FOCI Board Self Assessment Form (Aug 8 2019)

SELF ASSESSMENT FORM

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OMB EXPIRATION DATE: XX/XXXX/XXXX
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Version 1.1 – Effective 7/18/2017

SELF-ASSESSMENT FORM

Name:
Role with the Company: Select
Company and CAGE:

1. Which areas of expertise did you utilize during this assessment period?
national security
finance

information security

business development

business operations

technology

personnel security

cybersecurity
other

industrial security

network operations

T
F

acquisition

2. How would you assess your overall effectiveness fulfilling your fiduciary duties to the Company during
this assessment period?
select one

please explain

A
R

3. How would you assess your overall effectiveness fulfilling your duty to protect national security
information?
select one

please explain

D

4. How would you assess your understanding of the threat to the company’s critical technologies, assets,
and information?
select one
please explain

5. How and from whom do you receive the threat information?
please explain

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6. How would you characterize your understanding of the vulnerabilities to the company’s critical technologies,
assets, and information?
select one

please explain

7. How and from whom do you receive information on vulnerabilities?
please explain

T
F

8. How would you characterize your professional relationship with the following groups or individuals?
select one

select one

select one

select one

select one

select one

select one

select one

select one

select one

please explain as necessary

D

A
R

9. What are areas for improvement in your performance of your fiduciary and national security duties during the
next assessment period, and how do intend to sustain or improve your level of performance?
please explain as necessary

Signature:

Date:

E-mail:

Phone:

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