Employee Name:

[employee name]

Employee Position:

[employee position]

Company Name:

[your company name]

Created by:

[your name]

Healthcare Benefits:

Have all eligible employees been offered health insurance coverage?

• yes

• no

Is the health insurance plan compliant with the Affordable Care Act (ACA)?

• yes

• no

Have required notices, such as the Summary of Benefits and Coverage (SBC), been provided to employees?

• yes

• no

Are employee contributions for health insurance within the limits set by regulations?

• yes

• no

Retirement Benefits:

Do you offer a retirement plan such as a 401(k) or pension plan?

• yes

• no

Is the retirement plan administered in accordance with the Employee Retirement Income Security Act (ERISA)?

• yes

• no

Are employee contributions and employer matches being handled correctly?

• yes

• no

Have required disclosures, like Summary Plan Descriptions (SPDs), been distributed to participants?

• yes

• no

Leave Benefits:

Do you comply with federal and state laws regarding leave entitlements such as Family and Medical Leave Act (FMLA) and paid sick leave?

• yes

• no

Are employees properly informed about their leave rights and procedures for requesting leave?

• yes

• no

Is leave usage tracked accurately and consistently for all employees?

• yes

• no

Other Benefits:

Are other benefits such as tuition assistance or transportation benefits offered in compliance with applicable laws?

• yes

• no

Have required documents, such as COBRA notices or HIPAA privacy notices, been provided to employees as necessary?

• yes

• no

Are benefits provided equally to all eligible employees without discrimination?

• yes

• no

Recordkeeping and Reporting:

Are records related to employee benefits maintained accurately and securely?

• yes

• no

Are required reports, filings, and disclosures submitted to regulatory agencies on time?

• yes

• no