Readiness Assessment Procedure
A management-led check before the auditor starts: how to find gaps and exceptions, fix them, and decide when to begin the observation period.
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- Word
- Size
- 72 KB
- Length
- 26 pages
- Version
- 1.0
- Updated
What's inside
- How to use this procedure
- The procedure at a glance
- The twelve steps
- Walkthrough and test method
- The five finding words, and what to do about a gap
- Running a readiness assessment with the workbook (SOC 2 Readiness Self-Assessment)
- Tracking gaps in the deficiency tracker (P20-A08 Control Deficiency & Remediation Tracker)
- Retest
- When to start the observation period
- What to tell the sponsor
- Forms
- Roles and responsibilities
- Common mistakes
- Related documents
- Definitions
- Worked example: Acme
- Adapting this procedure
- Framework references
Preview
The document from section 1, as you will receive it. Highlighted [[text]] is for you to replace; shaded guidance boxes are for you to delete before approval. The cover and document control pages are in the file.
How to use this procedure
Decide what the report is for. Draw the boundary around the service your customers rely on. Make the controls work and leave records before the period starts. Tell customers plainly what the report covers and what it does not.
This procedure is the management-led check that comes before the CPA firm starts. Its job is to find the gaps in your system, your controls and your evidence while there is still time to close them, and to decide, on stated grounds, when the observation period should begin. It has twelve steps, RP-01 to RP-12. The other documents of the SOC 2 Report Readiness pack cite the steps by those numbers.
What readiness is. Management's own check of the system, the controls and the evidence before the observation period starts. It is not the auditor's work and it is not an opinion.
What it is not. It is not an audit and not a test by the CPA firm, and it does not predict the firm's opinion. It is also not the control testing of the control testing pack (P20), although it borrows that pack's rules: they are cited here by ID and are not restated. A SOC 2 report is an attestation by a licensed CPA firm, not a certificate. Nobody is “SOC 2 certified”, and no document in this pack says that you are or will be.
Legal note. This document helps an organisation get ready for a SOC 2 examination by a licensed CPA firm. It is not legal advice and not advice on an audit or attestation engagement. A SOC 2 report is the CPA firm's opinion on management's description of a system and on its controls. It is an attestation, not a certificate. This document does not say that you will receive any particular opinion, that any control meets a criterion, or that holding ISO/IEC 27001 or any other report equals or replaces a SOC 2 report. What the criteria require of you, how exceptions are described in the report and whether they affect the opinion are for the CPA firm to decide. Which customers accept which report is for them.
Who it is for
A security or IT manager at a software company who has been asked to get the company ready for a SOC 2 report. The procedure assumes that the scope has been discussed (A02) and that a description is being drafted (A03). It needs a few hours of the assessor's time for each key control, and a decision from the sponsor at the end.
Who does what
- Executive sponsor backs the examination with time and money, signs management's assertion with the examination owner, and decides scope questions that cost money.
- Examination owner runs the readiness work and the calendar, is the CPA firm's day-to-day contact, keeps the description, and reports the position in counts and words.
- Assessor walks through and tests the controls, records each finding in one of the five words, and rates the readiness items. Does not perform, own or approve the controls assessed (SR-11, P20 CA-10).
- Control owner performs the control as written, keeps the record it leaves, and answers the auditor's requests for that evidence.
- Head of Information Security owns the security controls, the risk assessment and the incident process; does not test their own controls (P20 CA-10).
- Legal reviews customer contracts and commitments, the engagement letter, the bridge letter and what is shared under a confidentiality agreement.
Choosing the assessor
SR-11 Nobody tests their own control (P20 CA-10). The readiness assessment is done by someone who does not perform the controls it reads, or the check is recorded as a self-check.
The assessor is the one new role this procedure asks for. Choose by looking at the list of controls: they must perform none of them, own none and approve none. The table lists the usual choices, best first.
Choice | Notes |
|---|---|
A manager or lead from another team | Usually workable in a company of any size. Give them the written control statements and an hour of orientation. |
An internal audit, risk or compliance function | Best where it exists. It must not be the owner of the controls it reads. |
A peer from another department who knows the system | Acceptable for a first look. Note who they are and why they do not perform the controls. |
An outside adviser, who is not the CPA firm that will examine you | Useful in a small company. Keep the roles apart (SR-24): the adviser assesses, management decides and the CPA firm examines. |
Nobody independent is available | Do the work, and record it as a self-check (SR-11, P20 CA-10). It still finds gaps, but the readiness result says that it was a self-check. |
The rules the procedure puts into practice
SR-10 A control must run before it can be observed. Controls should have operated, with records, for at least [[3]] months before a first Type 2 period starts (a house default). If they have not, expect exceptions early in a short first period, or take a Type 1 report first and begin the Type 2 period when the controls have run. Controls that are not yet running at all are ready for neither report.
