HomeMy WebLinkAboutHUMAN RESOURCES 01/17/2020 City of Bremerton 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 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 Records Retention Schedule(CORE)).
Legal Disposition Authority(taken from Records Retention Schedule) Agency Records
Description Date Method of
Records Series Records Retention Minimum
Records Series Title Minimum Retention Period (Box/Item numbers, Dates Covered Destruction(See
DAN Schedule Retention
volume,etc.) Met examples below*)
Employee Benefits GS2017-008 Local Retain for 6 years after Unemployment 2003-2014 12/31/19 Secure shredding
-Claims and Rev.0 Government benefit/beneficiary payment claims and
Appeals Common completed or denied and 6 related
Records years after expiration of correspondence
Retention appeal then Destroy
Schedule
Benefit Programs- GS2017-007 Local Retain for 3 years after end Unemployment 2003-2016 12/31/19 Secure shredding
Administration Rev.0 Government of calendar year and no notices to
Common longer needed for agency employer and
Records business then Destroy related
Retention correspondence
Schedule
Employment GS50-05A-26 Local Retain for 3 years after date 1-9 forms for 2016 12/31/19 Secure shredding
Eligibility Rev. 2 Government of hire or 1 year after 2016 separated
Verification-U.S. Common separation from agency, employees
Citizenship and Records whichever is later then
Immigration Retention Destroy
Services(USCIS) Schedule
*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 Record's Manager approval:
Employee Signatur • Printed Name: Debbie Klinefelter Division: Human Resources
The Records Manager must sign th a royal of this request prior to the destruction of the listed� � rrecor]dss:,� n ` C,-�7� �7 ^�,,,
Records Manager Signature: , � Printed Name: C.- r-c.V l Tte_. 1 --\,S-�✓ \ Date Approved: 1(1 (Roo
Form Revised 05/06/2014
City of Bremerton Public Records Destruction Log
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signatur � � Printed Nam • Date Records Destroyed: I / ( / (0Z0aD
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.
R:\Human Resources\HR\Human Resources\Records Destruction Log\2019.01.29 Destruction Log.docx
Form Revised 05/06/2014