Good Management Good Records Amendment Form

Note: Questions marked with an asterisk (

) indicate required information.

Part 1 - Your Contact Details

Please provide your contact details

Name:

Role in Organisation:

Organisation:

Telephone Number:

Email Address:

Part 2 - Information Governance Manager Contact Details

Have you discussed your request with your Organisations Information Governance Manager?

Yes No

If Yes - please provide their name and contact details.

Contacts Name:

Contacts Organisation:

Contacts Telephone Number:

Contacts Email Address:

Part 3 - Type of Request

Is your request:

An Amendment to an Existing Record

Record Name:

Reference Number:

A New Record Type

What category do you think this falls into?

Name of Record Type:

Name and Purpose of Record:

How long do you think it should be retained:

Part 4 - Reason for Request

Is the reason for the request:

New Legislation: If so, please provide the name of the Legislation. New Professional Policy / Guidance: If so, what is the name and reference number and who issued it. Current Retention not Appropriate: If so, please please explain why.

Please provide the relevant information relating to the Reason for the Request.

Details:

Part 5 - Background Information

Please provide any other background information which you think would be useful.

Background Information: