Western University of Health Sciences
Internal Control Self-Assessment Questionnaire

Department Department Reports to

Preparer Date

I. AUDITS

Is your department aware that it must immediately notify the Business Office when any contact from an external agency concerning an audit or review occurs and to refer the agency to the Business Office? Yes No N/A

Is management aware that establishing and monitoring a system of administrative and financial controls in their operational area is their responsibility? Yes No N/A

Are staff members aware that concerns about violations of University policy
or suspected improprieties should be reported to their supervisor, Business Office, Compliance Officer or management? Yes No N/A

Are staff members aware that the University policy will protect them from retaliation from management or fellow employees when reporting issues of waste, fraud, improper conduct and abuse? Yes No N/A

II. BUDGET MANAGEMENT

A. SPONSORED FUND MANAGEMENT

After receiving notification of approval, have all terms and conditions of the sponsored award been reviewed? Yes No N/A

Has the department received proper authorization from the appropriate offices to create a fund? Yes No N/A

Has the budget and fund information been processed in a timely manner? Yes No N/A

Have all subcontracts been issued and signed? Yes No N/A

Have encumbered salaries and other expenses been reviewed for accuracy? Yes No N/A

Are Revenue and Expenditure Reports reviewed for accuracy on a monthly basis? Yes No N/A

Are the revenue balances being monitored on a monthly basis? Yes No N/A

If a no cost extension is required, is the request made on time and in compliance with the provider’s terms and conditions? Yes No N/A

Are regular meetings planned with the PI to review the rate of expenditures and forecast budget and planning? Yes No N/A

Are institutional and other internal reports reviewed and necessary changes made to alleviate any financial problems? Yes No N/A

Are reconciliation worksheets prepared and sent back to the Business Office to assist in the preparation of financial reports and billings? Yes No N/A

Have all technical and programmatic reports been completed? Yes No N/A

Have accounts been prepared for closeout and inactivation pursuant to University policy? Yes No N/A

Has the department at least annually submitted a detailed budget to Cost Analysis? Yes No N/A

Has the department provided an adequate justification for its added costs? Yes No N/A

Are prior year surplus or deficit balances used in the calculation of the forthcoming budget? Yes No N/A

If a surplus or deficit exists, does the amount not exceed 10% of the original budgeted item? Yes No N/A

If a large surplus or deficit balance exists, has the department formalized a resolution to correct the balance? Yes No N/A

Has a default account been identified to fund any deficits? Yes No N/A

B. CASH RECEIPTS

Do staff members responsible for handling cash and checks have the ability to record or verify transactions posted to accounts receivable records or the Revenue and Expenditure Reports? Yes No N/A

Is each check restrictively endorsed upon receipt with the elements: "For deposit only Western University of Health Sciences?" Yes No N/A

To provide supporting documentation, are checks copied or is a cash receipt log used with the name of the payor, amount of receipt, purpose of payment recorded, and date when and location of where receipts were sent for deposit? Yes No N/A

In areas that collect cash by direct contact solicitations or special events, is the person who collects currency closely supervised and independent of accounting functions? Yes No N/A

Are prenumbered receipts or tickets used for in-person receipts to track collections so that the person to whom the funds are turned over can verify the count in the presence of the collector? Yes No N/A

Are all unused prenumbered receipts and unsold tickets accounted for? Yes No N/A

Are receipts properly coded as revenue or refunds? Yes No N/A

Are the cash receipt logs or check copies forwarded to the individual who will be reconciling the amounts to the Revenue and Expenditure Reports? Yes No N/A

Are deposits made by the next business day or when a predetermined level of receipts are on hand, but held no longer than five working days? Yes No N/A

Are cash receipts stored in a secure location with restricted access prior to deposit? Yes No N/A

Is the documentation for the transfer of cash or checks within the department sufficient so that lost or misappropriated funds can be traced to the responsible individual? Yes No N/A

If the department has received a check from a sponsoring agency, has The Office of Sponsored Research and Contract Management, Advancement or the Bursar’s Office been contacted? Yes No N/A

Are deposit transmittal forms submitted to the Bursar’s Office for cash receipts? Yes No N/A

Are foreign checks sent directly to the Bursar’s Office? Yes No N/A

Are appropriate forms submitted to the Advancement Office for gifts and endowments? Yes No N/A

Are differences noted during the monitoring and verification process investigated immediately by persons who are independent of the preparing deposits and posting accounts receivables? Yes No N/A

Has your department determined that its cash receipts are not subject to unrelated business income tax (UBIT)? Has the department contacted the Business Office to coordinate procedures if collections are subject to UBIT? Yes No N/A

