Information security acknowledgment form
An employee acknowledgment of the company's information security rules: passwords, devices, email, data handling and reporting incidents.
- ๐บ๐ธ US format ยท Letter size
- Free
This is a sample form. Check that the terms and pay match federal and state labor rules and your company policy.
Fill in what you need. The preview updates as you type.
What you type is not saved on our server.
A general template, not legal advice
This is a general template, not legal advice. This form records that an employee received your rules; it does not replace a written security policy. Electronic monitoring notice rules differ by state, so check yours before you rely on the monitoring sentence.
- Some states require written notice, and sometimes a signed acknowledgment, before an employer monitors email, phone or internet use. Check your state's rules.
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Information Security Acknowledgment
| Employee name | Casey Nguyen | Department | Accounting |
|---|---|---|---|
| Company | Acme Inc. | ||
| Policy | Information Security Policy, version 3.2, dated September 1, 2026 | ||
| Report incidents to | IT help desk, (555) 010-0020, security@acme.example.com | ||
I have received and read Information Security Policy, version 3.2 of Acme Inc.. I had the chance to ask questions about it. I understand the rules below and agree to follow them.
- 1. Use a password manager and turn on multi-factor authentication for every company account.
- 2. Lock your screen when you leave your desk. Laptops go home with you or into a locked drawer.
- 3. Customer data stays in Salesforce and the shared drive. Never send it to personal email.
- 4. Do not plug in USB drives you did not get from IT.
- 5. Check any request to change bank details or buy gift cards by phone before you act.
- 6. Only IT installs software on company devices.
- 7. Report phishing with the Report button in Outlook, and anything else to IT right away.
I understand that company devices, accounts, networks and data belong to Acme Inc., and that the company may monitor their use to the extent the law allows. I will report any security incident to IT help desk, (555) 010-0020, security@acme.example.com as soon as I notice it. Breaking these rules may lead to discipline, up to and including termination. This acknowledgment does not change my at-will employment, and the company may update the policy and will tell me when it does.
Employee signature: ______________________ Date: October 19, 2026
Received by (HR or IT): ______________________ Date: ____________
How to use it
Type the company, the name and version of your security policy and who to contact about incidents. Then type your rules one per line; they print as a numbered list. If you leave the rules empty, the form prints eight standard rules covering passwords and multi-factor authentication, devices, software, suspicious email, where data may be stored, personal information and incident reporting.
Leave the employee name empty to print a stack of blank forms for onboarding, or fill it in for one person. The employee signs, HR or IT signs the received line, and the form goes in the personnel file. Ask everyone to sign again when the policy changes.
Things to watch
The form only works if it matches the policy you actually hand out, so edit the rule list rather than relying on the standard one. If you monitor email or internet use, check whether your state requires a written notice before you do.
Calculators that go with this
Frequently asked questions
Why have employees sign a security acknowledgment?
It records that each person received the rules and agreed to follow them. Customers, auditors and cyber insurers often ask for this proof, and it helps if you later discipline someone for breaking a rule.
Can I use it for an acceptable use policy?
Yes. Type the name of your acceptable use policy and list its main rules. Many small companies combine acceptable use and security rules into one policy and one signature.
How often should employees sign it?
At hire and whenever the policy changes. Many companies also ask for a new signature each year after security awareness training.
Is what I type saved anywhere?
No. Everything stays in your browser and nothing is sent to our server. If you refresh the page it is gone, so print, save a PDF or download the DOCX when you are done.