SMALL BUSINESS RISK MANAGEMENT ASSESSMENT SURVEY

AGREEMENT TO PARTICIPATE

An Agreement to Participate in this Anonymous and Confidential Survey

Procedure and Risks:

As part of a junior level course entitled “Business Risk Management,” A University of Louisiana
at Monroe Risk Management and Insurance or Computer Information Systems major/minor will
ask you a specific set of questions related to the risk management practices you utilize in your
business in addition to collecting certain demographic information about the ownership, size and
activities of the business.

Students will record your responses. There are no known risks associated with participation in
the study.

Benefits:

It is hoped that the results of this study will benefit the business community through providing
greater insight into risk management practices of small businesses and assist in the development
of educational and other practical tools to help small businesses better manage the risks they face
as business owners/operations

Cost Compensation:

Participation in this study will involve no costs or payments to you.

Confidentiality:

All information collected during the study period will be kept strictly confidential. Only the
interviewer, the Professor and a student graduate assistant will have access to the specific
information provided in the study. No publications or reports from this project will include
identifying information on any participant. If you agree to join this study, please sign your name
on the following page.
 INFORMED CONSENT FOR INTERVIEWS
[Small Business Risk Management Assessment 2020]

NAME OF BUSINESS__________________________________

I, _____________________________________, agree to be interviewed for the project entitled

“An Assessment of Small Business Risk Management 2021” which is being produced by Dr.
Christine Berry of the University of Louisiana at Monroe. This project will end on Dec 30th
2021.

I certify that I have been told of the confidentiality of information collected for this project and
the anonymity of my participation; that I have been given satisfactory answers to my inquiries
concerning project procedures and other matters; and that I have been advised that I am free to
withdraw my consent and to discontinue participation in the project or activity at any time
without prejudice.

I agree that any information obtained from this research may be used in any way thought best for
this study as long as the anonymity of the participants is maintained.

________________________________________ Date ________________________

Signature of Interviewee

STUDENT NAME____________________________________