C. EXPENDITURE TRANSFERS

Are cost transfers and salary transfers made only for allowable purposes in accordance with University policies? Yes No N/A

Are original transactions charged directly to the proper accounts? Yes No N/A

Are salary cost transfers computed net of vacation accruals? Yes No N/A

Are the reasons for the transfers clearly and accurately documented on the transfer form? Yes No N/A

Are transfers completed in a timely manner? Yes No N/A

If the transfer is over 120 days from the original transaction date, does the transfer contain an adequate explanation for its tardiness? Yes No N/A

Are transfers authorized with at least two signatures? Yes No N/A

Are payroll cost transfers done in accordance with the efforts certified on Personnel Activity Forms (PAF)? Yes No N/A

Is payroll distribution used to verify the accuracy of the amount of salary being transferred? Yes No N/A

D. REVENUE AND EXPENDITURE

Are all revenue and expenditure transactions on reports reconciled monthly or as determined by specific agency reporting requirements? Yes No N/A

Are verification of transactions performed by staff who are knowledgeable of University and sponsoring agency cost policies? Yes No N/A

When possible, are verification procedures performed by staff who do not
Have access to cash or checks,
Make purchases, or
Authorize payments?

Does the reconciliation between source documents and statements include
Items on the report and not in departmental records?
Items in departmental records and not on the report?

Are all unresolved items promptly researched and corrected? Yes No N/A

Has the department chair, department manager, or PI reviewed and verified the monthly reports once the reconciliation is completed? Yes No N/A


E. DEPARTMENTS

If services are provided to outside customers, has the Business Office been notified of possible unrelated business income (UBIT)? Yes No N/A

Are all revenue and expenses posted to the department funds directly related to the department’s activities? Yes No N/A

For equipment and inventory purchases, have the proper accounts been used? Yes No N/A

F. SPONSORED ACCOUNTING

Is the department aware of the agency regulations for a given award? Yes No N/A

Was the sponsored agreement properly set up in the accounting system? Yes No N/A

Have the procedures been put into place to document compliance if there is cost sharing? Yes No N/A

Have program income and award interest earned been accounted for? Yes No N/A

Are costs expended in accordance with agency regulations? This includes but is not limited to:
Restricted supplements
Equipment thresholds
Travel restrictions
Federal salary cap
Administrative costs charged to federal awards
Subcontracts under or over $25,000

Are source documents forwarded to the Business Office to allow for sufficient audit detail? Yes No N/A

Are the department members aware of the Cost Accounting Standards instituted by the revisions to OMB Circular A-21 and are they familiar with the University’s Cost Accounting Standards Board Disclosure Statement for Educational Institutions (CASB DS-2)? Yes No N/A

Are all expenditures posted in a timely manner, to ensure that the Report of Expenditure can be completed in accordance with agency regulations? Yes No N/A

Is all sponsored funding received by the department posted correctly to the intended sponsored account? Yes No N/A

Are steps taken to restrict charges prior to and subsequent to the grant period? Yes No N/A

Are Personnel Activity Forms (PAFs) certified in a timely manner by an individual with first hand knowledge? Yes No N/A

Are payroll forms completed in a timely manner? Yes No N/A

Are accounts inactivated as prescribed by the University’s policies and procedures? Yes No N/A

III. INFORMATION TECHNOLOGY

Do employees with access to computer systems have an established need for this access? Yes No N/A

Do all employees with computer access use passwords and not share them? Yes No N/A

Are passwords changed on a regular basis? Yes No N/A

Does the department have procedures against unauthorized use or transmission of information, and procedures for reporting such events? Yes No N/A

Is access to the system removed for terminated or transferred faculty, staff and students in a timely manner? Yes No N/A

Do microcomputers located in heavily traveled public areas have a screen saver with password activation invoked? Yes No N/A

Is each computer software package licensed for the current user? Is an annual inventory of software conducted? Yes No N/A

Are computer files backed up on a regular basis with backup disks stored in a location away from the originals? Yes No N/A

Does the department have sufficient technical support for ongoing operations to keep down time minimal, as well as provide the needed information for users to perform their duties? Yes No N/A

Does the department have adequate resumption procedures for their automated systems that are considered critical or vital to their daily operations? Yes No N/A

When the department begins an information systems activity, is a structured system life cycle schedule being adhered to, to ensure a successful implementation in a timely and cost effective manner? Yes No N/A

IV. HUMAN RESOURCES

A. CONFLICT OF INTEREST

Do all faculty and staff members in the department have a copy or have access to the University’s policies regarding conflict of interest? Yes No N/A