SR-12 Evidence is dated, attributable to a person or system, retrievable without asking staff to reconstruct it, and kept at least until the report is issued and for as long as the records period of P22 asks.
SR-13 Do the readiness assessment before the period starts (A06, A09). Fix what is a blocking item. Do not start the period with a blocking item below In place.
SR-14 A gap found in readiness is a finding with an owner, a date and a retest (P20 A08). A gap is fixed, not hidden, and a fix that has not yet operated is described as that.
SR-15 Readiness is reported as counts and words, with blocking items named. There is no score, no percentage and no pass or fail, because the opinion is the CPA firm's.
SR-16 Agree the observation period dates in writing with the CPA firm before the period starts. Do not change them in the period without the firm. Start the next period on the day after the last one ends so that no day is uncovered.
Three rules of the control testing pack apply and are cited by ID: P20 CA-03 (what counts as a test), P20 CA-10 (nobody tests their own control) and P20 CA-14 (when a deficiency may be closed). Read them in the control testing pack before the first walkthrough. They are not repeated in this procedure.
Incidents. If an incident happens while you are getting ready, the incident plan decides who decides and who is told, and when (P09-A03 Incident Response Plan). This procedure changes no decision right and states no notification clock.
Guidance — delete before approval
Allow weeks, not days, from the first look to a start decision for a first examination, and plan the walkthroughs in the middle of it. The time cannot be shortened by working harder, because controls take time to run and fixes take time to operate. The worked example below runs five weeks from the first look to the planned start, with six blocking items to close.
Run the readiness workbook (SOC 2 Readiness Self-Assessment) early as a first look, before the walkthroughs. It will show many items Not started or Planned, which is its use: it tells you how long the blocking items will take.
The procedure at a glance
Read the table from top to bottom. The step numbers do not change, so records can cite them. Steps RP-05 to RP-08 repeat for each key control.
Step | Led by | Record | Rules |
|---|---|---|---|
RP-01 Confirm the scope | Examination owner | A signed scope note | SR-03, SR-04 |
RP-02 Draft the description | Examination owner | Draft description | SR-02 |
RP-03 List the controls and their owners | Examination owner | The completed register and plan | SR-09 |
RP-04 Choose the assessor | Examination owner | Assessor named | SR-11 |
RP-05 Walk through each control | Assessor | Walkthrough notes | SR-09, SR-12 |
RP-06 Test a few occurrences | Assessor | Workpaper (P20 A06) | SR-12 |
RP-07 Record each finding in one of five words | Assessor | Findings list | SR-14 |
RP-08 Decide what to do about each gap | Examination owner | Dispositions | SR-14 |
RP-09 Run the self-assessment | Examination owner | A readiness result in words | SR-13, SR-15 |
RP-10 Retest the fixes | Assessor | Retest records | SR-14 |
RP-11 Decide to start | Executive sponsor | Start decision | SR-13, SR-16 |
RP-12 Agree the dates with the CPA firm | Examination owner | Engagement letter dates | SR-16 |
Key control. A control that the principal commitments depend on, so that if it did not work as written a commitment could be missed. The examination owner and the sponsor choose the key controls, and write the choice down. This is a term of this pack and not of the AICPA.
The twelve steps
Each step has the same layout: what it does, who leads, what comes in and what comes out, how to do it, and what usually goes wrong.
RP-01 Confirm the scope
Read the scoping result (A02) and the boundary. Settle the type, the categories and the providers with the sponsor.
Led by: Examination owner. With: Executive sponsor. Rules: SR-03, SR-04.
Inputs: The scoping result (A02), The draft boundary and The commitments customers rely on.
Output: A scope note: report type, categories with the reason for each, period length, the providers that matter. Record: A signed scope note.
- Re-run the scoping assessment if any answer has changed since it was done.
- For each category beyond Security, name the customer or the written commitment that needs it (SR-03). A category with no reason comes out.
- List the providers that run part of the system, and the method you expect for each (SR-06).
