenance Form is to be used when: 1) adding a new policy, 2) revising an existing policy or 3) deleting an existing policy. The XX is responsible for retaining copies of approved Policy Maintenance Forms and all supporting documentation.

Policy Title and Number (if applicable):______

Policy Owner: ______

Date Submitted: ______

Policy Applies to (check all that apply): Staff Ministries/Volunteers Vendors Other:

Is this policy: New Revised

Requested Effective Date: ______

  1. List the purpose for proposed addition, revision or deletion (briefly explain the reason(s)for the proposed change):
  1. What is the impact of the policy addition/revision or termination on other policies? List the nature of theimpact on policies that are affected and how this impact will be managed.
  1. What is the fiscal impact, if any, of the change (including implementaiton)?
  1. Stakeholders: List the individuals/departments/ministries/vendors, etc. affected by the policy. How andwhen will this policy addition/revision/deletion be communicated ?
  1. Is there need for a policy implementation team? Yes No. If “yes”, list members and/or key functions that will comprise the implementation team.
  1. Using the chart below, please identify implemention and communication strategies, the responsible party and critical deadlines that are essential to the successful additoin/revision or termination of the above referenced policy – answering “who”, “what”, “when” and “how” for each strategy. Please feel free to attach an additional sheet if necessary.

Implementation and Communication Strategies
(what actions must be completed to implement the policy?) / Responsibility
(who is responsible for the action?) / Critical Deadline(s): (when must the action be completed?) / Budget (how much will it cost to implement the action?
  • Procedures and resources related to implementation :

  • Methods of dissemination and communication:

  • IT systems changes:

  • Administrative changes :

  • Training, meetings:

  • Measures to support ongoing enforcement of the policy:

  • Monitoring and measuring implementation and effectiveness of the policy

  • Other

Approvals Required Prior to Distribution:

With respect to the above policy/policy revision, I certify that:

  • All necessary arrangements, including training to implement the policy have been included in this plan;
  • Stakeholders have been consulted during the development of the policy and their feedback has been considered;
  • All initial and ongoing strategies for communication of the policy have been included in the plan.

Policy Owner / Date
Executive Director Of Operations / Approval Date

2801 E. President George Bush Highway | Plano, TX 75074 | Phone: 972.437.3493 | Fax 972.744.9514 | ndcbf.org