Expected date of review:
Membership and Yearly Health Check Form
The purpose of this form is to gather data about your organisation, which will be entered into our database(a comprehensive information source on the third sector and volunteering in the Clackmannanshire area). The wide range of information gathered will help us and members of the public access good quality information. Only CTSI will have access to all the information - organisational details will be displayed on ourwebsite’s online directory for public use.
The minimum information we require for your membership is highlighted. We won’t be able to use the data you give us if you miss out any of these fields. If you answer “no” to any of the questions, but would like guidance to build on this area, please contact CTSI and the relevant Development Officer will work with you on your query.
Your membership will be reviewed annually to ensure the information we hold remains up to date and correct. If any details change before your review, please contact us to update them.
In addition to, this process will assist your organisation get into/stay ingood shape, and assist you recognise areas requiring development. As you go through the form you will be able to:
Plan ahead to meet change
Manage your resources efficiently
Value your volunteers, staff and board/committee
Offer quality services and activities to members and users
Work well with other organisations
Regularly monitor and evaluate your effectiveness
Recognise what you already do well
Identify specific areas/activities that could be improved, updated or developed
Provide a framework to prioritise and manage your organisation’s future
Check that procedures meet practice
Identify additional skills, knowledge or training needed within the organisation
Section 1 – Organisation
1. Organisation Name:
2. Organisation Type:
☐Organisation ☐Branch/Subsidiary ☐Partnership/Network/Forum
3. Website Address:
4. Social Media:
Facebook -
Twitter -
Other -
5. Do you have a newsletter or e-bulletin?
(Please provide details of how we would access this)
6. What is the legal status of your organisation?
☐ Scottish Registered Charity
☐Unincorporated Association
☐Company Limited by Guarantee
☐ Scottish Charitable Incorporated Organisation (SCIO)
☐ Trust
☐ Industrial Provident Society
☐ Social Enterprise
☐ Community Interest Company (CIC)
☐ Not Known/Other
Please Specify
7. If your organisation is a registered charity, what is your charity number?
8. If your organisation is registered with Companies House, what is your company
number?
9. Correspondence/Head Office/General Office Details:
Contact Name:Address Line 1:
Address Line 2:
Town:
Postcode:
Phone Number*:
Email*:
(If you do not have a general phone number/email please leave blank)
10. Preferred method of contact:
☐ Phone ☐ Mobile ☐ Email ☐ Post
11. Main Contact:
Job Title:
Office Phone Number:
Work Mobile Number:
Work Email:
Section 2 –Accessibility
1. Do you have accessible premises?
☐ Yes ☐ No
2. Do you have accessible parking spaces at the premises?
☐ Yes ☐ No
- Do you have accessible toilets at the premises?
☐ Yes ☐ No
- Are there any other accessibility provisions at this location?
- Please tell us when your office is open:
Day: / Opening hours:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
6. Do you have any meeting space available for Community use?
☐ Yes ☐ No
If yes, what is the hourly rate for its use?
Section 3–Geography
1. In which geographical area do you operate?
☐ International
☐UK Wide
☐ Scotland Wide
☐ More than one Local Authority Area
☐ Forth Valley (Falkirk, Stirling and Clackmannanshire)
☐ Clackmannanshire
☐ Neighbourhoods
Section 4 - Activity of Organisation
1. Please provide a brief statement about your organisation’s main aims and
objectives. This should be no longer than 150 words.
2. What are your organisation’s main areas of activity? (Please select a max of 3)
☐ Addictions☐ Advice/Information
☐ Advocacy
☐ Animal Welfare
☐ Arts and Culture
☐ Befriending/Mentoring
☐ Ethnic Minorities
☐ Campaigning/Lobbying
☐ Carers
☐ Charity Shop
☐ Childrens’ Services
☐ Community Council
☐ Community Development
☐ Community Facilities
☐ Community Forum
☐ Community Safety
☐ Community Transport / ☐ Counselling
☐ Credit Union/Community Banking
☐ Drug/Alcohol Issues
☐ Education/Learning/Training
☐ Emergency Response
☐ Employment
☐ Environment/Recycling
☐ Equality
☐ Faith/Religion/Belief
☐ Family Support
☐ Fundraising/Funding
☐ Health
☐ Helpline
☐ Housing Association
☐ Law and Justice
☐ Learning Disability
☐ Men / ☐ Mental Health
☐ Offenders/Ex-Offenders
☐ Older People
☐ Overseas Aid/Developing World
☐ Physical Disability
☐ Poverty
☐ Refugees/Asylum Seekers
☐ Self help/Support
☐ Sensory Impairment
☐ Sexuality
☐ Single Parent
☐ Social Care
☐ Social Economy/Enterprise
☐ Sport/Leisure/Recreation
☐ Volunteering
☐ Women
☐ Young People
Section 5–Board and Committee
Please provide us with a signed copy of your governing document (e.g Set of Rules, Constitution, Memorandum Articles of Association)
