Physical Record Disposition Authorization

Instructions for completing this form are available at www.uleth.ca/records-management/forms.

Department Click here to enter department or unit name	Date Click drop-down to select
Location of Records ☐ Records Centre ☐ Other: Click here to enter room number	Total Number of Boxes Click here to enter
Prepared by Click here to enter name and position of person who prepared this form	Phone Number Click here to enter extension

In accordance with the current University of Lethbridge Classification System (ULCS), the records listed on the subsequent page(s) have passed their approved retention period and are, therefore, eligible for disposition.

Records scheduled for archival selection will be reviewed by the University Archivist for transfer to the University Archives. Records scheduled for destruction according to the ULCS will be shredded.

☐	I have reviewed these files and determined that some of these records are subject to audit, litigation, or administrative action. Please stop the disposition process for the records identified with an “X” in the Hold column. The remaining files are no longer required. Please charge shredding costs to account:

Fund	-	Org	-	6015	-	Prog

OR

☐	I have reviewed these files and determined that, to the best of my knowledge, these records are no longer required for litigation, audit, or administrative purposes. Please charge shredding costs to account:

Fund	-	Org	-	6015	-	Prog

☐	Electronic and other convenience copies of these records have been destroyed/deleted in conjunction with this disposition. This includes electronic copies stored on departmental or personal computers, shared drives, flash drives, mobile devices, email and/or any other storage device.

Disposition authorized by:
Click here to enter name of Designated Records Liaison, Click here to enter DRO’s position title	Date
Click here to enter name of department head, if applicable, Click here to enter department head’s position title (if applicable)	Date
Click here to enter name of senior administrator, Click here to enter senior administrator’s position title	Date
Ashley Haughton, Records and Information Manager	Date
I have reviewed the records with a scheduled disposition of “Archival Selection” and have transferred those indicated with a “✔” in the Transferred to Archives column to the University Archives. The remaining records may be destroyed.
Michael Perry, University Archivist	Date

Physical Records Eligible for Disposition	Date: Click drop-down to select
Box #	File Name/Description of Record	M or C (Master or Copy)	ULCS #	FD per ULCS	From Date If known (YYYY)	To Date (YYYY)	Date Eligible for Disposition (YYYY)	Hold (If appl.)	Records Management Use
Location	Transferred to Archives