- The sponsor agrees the scope note and the date is recorded. Anything that costs money is the sponsor's decision.
Watch for: Treating the scope as settled because it was settled once. Re-scope when the service, the boundary, a major provider or a commitment changes (SR-08).
RP-02 Draft the description
Write the nine topics of the description with the template (A03). Draft first, then check each statement against how the system really works.
Led by: Examination owner. With: Head of Engineering and Head of Information Security. Rules: SR-02.
Inputs: The scope note, The template (A03) and Contracts and service levels.
Output: A draft description covering the nine topics, owned by management. Record: Draft description.
- Draft the twelve sections of the template. Start with the boundary and the commitments.
- Read each statement with a person who runs that part of the system, and change it until they agree it is true today.
- Management owns the description (SR-02). Advisers may help; they do not write it for you.
Watch for: A description that describes the plan. The readiness assessment tests what runs, and the description must say the same.
RP-03 List the controls and their owners
For each criterion in scope, write down the control or controls you rely on, the owner and the evidence (A04, A05).
Led by: Examination owner. With: Control owner and Head of Information Security. Rules: SR-09.
Inputs: The draft description, The criteria register (A04), The control inventory (P20-A03) and The evidence plan (A05).
Output: For each criterion in scope: the controls, their owners and the evidence; the key controls marked. Record: The completed register and plan.
- For each control, one named owner, one written statement of what is done and how often, and the record it leaves (SR-09).
- Reuse the owners and statements that already exist in your control inventory. Do not write a second set.
- Mark the key controls, and write down why each is key.
Watch for: Two owners for a control, or none. With two nobody acts, and with none nobody answers the CPA firm.
RP-04 Choose the assessor
Choose a person who does not perform the controls. If none exists, record the check as a self-check.
Led by: Examination owner. With: Executive sponsor. Rules: SR-11.
Inputs: The list of controls and their owners.
Output: The assessor named, with the reason they do not perform the controls; or a note that the check is a self-check. Record: Assessor named.
- Check the candidate against the list of controls: they perform none, own none and approve none (SR-11, P20 CA-10).
- Give them the written statements, this procedure and the forms, and time. A rushed assessor reads what they are told.
- If nobody independent exists, record the check as a self-check and say so in every report on it.
Watch for: Asking the control owner to assess their own control because they know it best. They do know it best, which is the problem.
RP-05 Walk through each control
For each key control, follow one real occurrence from start to record, as the auditor will. Ask for the record, do not rely on being told.
Led by: Assessor. With: Control owner. Rules: SR-09, SR-12.
Inputs: The written statement of each key control, The list of owners and Access to the systems of record.
Output: A walkthrough record for each key control (form 1). Record: Walkthrough notes.
- Follow one real occurrence of each key control from trigger to record, with the person who performed it, in the system where the record lives.
- Ask for the record yourself, as P20 CA-03 requires.
- Compare what you saw with the written statement, attribute by attribute (see the walkthrough method).
Watch for: A demonstration. Ask for the last real occurrence and not for an example prepared for you.
RP-06 Test a few occurrences
Take a handful of occurrences of each key control from the system of record and check them against the written statement.
Led by: Assessor. With: Control owner. Rules: SR-12.
Inputs: The walkthrough records and The population of occurrences from the system of record.
Output: A workpaper for each control tested (P20-A06), with every occurrence examined recorded, including the ones that did not match. Record: Workpaper (P20 A06).
- Take the population from the system of record, not from a list the owner supplies.
- Choose a handful of occurrences yourself, spread across the time the control has run.
- Check each against the written statement and record the result for each occurrence.
Watch for: Choosing the occurrences the owner is proud of. Keep every occurrence you examined, not only the good ones.
RP-07 Record each finding in one of five words
Use the finding words. A finding is a design, operating, evidence or scope gap, or no gap found.
Led by: Assessor. With: Examination owner. Rules: SR-14.
Inputs: The walkthrough records and the workpapers.
Output: A finding record for each control and each scope question (form 2), each in one of the five words. Record: Findings list.
- Use the questions in the section on the five words, in order. The first question answered No gives the word.
- Write what was found as a fact: what was seen, where, on which date. Leave out blame.
- Say whether the control is a key control and whether the readiness item it supports is blocking.
Watch for: Softening the word. A design gap called an evidence gap will not be fixed in time.
