ACA Compliance Audit Checklist
Document your ACA compliance audit review, checklist status, findings, and follow-up actions in this streamlined and professional workflow form.
Audit Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Auditor Name
*
First Name
Last Name
Company/Organization Name
*
Plan Year or Reporting Period
*
ACA Eligibility Determination Status
*
Compliant
Partial Compliance
Non-Compliant
Not Applicable
Affordable Coverage Verification Status
*
Compliant
Partial Compliance
Non-Compliant
Not Applicable
Minimum Essential Coverage Offered Status
*
Compliant
Partial Compliance
Non-Compliant
Not Applicable
Summary of Findings
*
Corrective Actions Required
*
Responsible Party for Corrective Actions
*
Due Date for Corrective Actions
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Final Notes or Sign-Off Comments
Submit Audit Checklist
Should be Empty: