In our organization (500 people) when a Level II procedure is being approved we route it around in a folder to each approver. After an approver signs it, he/she passes it on to the next approver, so on and so forth until everyone who needs to sign has done so. Needless to say, from a QSM's perspective this can be troublesome since some approvers like to let these procedures sit on their desks and grow mold. How does everyone else manage the Level II procedure approval process in their organization so that the approvals take place in a timely manner? I am particularly interested in hearing from those organizations that use either Adobe Acrobat or MS Word and electronic signatures to manage this process.