RP-08 Decide what to do about each gap
For each gap choose a disposition, with an owner and a date, and track it (P20 A08).
Led by: Examination owner. With: Executive sponsor and Control owner. Rules: SR-14.
Inputs: The findings.
Output: A disposition for each gap, an owner, a due date and a row in the deficiency tracker (P20-A08). Record: Dispositions.
- Choose one of the three dispositions with the disposition guide below. A gap on a blocking item or on a key control is fixed before the period starts.
- Accepting a gap is a risk acceptance, with the approval the risk process sets (P05 RM-08), and the description says what was accepted.
- Set a due date from the planning days of the gap's priority, or a nearer one the owner can keep.
Watch for: Accepting a gap to save the date. The CPA firm tests what is written, and an accepted gap is still written.
RP-09 Run the self-assessment
Rate the readiness items (A09). Count the blocking items below In place.
Led by: Examination owner. With: Assessor. Rules: SR-13, SR-15.
Inputs: The findings and dispositions and The readiness workbook (A09).
Output: A readiness result in words, with the counts and the blocking items named. Record: A readiness result in words.
- Rate each readiness item with the level words, using the findings: see running the workbook.
- Count the blocking items below In place. Read the result word from the workbook, and copy it unchanged into the report.
- Report counts and words. There is no score (SR-15).
Watch for: Rating from memory. A rating needs a finding, a walkthrough or a record behind it.
RP-10 Retest the fixes
A fixed control is retested only after it has operated for a while (P20 CA-14).
Led by: Assessor. With: Control owner. Rules: SR-14.
Inputs: The tracker rows for fixed gaps and The fixed control, after it has operated.
Output: A retest record for each fix, by someone other than the owner. Record: Retest records.
- Retest only after the fixed control has operated for a while (P20 CA-14). A control fixed yesterday has not yet shown that it works.
- Someone other than the owner retests. Record the result in the tracker, and close the row only on a retest that finds no gap.
- A fix that has not yet operated is described as that in every report (SR-14).
Watch for: Closing a row because the fix was made. Closing needs the retest.
RP-11 Decide to start
The sponsor and the examination owner decide with the start decision rule. They record who decided, and when. If the dates are the only reason to hold, record Hold, agree the dates (RP-12), then record Start.
Led by: Executive sponsor. With: Examination owner. Rules: SR-13, SR-16.
Inputs: The readiness result, The open gaps on key controls and The state of the dates.
Output: A start-decision record (form 3): Start or Hold, the reasons, who decided and when. Record: Start decision.
- Apply the start decision rule to three facts: the blocking items below In place, the open design or operating gaps on key controls, and whether the dates are agreed in writing.
- Start only when none of the three holds a reason. Otherwise Hold, with the actions and the date of the next decision. If the dates are the only reason, Hold, agree them with the CPA firm (RP-12), then record Start.
- The sponsor and the examination owner decide together, and the record shows who and when.
Watch for: Treating the planned start as a promise. The date serves the controls and not the reverse.
RP-12 Agree the dates with the CPA firm
Confirm the period dates in writing before the period starts. This closes the last reason to hold when only the dates are missing.
Led by: Examination owner. With: Executive sponsor and Legal. Rules: SR-16.
Inputs: The start decision, or a Hold whose only reason is that the dates are not yet agreed and The draft engagement letter.
Output: The period start and end dates, agreed in writing with the CPA firm before the period starts. Record: Engagement letter dates.
- Confirm the dates in writing, in the engagement letter or an exchange the firm acknowledges. Do not change them in the period without the firm (SR-16).
- Put the next period's first day on the calendar: the day after this one ends, so that no day is uncovered (SR-16).
- Tell the customer-facing lead what they may say about the report, and when (A10).
Watch for: Starting on a verbal agreement. A date that is not written is a date the firm can understand differently.
Walkthrough and test method
The walkthrough and the test of occurrences are how an assessor learns whether a control works as written. Both follow P20 CA-03, which says what counts as a test. This section says how to carry them out.
The walkthrough
A walkthrough follows one real occurrence of a control from trigger to record. Do it for each key control (RP-05).
- Pick the control, read its written statement and note the owner, the frequency and the record it should leave.
- Ask for the most recent real occurrence, and for one from a different month where the control has run that long.
- Sit with the person who performed it. Ask them to show it in the system, not to describe it.
- Follow it from the trigger to the record: what started it, what was done, who approved it, what was written down and where.
