Policy Acknowledgment Form: Free Template for US and Canada (Word and PDF)

Short answer: a policy acknowledgment form is a one-page record that an employee received a specific version of a policy, on a specific date, and agreed to follow it. Use one form per person for each policy version. The laws below require you to give certain policies out; a signed form is the simplest proof that you did.

This page is part of our guide to employee handbook and policy acknowledgments. It is general information, not legal advice.

What a policy acknowledgment form should include

• The policy and its version: the policy's name, its version number and its effective date. "The handbook" stops being enough the first time you update it.
• How and when it was provided: a printed copy, email, intranet or a meeting, and the date.
• The language: California and New York both have rules about giving policies in languages other than English (below).
• The sign-off wording: what the employee confirms, in plain words.
• The employee: name, job title or department, signature and the date signed.
• For the employer: who received the signed form, when, and where it's filed.

Acknowledgment wording you can copy

Both forms use this sign-off. It records receipt; the policy itself says what the rules are.

I acknowledge that I received the policy named above, in the version and on the date shown. I have read it, and I understand that I am expected to follow it. If I have questions about it, I can ask [name or role].

The Canadian form adds a line for the information and instruction given on the policy:

I also received information and instruction on this policy on [date], by [for example, a briefing or training session].

When US law requires you to hand out a policy

• California requires a written harassment, discrimination and retaliation prevention policy. Its regulation lists ways to distribute it, including a printed copy with an acknowledgment form, an email with an acknowledgment return form, and posting it on an intranet with a system that tracks who has read and acknowledged it. Where 10% or more of the workforce at a facility speaks a language other than English, the policy must be translated into that language (2 CCR §11023).
• New York requires every employer to give employees its sexual harassment policy at hire and at every annual training, in English and in the employee's primary language (Labor Law §201-g). The state encourages a signed acknowledgment but doesn't require one.
• Massachusetts requires employers with six or more employees to give every employee an individual written copy of the sexual harassment policy every year, and new employees a copy when they start (G.L. c. 151B, §3A).
• Illinois requires restaurants and bars to have a written sexual harassment policy (775 ILCS 5/2-110).
• New Jersey is the one place on this list that requires an acknowledgment: employers with 50 or more employees must give each employee the Gender Equity Notice at hire, every year by December 31 and on request, and get a written or electronic acknowledgment that the employee received and read it within 30 days (N.J.S.A. 34:11-56.12).

In New York and Massachusetts, that means a new acknowledgment every year, not just at hire. The requirements finder lists the policies, notices and training each state requires, with the official source for each.

Policy acknowledgements in Ontario and the rest of Canada

Ontario's Occupational Health and Safety Act requires every employer to have workplace violence and workplace harassment policies and review them at least once a year. Where more than five workers are regularly employed, the policies must be in writing and posted in the workplace or in a readily accessible electronic format (s. 32.0.1). The employer must also give each worker information and instruction on the contents of the policies and programs (ss. 32.0.5(2) and 32.0.8).

The Act doesn't ask workers to sign the policies. A signed acknowledgement is a simple way to show that each worker received them and when, and the extra line on the Canadian form records the information and instruction too. Ontario employers can start from our workplace violence and harassment policy template.

Other provinces set their own rules. The requirements finder lists what each province requires, with the official source.

What to keep as proof

• The signed form, one per person, per policy version.
• A copy of the exact version they signed. In a dispute, the question is usually what the policy said at the time.
• How and when it was sent, and any reminders.
• Refusals and exemptions, noted and dated, with who recorded them.

Keep forms for former employees too; claims can come later. How long to keep signed policy acknowledgments.

Paper forms, and where they break

• Chasing: someone has to hand out the form, collect it and follow up with everyone who hasn't returned it.
• Versions: a form that says "the harassment policy" can't show which version once you've changed it.
• New hires: people who join after the last round are the ones most often missed.
• Every year: in New York and Massachusetts, the whole round starts again.
• Finding one: when a claim or an inspector asks about one person, the form has to be in the right folder.

Collecting acknowledgments online

With Ethica, you upload the policy PDF and assign it to everyone or to a role, and new hires in that role get it automatically. Each employee gets an email with a private link, reads the policy in their browser and signs with one click, with no account or password. Ethica reminds anyone who hasn't signed and keeps a record for each person: the version and exact file they signed, when, the statement they confirmed, and the IP address and browser they signed from. Set it to repeat every year where your state requires it, and export the records as a spreadsheet or a zip whenever someone asks. Each employee needs an email address.

See how to add a policy for employees to sign.

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