HomeMy WebLinkAboutRISK MANAGEMENT 05/16/2017Local 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 Retention Schedule)
Agency Records
Description
Date
Method(s) of
Records:Series
Records Series
Records Retention
Minimum Retention Period
(Box/item numbers,
Dates Covered
Minimum
Destruction
Title
. DAN
Schedule
volume, etc.)
Retention
(See examples,
Met
below*)
Meetings and
GS50-01-
local Gov't CORE
2 years after end of
Safety & Health
2014
12/31/16
Secure
Hearings
g
43 Rev. 1
Version 3.3
calendar year
y
committee Agenda
and Minutes
Recycling
*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 inventorying the listed records must sign below prior to the Records Manager's approval:
�f �,�,�f Thelma Swem Risk Management
Employee Signatures -1/,2 i / /�(/i�� Printed Name: Division:
The Records Manager must sign the approval of this'request prior to the destruction of the listed records:
i
Records Manager Signature: / Ir� %% P SYi Printed Name: Thelma SWem Date Approved: 5/16/17
The person/people responsible the dent? cG do f records must sign upon destruction of the listed records:
'Melisa Folmer 5/16/17
Employee SignaturePirinted Name: Date Records Destroyed:
Vendor Business Name (if used): n/a 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.