- Ask for the record from its system of record, and look at it yourself.
- Compare with the written statement, one attribute at a time, and write what matched and what did not.
- Note anything the person did that the statement does not say, and anything the statement says that the person did not do.
- Give the control a finding word before you leave the system, while you still remember what you saw.
Compare what you saw with the statement on five attributes, and write the answer for each on the walkthrough record.
Attribute | Question | What to look at |
|---|---|---|
Who | Was it done by the owner or approver the statement names? | The user in the log or the ticket |
What | Was the action the statement describes the action that was taken? | The configuration, the approval, the review comment |
When | Was it done at the frequency and by the time the statement gives? | Timestamps on the record, compared with the due date |
How | Was it done through the system or route the statement names? | The system of record, not a message about it |
Record | Does a dated record exist that an outsider could read without help? | The record itself, retrieved without asking the owner to rebuild it (SR-12) |
Testing a handful of occurrences
After the walkthrough, take a handful of occurrences of the same control and check each against the statement (RP-06). The population comes from the system of record and is checked against a second source where one exists (P20 CA-04). You choose the occurrences, spread across the time the control has run, and the owner does not. Record the result for each occurrence on a workpaper (P20-A06 Control Test Workpaper Template, P20 CA-11).
The CPA firm decides which occurrences it samples and how many. Do not assume a sample size, do not choose the occurrences yourself, and keep every occurrence, not only the good ones. The counts in this plan show how many occurrences the period holds, not how many will be tested.
A handful is for finding gaps. It says nothing about how many occurrences the CPA firm will take, and a handful with no exception is not a conclusion about the whole period.
A control that has not run yet
A control cannot be tested before it has run. Do a walkthrough of its design (P20 CA-02) and rate it by its level, not by a test. How many occurrences fall in a period depends on how often the control happens: a control that happens quarterly gives 2 occurrences in a six-month period, and a control that happens once a year may give none (0), so schedule it inside the period. With 2 occurrences one late one is half of them, and it will be seen.
Guidance — delete before approval
Use the evidence standards (P20-A07 Control Evidence Standards Checklist) to decide what a good record looks like for each control. A record that only the owner can explain is not yet evidence.
The control inventory (P20-A03 Control Inventory & Ownership Register) gives the owner and the statement of each control. Test against that statement. If the statement is wrong, correct it first and say so in the finding.
Keep everything you examined, including occurrences that matched. A workpaper with only the failures cannot be reviewed.
The five finding words, and what to do about a gap
Every control and every scope question ends in exactly one of five words. The words are the same in the readiness workbook, in the tracker and in your reports to the sponsor.
Word | Meaning |
|---|---|
Design gap | The control does not exist, or as written it would not do what the commitment needs. |
Operating gap | The control exists but is not performed as written, or not as often as written. |
Evidence gap | The control is performed but leaves no record that the auditor could inspect. |
Scope gap | A system, provider or commitment that matters is not in the boundary or the description. |
No gap found | The control is designed, performed and leaves a record, as far as this check could see. |
Choosing the word
Question, in this order | If the answer is No, the word is |
|---|---|
Is the system, provider or commitment that this control concerns inside the boundary and the description? | Scope gap |
Does the control exist, and would it, as written, keep the commitment? | Design gap |
Is it performed as written, as often as written, by the person written? | Operating gap |
Does it leave a record that the auditor could inspect? | Evidence gap |
Ask the four questions in order. The first question answered No gives the word. If all four are answered Yes, the word is No gap found. A control with more than one gap carries the first word in the findings list and the others in the text of the record.
Choosing what to do
Disposition | Meaning |
|---|---|
Fix before the period starts | The gap is on a blocking item or would produce an exception on a key control. Close it, then retest. |
Fix in the period and expect an exception | The gap is not blocking, can be closed quickly, and any occurrence before the fix may be reported as an exception. |
Describe it and accept it | The control stays as it is, the description says so, and management accepts the risk (P05 RM-08). |
The table below says which disposition is usual. The sponsor and the examination owner decide. Where the table and your judgement differ, write down why.
