What it is
When the AICPA Code has no specific rule for a relationship or service, the member uses the conceptual framework: identify threats, evaluate whether they are at an acceptable level, apply safeguards, and decline the work if no safeguard is enough. The worksheet records each step.
It lists the seven threat categories, asks for the facts and the level of each before safeguards, records the safeguards considered and whether each brings the threat to an acceptable level, and closes with the conclusion, the governance communication, consultation and partner review.
When to use it
- A relationship or service has no specific answer in the Code.
- A nonattest service, a family relationship or a financial interest is raised.
- Annual independence review of a long-standing client.
What’s inside
- Engagement and relationship header
- Seven threat categories with facts and level
- Safeguards table by type
- Conclusion, communication to those charged with governance and review
Standard cited
This template follows ET 1.210.010. It is written in our own words, except for phrases the standard requires the document to contain, with [bracketed placeholders] for client details, amounts in USD and dates as MM/DD/YYYY. Check it against the current standard and your firm’s methodology before use.
Questions
What are the threat categories?
Adverse interest, advocacy, familiarity, management participation, self-interest, self-review and undue influence. The worksheet has a row for each.
What counts as an acceptable level?
A level at which a reasonable and informed third party who weighs the facts and circumstances would conclude that compliance is not compromised.
When must the work be declined?
When no safeguard eliminates the threat or reduces it to an acceptable level. The worksheet’s conclusion has a place to record it.
Related templates
- Firm Independence Compliance Checklist (Annual)
- Nonattest Services Independence Evaluation Form
- Engagement Independence Confirmation (AICPA Code ET 1.200)
- New Client Intake and Conflict Check Form
Last updated 11/05/2026. All free templates.