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
Phone
This field is for validation purposes and should be left unchanged.

Risk Management Program Questionnaire

Step 1 of 6

Background Information

Volunteer Screening and Management

Assets and Insurance

Financial Controls

Other Exposures

Additional Attachments