HomeMy WebLinkAboutRISK MANAGEMENT - 04/29/2014 Local Government Public Records Destruction Log
The purpose of this form is to document compliance and reasonable accountability by verifying that specific public records have met current, approved minimum
retention periods before being destroyed pursuant to RCW 40.14.070, WAC 434- 610 -070, and WAC 434 - 640 -010, -020, and -030 Please fill out this form when
destroying all public records whose minimum retention is other than "Retain until no longer needed for agency business then destroy" (such as records covered in
the "Records with Minimal Retention Value" section of the Local Government Common Records Retention Schedule (CORE).
Legal Disposition Authority (taken from Records Rete Schedule) Agency Records
Description Date Method(s) of
Records Series Records Series Records Retention Minimum Retention Period lsox/item numbers, Dates Covered Minimum Destruction
Title DAN Schedule Retention (See examples,
volume, etc.) Met below')
Accidents/ GS2010 -0 CORE 3 years after date of 1 file folder 1/l/2007-12/31/2007 12/31 /10 secure recycling for
Incidents 81 Rev. 2 incident contractor shredding
Claims GS50-01-10 Rev. 1 CORE 6 years after claim closed 10 file folders 1/1/2007 - 12/31/2007 12/31110 same as above
*Examples of methods of destruction: electronic deletion, in -house OR outside contractor shredding, secure recycling, other (describe)
Statement. The public records listed above have met their minimum retention period(s), are not subject to ongoing or reasonably
anticipated litigation or public records requests, are not needed for audit or other agency business, and shall be destroyed.
The individual responsible for invent: the listed records must sign below prior to the Records Manager's approval:
Employee Signature 1 �L Thelma Swem � Printed Name: Division: Risk Management
The Records Manager must sign the approval of t request prior to the destruction of the listed records:
Records Manager Signature: U 1 Z Printed Name: Thelm Sw Date Approved: 4/29/
The person /people responsible fo the des ction of records must sign upon destruction of the listed records:
Employee Signature: % , Printed Name. Thelma Swem Date Records Destroyed: 4/29/14
Vendor Business Name (if used): Phone:
Vendor Signature: Printed Name: Date Records Destroyed:
The retention and disposition action for this Public Records Destruction Log is "Retain for the life of the agency" pursuant to CORE series GS50- 09 -06.
This sample form was prepared by Washington State Archives as a courtesy to local government agencies in January, 2014.
It may be modified to meet individual agency needs.