Do faculty and staff members know the conditions when a written report needs to be prepared before undertaking any commitment that may conflict or appear toconflict with their primary commitment to the University? Yes No N/A

Have faculty and/or staff members made purchases with vendors where there is a personal interest or reward? Yes No N/A

Is the department free of any situations where a staff member supervises or has significant control over the work or career of another staff member who is his/her relative or is someone with whom he/she shares a residence? Yes No N/A

B. INDEPENDENT CONTRACTORS AND OTHER PAYMENTS TO
NON-EMPLOYEES

Has the department determined the classification of an individual as either an independent contractor/consultant or employee by following IRS criteria? Yes No N/A

If a contractor meets the independence criteria, has the department completed a Contract for Personal Services Rendered By a Consultant? Yes No N/A

Has contract been signed by the independent contractor/consultant, the department administrator and head, or dean? Yes No N/A

If the cumulative payment to the independent contractor/consultant was $600 or more has the ID number been obtained? Yes No N/A

If the independent contractor is a University employee, are payments being made through the payroll system, and is the documentation reviewed and approved by divisional human resources offices and/or Business Office? Yes No N/A

C. PAYROLL

Are staff members who approve or process payroll documents (e.g., weekly payroll vouchers/diskettes and electronic documents) restricted from access to payroll checks? Yes No N/A

Are University signature authority controls being applied? Yes No N/A

Are efforts being applied to process payroll electronically? Yes No N/A

Is access to time cards restricted from workers after they are approved by supervisors? Yes No N/A

Are terminated employees removed promptly from payroll and access rights? Yes No N/A

Are new hires processed and paid in the appropriate pay cycle? Yes No N/A

Are pay increases processed in the pay cycle of the anniversary date? Yes No N/A

Are efforts made to avoid salary expense transfers? Yes No N/A

Are original transactions charged directly to the proper accounts? Yes No N/A

Are NIH salary caps and guidelines followed? Yes No N/A

Are visa expiration dates monitored? Yes No N/A

D. GENERAL

Are all personnel/payroll records adequately secured and kept confidential? Yes No N/A

Before a commitment of employment is made or an individual is allowed to work, have all procedures relating to staff employment or academic/research appointments been followed, e.g., reference checks, education verification? Yes No N/A

Has a Form I-9 been completed within three days of an individual’s start date? Yes No N/A

If the department is hiring a non-U.S. citizen, has the Human Resource department been consulted? Yes No N/A

Has a Form I-9 for a non-U.S. citizen on payroll been renewed and verified in a timely manner? Has the I-9 data been updated in the payroll system? Yes No N/A

For non-exempt staff, has payment for overtime been made in accordance with the Fair Labor Standards Act? Yes No N/A

Are time records reviewed each pay period? Yes No N/A

Has management been trained and does management use the reports available? Yes No N/A

Are annual written performance evaluations completed prior to the salary review date? Yes No N/A

Has the supervisor properly documented the actions leading to a termination? Yes No N/A

Has the divisional human resources office been contacted regarding the appropriate procedures to follow regarding termination? Yes No N/A

Were the proper steps taken verified for leave of absences and terminations promptly? Yes No N/A

Upon termination is the employee
Promptly removed from payroll?
Required to turn in ID badges and keys?
Required to turn in University service cards such as: credit cards and library cards?
Denied systems access by canceling users IDs and passwords?
Required to return University owned property?

V. PROCUREMENT AND DISBURSEMENT SYSTEMS

A. PETTY CASH

Has the petty cash fund been properly authorized? Yes No N/A

Is the petty cash fund and/or unissued checks kept in a secure place? Yes No N/A

Is the fund’s custodian the only person with access to the fund? Yes No N/A

Has the fund’s custodian received the required petty cash training offered by the Business Office? Yes No N/A

Is the fund used for the intended business purpose? Yes No N/A

Are all petty cash disbursements supported by a petty cash and a purchase receipt or other appropriate documentation? Yes No N/A

Does the budget administrator, as well as the custodian, review expenditures for appropriateness and compliance? Yes No N/A

Does the budget administrator confirm the cash on hand when the Petty Cash Report is submitted? Yes No N/A

Are Replenishment Reports prepared monthly so that expenditure statements will reflect activity in a timely manner? Yes No N/A

Is the authorized fund amount equal to the total amount of expenditures reimbursed over a typical two-month period? Yes No N/A

Is the size of the fund reviewed periodically to determine whether it should be increased or decreased? Yes No N/A

