"Risk Assessment Questionnaire" - Tennessee

Risk Assessment Questionnaire is a legal document that was released by the Tennessee Department of Transportation - a government authority operating within Tennessee.

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Download "Risk Assessment Questionnaire" - Tennessee

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James K. Polk Building
Suite 1800, 505 Deaderick St.
Nashville, TN 37243
Tennessee Department of
Telephone: 615.741.2781
Email: T Email: TDOT.MultimodalAdmin@tn.gov
Tran
FAX : 615.253.1482
RISK ASSESSMENT QUESTIONNAIRE
Agency: ________________________________________________________ 
I. General Assessment
1. Subrecipient experience with State or Federal Funds:
Risk Factor
Your Score
5+ years
1
3-5 years
3
0-3 years
5
Comments:
2. Subrecipient experience with specific Grant program:
Risk Factor
Your Score
5+ years
1
3-5 years
3
0-3 years
5
Comments:
3. Management or staff turnover or reorganization that affects this program:
Risk Factor
Your Score
No turnover or reorganization
1
Little turnover or reorganization
3
Significant turnover or reorganization
5
Comments:
4. Experience of staff and management assigned to the program:
Risk Factor
Your Score
5+ years/funding cycles
1
2-5 years/funding cycles
3
Less than 2 years/funding cycles
5
Comments:
Page | 1
 
James K. Polk Building
Suite 1800, 505 Deaderick St.
Nashville, TN 37243
Tennessee Department of
Telephone: 615.741.2781
Email: T Email: TDOT.MultimodalAdmin@tn.gov
Tran
FAX : 615.253.1482
RISK ASSESSMENT QUESTIONNAIRE
Agency: ________________________________________________________ 
I. General Assessment
1. Subrecipient experience with State or Federal Funds:
Risk Factor
Your Score
5+ years
1
3-5 years
3
0-3 years
5
Comments:
2. Subrecipient experience with specific Grant program:
Risk Factor
Your Score
5+ years
1
3-5 years
3
0-3 years
5
Comments:
3. Management or staff turnover or reorganization that affects this program:
Risk Factor
Your Score
No turnover or reorganization
1
Little turnover or reorganization
3
Significant turnover or reorganization
5
Comments:
4. Experience of staff and management assigned to the program:
Risk Factor
Your Score
5+ years/funding cycles
1
2-5 years/funding cycles
3
Less than 2 years/funding cycles
5
Comments:
Page | 1
 
5. Subrecipient timeliness in document submission:
a) Applications
b) Amendments
c) Fiscal or Financial Reporting
d) Budgets/Revisions
e) Close-out
f) A-133 audits and corrective action (if applicable)
Risk Factor
Your Score
On time submission of all documents
1
Rarely late or sometimes late on some documents
3
Consistently late on some or all documents
5
Comments:
6. Subrecipient timely response to program/fiscal questions:
Risk Factor
Your Score
Always timely in response
1
Sometimes late in response
3
Consistently late in response
5
Comments:
7. Complexity of the business environment or program funding/matching requirements:
Risk Factor
Your Score
Simple program requirements and operations
environment
1
Moderately complex program requirements and
operations environment
3
Complex operations environment and program
requirements
5
Comments:
8. Effective written procedures and controls for this program:
Risk Factor
Your Score
Formal/Written and Distributed to Employees
1
Informal Policies and Controls
3
No Policies or Controls
5
Comments:
Page | 2
 
II. Overall Fiscal Assessment
1. Variations between program expenditures and budget:
Risk Factor
Your Score
No variations
1
Small variations
3
Large and frequent variations
5
Comments:
2. Subrecipient amount of program budget carryover:
Risk Factor
Your Score
No carryover
1
Small amount of carryover
3
Large amount of carryover
5
Comments:
3. Difficulty meeting matching requirements:
Risk Factor
Your Score
Always meets matching requirements (No
difficulty)
1
Meets matching requirements most of the time
(Some difficulty)
3
Consistently has difficulty meeting matching
requirements
5
Comments:
Page | 3
 
III. Legal Assessment
1. Does the subrecipient have or previously had a lawsuit(s) filed against them? (Obtain
all necessary documentation if answer is yes)
Risk Factor
Your Score
No previous or current lawsuits
1
Has previously had a lawsuit
3
Has a lawsuit
5
Comments:
2. Subrecipient staff that have been jailed, convicted of a felony or are currently under
criminal investigation:
Risk Factor
Your Score
No staff jailed, convicted or currently under
criminal investigation
1
Has staff that has been jailed, convicted or is
currently under criminal investigation
5
Comments:
IV. Monitoring/Audit Assessment
1. Past Audit findings from the A-133 Audit or any other Internal Audit:
Risk Factor
Your Score
No material findings
1
Some findings, not material
3
Has material findings
5
Comments:
 
 
Page | 4
 
2. Have there been any previous audit findings (i.e. other comprehensive audit, Internal
Audit)?
Risk Factor
Your Score
No material findings
1
Some findings, not material
3
Has material findings
5
Comments:
3. Has the subrecipient been debarred or suspended? If so, when?
Risk Factor
Your Score
Never debarred or suspended
1
Has been debarred or suspended
5
Comments:
4. Corrective Action Plans (CAP) and Resolution (Obtain copy)
Risk Factor
Your Score
No CAPs past or current
1
Has had CAPs but been resolved on time
3
Has CAPs and not resolved on time
5
Comments:
5. On-site monitoring visits:
Risk Factor
Your Score
Less than one funding cycle has passed since on-
site visit
1
Less than three funding cycles have passed since
on-site visit
3
More than three funding cycles have passed since
on-site visit
5
Comments:
Page | 5
 
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