Sanctions Screening Checklist Form
Complete this form to document the screening of a person or organization against sanctions-related risk.
Screening Subject Type
*
Person
Organization
Full Name (Person) or Organization Name
*
Date of Birth (if Person) or Registration Number (if Organization)
Country of Association
*
Please Select
United States
United Kingdom
European Union
Canada
Australia
Other
Screening Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Sanctions Lists Checked
*
OFAC (US)
UN Sanctions
EU Sanctions
UK Sanctions
Other
Screening Method
*
Manual Search
Automated Screening Tool
Other
Screening Result
*
No Match Found
Potential Match (Further Review Required)
Match Found (Action Required)
Comments or Notes
Screened By (Name or ID)
*
Submit Screening
Should be Empty: