Classification Checklist A Form (completed by the requisitioner) : Procurement

I. Contact Information

Individual's Information


Name	Social Security Number

Requisitioner's Information


Name	Department

II. Multiple Relationships with the Institution

A. Does this person currently work for the Institution as an employee/student? Yes No

B. Is it currently expected that WHOI will hire this individual as an employee/student in the near future? Yes No

C. During the 12 months prior to the date the services are to commence, did the individual have an official WHOI appointment (including temporary) and provide the same or similar services? Yes No

III. Classification Specifics

A. Nature of Work

1. Describe the nature of the work you wish this individual to perform.

2. What is the anticipated duration of this relationship?

3. During this period, how many hours, days, weeks is it anticipated the contractor will perform services?

4. What are the skills required to perform this task?

B. Define the Relationship (Choose one)

	The individual will perform services for an Institution employee under an arrangement whereby the WHOI employee serves in a supervisory capacity (i.e. the individual will be working under the direction of a WHOI employee).
	The individual will serve in an advisory or consulting capacity with an Institution employee (i.e. the individual will be working with a WHOI employee in a "collaboration between equals" type arrangement).

C. Level of Direction

1. Does the individual provide the same or similar services to other entities or to the general public as part of a trade or business? Yes No

2. Will the department provide the individual with specific instructions regarding performance of the required work rather than rely on the individual's expertise? Yes No

3. Will there be a set number of hours and/or days of the week that the individual is required to work? Yes No

Requisitioner's signature: ______________________________________ Date: _____/_____/_____

MS#1 • Woods Hole, MA 02543 • 508.289.2371 • Fax 508.457.2192 • procurement@whoi.edu