Questionnaire Selection Coverage List

EMPLOYEE DISHONESTY

PRIOR POLICY

Did the applicant carry Employee Dishonesty prior to this policy? ___ Yes ___ No

If yes, indicate carrier, limit and policy terms._____________________________

_________________________________________________________________

_________________________________________________________________

EMPLOYEES

Does the applicant employ any person who has committed a theft or dishonest act? ___ Yes ___ No

(Note – these employees are excluded from coverage and should not be included for rating purposes.)

Are all potential employees screened prior to employment? ___ Ye ___ No

Are references required and verified? ___ Yes ___ No

Does applicant contract with another firm to lease employees? ___ Yes ___ No

Does applicant lease employees directly? ___Yes ___ No

Does applicant use volunteers? ___ Yes ___ No

(Note – temporary leased employees who are substituting for regular employees are covered;

others, including volunteers, are excluded and should not be included for rating purposes.

Refer to PF&M – 251.4-3 for endorsements that may be used to provide coverage for these individuals.)

MANAGEMENT CONTROLS

Does someone outside of the applicant’s accounts payable unit confirm correctness of all invoices paid monthly? ___ Yes ___ No

Are invoices stamped 'paid' at the time checks are issued to prevent duplicate checks from being issued to fictitious persons? ___ Yes ___ No

Are improvements in internal controls, as suggested by auditors, implemented? ___ Yes ___ No

Is there adequate separation of duties between employees who:

Receive money and keep books? ___ Yes ___No

Disperse money and keep books? ___ Yes ___ No

Reconcile bank accounts and deposit or withdraw? ___ Yes ___ No

Is jobsite ordering permitted? ___ Yes __ No

Is there a jobsite verification of items ordered and delivered? ___ Yes ___No

Is the jobsite verification required in order for invoices to be paid? ___ Yes ___ No