Placek Consulting, LLC Risk Management Program Questionnaire

Which risk management plan are you interested in?*
- Basic Risk Management Plan
- Comprehensive Risk Management Plan
- I'm undecided
Background Information
Organization Name:*
Primary Contact:*
First Last
Email:*
Address:*
Street Address Address Line 2 City State ZIP Code
Phone:*
Fax:
Website:
Affiliation(s):
Type of Entity:*
Describe your current programming and any programming you anticipate adding in the next 2 years:
Provide an approximate number of participants in your programs by age:
Less than 4 years of age:
4-9 years of age:
10-13 years of age:
14-17 years of age:
18 years of age or older:
Approximately how many adults are involved in your organization by the following roles:
Volunteer Coaches:
Volunteer Assistant Coaches:
Volunteer Team Managers/Parents:
Officers and Board Members:
Paid Office Staff:
Paid Coaching Staff:
If you have paid staff, how many are employees?
Independent Contractors?

Volunteer Screening and Management
Please use the following scale to answer the next two questions:

1 – Used consistently on every volunteer
2 – Intended to be used consistently but in practice is only used on occasion
3 – Used informally or on an ad hoc basis
4 – Never used

Indicate which of the following tools you currently use to screen volunteers:
Criminal Background Checks:*
Please enter a value between 1 and 4.
Volunteer Screening Committee:*
Please enter a value between 1 and 4.
Volunteer Application:*
Please enter a value between 1 and 4.
Reference Checking:*
Please enter a value between 1 and 4.
Personal Interviews:*
Please enter a value between 1 and 4.
Internal Complaint/Abuse Database:*
Please enter a value between 1 and 4.
External Complaint/Abuse Database:*
Please enter a value between 1 and 4.
Indicate which of the following tools you currently use to train or supervise volunteers:
On Site Monitors:*
Please enter a value between 1 and 4.
Formal Review Process:*
Please enter a value between 1 and 4.
Volunteer Interaction Policies:*
Please enter a value between 1 and 4.
Two Adult Policy:*
Please enter a value between 1 and 4.
Complaint Reporting Process:*
Please enter a value between 1 and 4.
Video Surveillance:*
Please enter a value between 1 and 4.
Required Licensing/Certifications:*
Please enter a value between 1 and 4.
Player Safety Training/Orientation:*
Please enter a value between 1 and 4.
Do you have written child protection policies in place?*
- Yes
- No
If so, please attach copies:

Financial Controls
Describe your current financial control policies to assure that only legitimate payments are made from and to organizational accounts:
If these policies are written, please attach a copy.
What position(s) by title is responsible for maintaining the financial records of your organization?
What position(s) by title is responsible for maintaining organizational records (contracts, registration data)?
Do you utilize a bookkeeping or accounting service?
- Yes
- No
Do they perform an audit on an annual basis?
- Yes
- No

Other Exposures
Are any teams responsible for locating or procuring their own practice facilities?*
- Yes
- No
Do any other organizations use your facilities? *
- Yes
- No
Do other companies offer soccer related camps or training services at your locations? *
- Yes
- No
Do you operate any camps or paid training programs apart from team soccer activities?*
- Yes
- No
Describe how weather related cancellation decisions are made:

Additional Attachments
Attach any existing written policies that are designed to address risks to the organization and its participants.
File
File
File
Comments
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Risk Management Program Questionnaire

Step 1 of 6

Background Information

Volunteer Screening and Management

Assets and Insurance

Financial Controls

Other Exposures

Additional Attachments