1. Which documents are you providing?
2. When did you last review these documents?
3. Are you a membership organisation?
☐ Yes ☐ No
a)If so, do you have a register of members?
☐ Yes ☐ No
b)Do you have an application process for new members?
☐ Yes ☐ No
c)How often does your membership meet?
☐ Monthly ☐ Bi-Monthly ☐ Quarterly ☐ Twice a Year ☐ Annually
4. When was your last AGM?
5. How many current board members do you have?
a) Please provide details of your office bearers:
Chair:
Name:
Contact Number:
Email: __
Secretary:
Name:
Contact Number:
Email: __
Treasurer:
Name:
Contact Number:
Email: __
b) What is your process for recruiting and managing board members?
c) Do you have a strategy/business plan/workplan?
☐ Yes (please provide a copy) ☐ No
d) Do you have a succession plan in place?
☐ Yes ☐ No
- Have you achieved/or are you working towards any quality standards? (e.g. EFQM)
☐ Yes ☐ No
If yes, please list:
9. Does the board/committee have a policy (such as a code of conduct) to deal with
conflicts of interest within the board?
☐ Yes (please provide a copy) ☐ No
10. Do you have a risk management register?
☐ Yes ☐ No
Section 6–Finance
1. Does your organisation have its own bank account?
☐ Yes ☐ No
2. Does the account require dual signatories who are unrelated?
☐ Yes ☐ No
3. What percentage of your organisations income is earned through trading?
4. Where do you obtain funding? (please tick all that are relevant)
☐ Business Sector☐ Central Gov’t - Scottish
☐Central Gov’t – Westminster
☐ Charitable Trust / ☐ Communities Scotland
☐ Donations
☐ Earned Income
☐ European Money
☐ Health (board/trust) / ☐ Local Authority
☐ Local Enterprise Co.
☐ Lottery Board
☐ Other
5. Do you have a funding strategy?
☐ Yes (please provide a copy) ☐ No
6. Do you have a fundraising officer?
☐ Yes ☐ No
If yes, please provide details:
Name:
Contact Number:
Email: __
7. What was the date your accounts were last audited/independently verified?
8. To which regulators are you required to submit your accounts? (e.g OSCR,
Companies House, Office of the CIC Regulator etc.)
Section 7–Operational
1. Which regulatory bodies are you registered with? (e.g SSSC, CQC)
- Please tick the policies your organisation has:
☐ Equal Opportunities
☐ Health and Safety
☐ Volunteer
☐ Other / ☐ Vulnerable Adults
☐ Equality and Diversity
☐ Child Protection
Please Specify:
3. How often are your policies reviewed?
- Do you have contracts with the public sector?
☐ Yes (please outline below) ☐ No
- Are you registered with Public Contracts Scotland?
☐ Yes ☐ No
- Have you completed a European Single Procurement Document (ESPD)?
☐ Yes ☐ No
- Are you VAT registered?
☐ Yes ☐ No
- Do you have a marketing plan?
☐ Yes (please provide a copy) ☐ No
Section 8–Employees
1.How many staff do you employ?
Full-time:Part-time:
2. Do you have a recruitment and induction process?
☐ Yes ☐ No
3. Do you have contracts of employment for all staff?
☐ Yes ☐ No
4. Do you have a job description for each staff member?
☐ Yes ☐ No
5. Are your organisation’s policies built into the induction process for staff, volunteers
and board members?
☐ Yes ☐ No
6. Do you provide formal and documented support and supervision sessions for
each staff member?
☐ Yes ☐ No
How often do you do this?
