Management Analysis

A. Organization Information

Legal Business Name________________________________________________________________

Street Address______________________________________________________________________

City______________________________________________State__________Zip________________

Contact Name __________________________________Email Address_________________________

Business Phone _________________________________Cell Phone____________________________

# of Employees ___________________Payroll Frequency (weekly, bi-weekly, etc.)________________

B. Current Human Resource Management Questionnaire (Please Circle the Correct Answer)

1. Do you currently process your New Hire Reporting to your State Government? YES or NO2. Do you process your payroll in-house? YES or NO 3. Do you offer Direct Deposit to your employees? YES or NO4. Do you currently offer an Orientation Package for New Hires? YES or NO5. Do you have an up-to-date Employee Manual? YES or NO6. Do you ever contract employees from a Temporary Agency? YES or NO7. Do you administer COBRA in-house? YES or NO8. Do you have completed I-9 forms on your employees? YES or NO9. Do you have a Safety Program for your employees? YES or NO

10. Do you offer a 401(k) Plan to your employees? YES or NO 11. Do you currently complete your OSHA 200 Log? YES or NO

12. Do you currently offer your employees a Section 125 Cafeteria Plan? YES or NO

C. Circle the current Employee Issues or Concerns you would like to improve for your

organization.Medical or Dental Insurance 401(k) Plan Safety Program Payroll ProcessingEmployee Manual OSHA Compliance Direct Deposit Workers’ CompUnemployment Management Legal Compliance Hiring Process Employee Perks

D. Workers’ Compensation InformationPlease attach your most recent Workers’ Compensation Declaration Page that includes:1.) Job Title or Code 2.) Rate per Code 3.) # of employees per Code 4.) Annual Payroll

E. State Unemployment Information Please attach your most recent State Unemployment Statement.

F. Benefit Information Please attach a copy of your most recent Health, Dental, Life Statements.

Pick Up Arrangements_________________________________________________Date______________