Title Page
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Conducted on
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Prepared by
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Location
Regulatory/Compliance Requirements
- Regulations
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Requirements (Attach file if needed)
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Source of Requirements (Regulation/Policy/Standard)
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Relevant Department/s
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Current Compliance Status
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Current State
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Required State
Risk Management
- Risks
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Compliance Gap
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Risk Impact
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Likelihood
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Priority
Action Plan
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Gap Identified
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Corrective Action
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Responsible Department/Person
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Status
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Deadline for Resolution
Monitoring and Review
- Compliance Tracking
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Monitoring Plan
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Review Frequency
Sign-off
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Compliance Gap Analysis Template Reviewed By
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Designation of the Reviewer
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Reviewer's Comment or Feedback
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Date Reviewed