7. Are you an accredited living wage employer?
☐ Yes ☐ No
8. Are all eligible staff enrolled in a pension scheme?
☐ Yes ☐ No
9. Do you provide opportunities for training and personal development for staff?
☐ Yes ☐ No
10. Do you participate in employer supported employment?
☐ Yes ☐ No
Section 9–Volunteering
1. Do you have a Volunteer Policy?
☐ Yes (please provide a copy) ☐ No
2. Do you engage/involve volunteers?
☐ Yes ☐ No
a) If yes, how many volunteers are involved in your organisation, including board
members?
b) On average, how many volunteering hours are carried out in a week?
3. Do you provide volunteer expenses?
☐ Yes ☐ No
4. Is volunteering activity covered within your insurance?
☐ Yes ☐ No
5. Do you have a Volunteer Manager/Co-ordinator/Named contact for volunteer?
☐ Yes ☐ No
If yes, please provide details:
Name:
Contact Number:
Email:
6. Would you like to engage with our Volunteer Development Officer about
promoting your opportunities through ourselves?
☐ Yes ☐ No
7. Does each volunteering role have a clear role description?
☐ Yes ☐ No
8. Does any role require a PVG? (for those working with vulnerable groups)
☐ Yes ☐ No
9. Do you carry out a risk assessment for each role?
☐ Yes ☐ No
10. Do you provide documented support/catch up sessions for each volunteer?
☐ Yes ☐ No
a)If so, how often?
11. Have you achieved the Volunteer Friendly Award?
☐ Yes ☐ No
12. Are you registered to provide Saltire Awards to young volunteers? (12-25)
☐ Yes ☐ No
13. How do you recognise your volunteer’s contribution?
Section 10–Partcipating and Influencing
1. Are you aware of the Community Planning Partnership in Clacks?
☐ Yes ☐ No
2. Do you know about the Local Outcome Improvement Plans (LOIPS)?
☐ Yes ☐ No
3. Do you know about the third sector forums that CTSI facilitate?
☐ Yes ☐ No
4. Please tick which Fora that you have attended:
☐ Third Sector Forum☐ Health and Social Care Forum
☐ Volunteer Managers’ Forum / ☐ Children and Families Forum
☐ CSEN
☐ Community Breakfast
5. Do you know about the Online Discussion Boards hosted on our website?
☐ Yes ☐ No
To register to participate, please visit ctsi.org.uk/register
Section 11–Membership
1. We have different monthly e-bulletins, please tick all that you would like to
receive:
☐ Events and Training☐ Community News
☐ Health and Social Care / ☐ Volunteering
☐ Funding
Email Address:
Alternatively, you can subscribe at any time on our website.
By joining our membership, your organisation will contribute to the collective voice of the third sector and give Clackmannanshire the authority in its partnership work with other agencies.
Member organisations are:
Eligible to nominate someone from their organisation to serve on our Board of Directors
Eligible to attend and vote at our annual general meeting (AGM)
In order to develop the work that we do, we cannot consider membership* to our organisation without a signature and a signed copy of your Constitution/Memorandum and Articles of Association.
Signature:
☐ If completing electronically, please tick this box to confirm the above. Your email will
be accepted in lieu of a signature
*should CTSI be wound up whilst our organsiation is a member or within one year of ceasing to be a member, we agree to contribute a maximum of £1 (one pound) to the company’s assets.
Section 12–Consent for Storage of Data
CTSI would like to thank you for contributing; your participation is greatly appreciated and will help to inform accurate research on the vital local and national contribution of Clackmannanshire’s third sector.
Note on Personal Data:
Any personal information you give us (e,g. the name, personal email or home address of a main contact) will be held and used in accordance with the Data Protection Act 1998. Personal information held will not be disclosed to any unathorised person or body without your permission.
Only CTSI personnel will have access to all information you supply.
General organisational information will be made available to other organisations and the public through our websites organisation directory. We will not display personal contact names or information unless you give us permission to do so. You also have the right to see what data we store about you, how we use it and to prevent us from using it. We reserve the right to charge a small administration fee (to cover our costs) for access to this information.
Anonymised statistical data gathered from our database may be used to report to our funder and policy makers at a local or national level and in activity such as our Service Directory or Annual Impact Report.
If you have any queries or concerns regarding the Data Protection Act and this statement then please write to: Business Manager, Clackmannanshire Third Sector Interface, The Hub, Whins Road, Alloa, FK10 3TA, or by email
By signing, I agree that I have the requisite authority to provide this information on behalf of the organisation mentioned herein.
Name:
Role:
Date: __
Signature:
☐ If completing electronically, please tick this box to confirm the above. Your email will
be accepted in lieu of a signature
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