What it is
Each internal auditor completes this statement each year and before an engagement if circumstances change. It records disclosures about past responsibilities, relationships, financial interests, management pressure and gifts, and the safeguard or response for each.
The chief audit executive reviews the statements and confirms organizational independence to the audit committee at least once a year.
When to use it
- At the start of each year.
- Before assigning an auditor to an engagement.
- For the annual confirmation to the audit committee.
What’s inside
- Statement of understanding
- Seven disclosure questions
- Safeguards and response table
- Chief audit executive confirmation to the committee
Standard cited
This template follows IIA Global Internal Audit Standards (2024). 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 if an auditor used to work in the area?
Disclose it and, as your charter says, do not assign that auditor to assess the area for a set period. Record the safeguard.
Who is told of impairments?
The chief audit executive discloses any impairment, in fact or appearance, and the planned response to the audit committee.
Related templates
- Internal Audit Charter
- Internal Audit Quality Assurance and Improvement Program Plan
- Global Internal Audit Standards Conformance Checklist
- Audit Committee Charter
Last updated 11/05/2026. All free templates.