Risk Management Program Questionnaire Please fill out this form and we will get in touch with you shortly. Alternatively, you may download the pdf here and email it to firstname.lastname@example.org Note: This Questionnaire is designed specifically for soccer associations. Please contact email@example.com for a questionnaire tailored for other sports. Step 1 of 6 0% Which risk management plan are you interested in?*Basic Risk Management PlanComprehensive Risk Management PlanI'm undecidedBackground InformationOrganization Name:*Primary Contact:* First Last Email:* Address:* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone:*Fax:Website: Affiliation(s):USYSAAYSOSAYUSSSAUS Club SoccerOtherType of Entity:*Non-Profit Corp.Not for Profit Unincorporated Assoc.For ProfitDescribe 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 ManagementPlease 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?*YesNoIf so, please attach copies: Assets and InsuranceDo you own or lease your facilities?OwnLeaseDo you have buildings, including storage buildings, on your facilities?YesNoAre buildings owned or leased?OwnedLeasedWhat is the approximate value of the contents in your buildings?What is the approximate value of other fixtures or equipment that you own?Do you maintain property and contents insurance coverage for the buildings?YesNoDo you maintain property damage insurance for your equipment and fixtures?YesNoDo you require your treasurer and all persons with authority to write checks to be bonded? YesNoDo you carry any liability or medical payments insurance other than what is provided through your governing body?YesNoDo you regularly review your insurance needs and coverages with a licensed insurance agent?YesNoHow Frequently? Financial ControlsDescribe 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?YesNoDo they perform an audit on an annual basis? YesNo Other ExposuresAre any teams responsible for locating or procuring their own practice facilities?*YesNoDo any other organizations use your facilities? *YesNoDo other companies offer soccer related camps or training services at your locations? *YesNoDo you operate any camps or paid training programs apart from team soccer activities?*YesNoDescribe how weather related cancellation decisions are made: Additional AttachmentsAttach any existing written policies that are designed to address risks to the organization and its participants.FileFileFileNameThis field is for validation purposes and should be left unchanged.