Simply replace the unfilled areas such as "" and "[date]" with your information.
Dear Valued Staff Members,
Attached please find an updated version of the [name of policy] for your information. There have been some changes made to this policy, and it is important that you take the time to review these changes. Please read the policy at your earliest convenience. Should you have any questions or not understand any portion of the policy, please see your supervisor or manager for assistance, or contact Human Resources.
Once you have read and feel you fully understand the policy, please detach the Policy Review form, sign and date it, and forward it to your supervisor for filing.
Thank you very much for helping us to keep the business running as smoothly as possible by educating yourself on this important policy.