Have inactive petty cash accounts been closed? Yes No N/A

B. ENTERTAINMENT, BUSINESS MEALS, HOSPITALITY,
COURTESIES, AND OTHER FUNCTIONS

Are entertainment costs in compliance with the University’s Business Travel and Expense Policies and sponsoring agency regulations? Yes No N/A

Is the purpose for these types of expenses of a business nature rather than personal? Yes No N/A

Do expense reimbursement requests include written documentation stating the business purpose of the activity, the names of all individuals present, and original receipts? Yes No N/A

Are proper foapal codes used when coding various entertainment expenses? Yes No N/A

Are departmental personnel approving such expenses familiar with the University’s Business Travel and Expense guidelines? Do they have a copy of it? Yes No N/A

C. PROCUREMENT AND DISBURSEMENTS

Does the department obtain competitive prices for purchases where applicable? Yes No N/A

Does the department use the University’s “Selected Vendors” when possible to take advantage of discounts? Yes No N/A

Do transactions bear evidence of approval, with the correct signatures, in accordance with University policy? Yes No N/A

Are departmental staff submitting invoices to Accounts Payable to allow sufficient processing lead time to meet vendor payment deadlines? Yes No N/A

Are vendors submitting invoices directly to Accounts Payable for purchase order payments? Yes No N/A

Are purchase receipts and other necessary documentation retained by the department’s authorized verifier to support purchases? Yes No N/A

Have transactions for purchases made using Banner been electronically approved each timely by the authorized verifier? Yes No N/A

Have expenditure statements or on-line systems been reviewed for accuracy of encumbrances and payments made? Yes No N/A

D. SIGNATURE AUTHORITY

Has the department identified faculty and staff members authorized to sign the following in either paper or electronic form?
Payroll documents
Payroll forms for new hires, leave of absences, and terminations; salary changes; pay supplements; demographic changes ; budget line changes by transfer; staff attendance, vacation and sick leave;
Time cards
Procurement documents
Confirming purchase orders
Purchase requests
Coded invoices
Check requisitions
Cost/budget transfer documents
Material and supply forms
Travel forms

Is a list of the department’s authorized signers maintained and up-to-date? Yes No N/A

Do department heads and principal investigators understand their responsibility? Yes No N/A

Are documents signed by the appropriate individuals at both the departmental and divisional levels? Yes No N/A

E. TRAVEL

Are travel advances requested using the Travel Advance Request Form signed by the traveler and an authorized approver? Yes No N/A

Are travel advances used only for expenses, such as meals, which could not be paid by a check request prior to the trip day? Yes No N/A

Are corporate cards used in lieu of travel advances whenever possible? Yes No N/A

Have travelers verified in advance that their trip is eligible for reimbursement? Yes No N/A

Are Travel and Entertainment Expense Reports prepared and submitted for every trip made by a University employee within two weeks of return of trip? Yes No N/A

Are travel reimbursements to qualified non-University employees made on a Non-Employee Travel and Entertainment Expense Report? Yes No N/A

Are original receipts or other appropriate documentation attached to support charges? Yes No N/A

Are reported expenses in compliance with the University’s Business Travel and Expense Policies? Yes No N/A

Are the correct per diem rates or currency conversion rates being used for foreign travel expenses? Yes No N/A

Is consultant travel included in the consulting contract? Yes No N/A

Are Travel and Entertainment Expenses Reports accurately totaled? Yes No N/A

Are all appropriate forms signed by the traveler and an authorized approver? Yes No N/A

VI. PROPERTY MANAGEMENT

EQUIPMENT ACCOUNTING

Were equipment purchases made in accordance with purchasing guidelines? Yes No N/A

Are proper equipment foapal codes used for equipment with a per unit cost of $1000 or more and with a useful life of more than one year? Yes No N/A

Does all University equipment have a University property tag that is easily visible? Yes No N/A

Is Advancement notified of any donated equipment? Yes No N/A

Is Facilities notified of any transfers, or fabrication of equipment? Yes No N/A

Is Facilities notified of equipment lost, stolen, salvaged, or scrapped? Yes No N/A

Is Facilities notified when equipment is moved to another University location or to an employee’s home? Yes No N/A

Is Facilities notified of any sponsor-vested equipment on loan or purchased with sponsored funds? Yes No N/A

VII. RECORD RETENTION

Are department employees responsible for financial records aware of retention rules? Yes No N/A

Are documents that the Business Office does not have, such as original award documents, contracts retained in the department in accordance with record retention practices and grant and/or contract requirements? Yes No N/A

Does the department store its records in a secure area? Yes No N/A

Is the department maintaining only necessary records, so it is not using excess storage space or incurring unwarranted storage costs? Yes No N/A

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