Situation | Usual disposition | Why |
|---|---|---|
Any gap on a blocking readiness item below In place | Fix before the period starts | The rule of the start decision allows no blocking item below In place (SR-13). |
A design gap or an operating gap on a key control | Fix before the period starts | The control would produce an exception that a retest cannot yet show fixed. |
An evidence gap on a key control | Fix before the period starts | Without a record the control cannot be shown to have run, even when it did. |
A scope gap | Fix before the period starts | The boundary and the description decide what the report is about. Change them before the dates are agreed. |
A gap on a control that is not key, quick to close | Fix in the period and expect an exception | Any occurrence before the fix may be reported. Say so to the sponsor in advance. |
A gap that cannot be closed in a useful time, with a risk management accepts | Describe it and accept it | Record the acceptance (P05 RM-08), and make the description say what is and is not done. |
Running a readiness assessment with the workbook (SOC 2 Readiness Self-Assessment)
The workbook holds 32 readiness items, RI-01 to RI-32, in five areas. You rate each item with one of four level words, and the workbook counts them and returns one of three result words. Use it twice: early, as a first look, and again at RP-09 with the findings behind the ratings.
Level | Meaning |
|---|---|
Not started | Nothing is in place for this item. |
Planned | It is planned, owned and dated, but not yet in place. |
In place | It is designed and running, but has not yet run for the months SR-10 asks for, or left enough records to sample. |
Operating | It runs as written, an owner performs it, and the records exist for a sample to be taken. For a first Type 2 period it has run with records for at least 3 months (a house default, SR-10). |
An item that does not apply is rated Not applicable with its reason written beside it. A blank is not a rating, and the workbook reports that ratings are missing.
Area | Name | Items | Blocking items |
|---|---|---|---|
SC | Scope and description | 6 | 5 |
GV | Ownership and governance | 5 | 3 |
CO | Controls in operation | 10 | 8 |
EV | Evidence and assessment | 5 | 4 |
AU | CPA firm, dates and customers | 6 | 2 |
From a finding to a rating
Rate an item from the findings on the controls it rests on. The table gives the highest level an item may be given for each word. It is a guide. The level words of the workbook decide, and you write the reason beside the rating.
Finding | Highest level | Why |
|---|---|---|
Scope gap | Planned | Until the boundary or the description is changed and the change is real |
Design gap | Planned | The control is not yet designed as it needs to be. Planned, owned and dated is as far as it goes |
Operating gap | In place | Designed and running, but not as written, so not yet something a sample would support |
Evidence gap | In place | Performed, but with no record a sample could be taken from |
No gap found | Operating | Operating where records exist for a sample. In place where the control is new and has not yet left enough records |
The result
Not ready to start the observation period: at least one blocking item is below In place. Ready to start, with actions: no blocking item is below In place, but some items are below Operating. Ready to start: every applicable item is Operating, and each item that does not apply has its reason recorded. The result is one of three words with the counts beside it. It is never a score, a share or a pass or a fail. An item at In place has not yet run for the three months SR-10 asks for, so expect exceptions early in the period or take a Type 1 report first; only four items can be Not applicable (RI-05, RI-06, RI-19 and RI-21), and an item left out of the result that way should be confirmed with the CPA firm.
Report the result word with the counts. Do not turn them into a share, a rating or a colour (SR-15).
Gaps by priority
The workbook ranks every item below Operating into three priorities and gives each a planning number of days. These are house defaults for planning, not rules of the AICPA. They are not deadlines for the deficiencies that the control testing pack (P20) finds, which keep the deadlines that pack sets (P20 CA-13).
Priority | Exposure | What to do | Planning days |
|---|---|---|---|
Priority 1 | A blocking item below In place; the period should not start | Close it before the period starts. | 30 |
Priority 2 | A blocking item at In place; it will be tested as it stands | Make it Operating and keep its records. | 60 |
Priority 3 | Any other item below Operating | Plan it into the period. | 90 |
Guidance — delete before approval
Run the workbook in a copy, one per assessment, and keep each copy with its date. The sequence of copies is the history of your readiness, and it is useful when the sponsor asks how long a gap has been open.
Where a readiness item points to a document of another pack (the workbook names it), read that document before you rate the item. For example, P05-A05 Information Security Risk Register for the item on risk assessment.
Tracking gaps in the deficiency tracker (P20-A08 Control Deficiency & Remediation Tracker)
Every gap that is not "No gap found" becomes a row in the deficiency and remediation tracker (P20-A08 Control Deficiency & Remediation Tracker), with an owner and a due date (SR-14). The tracker belongs to the control testing pack. This procedure uses it so that readiness gaps and test deficiencies are in one place.
What the finding record holds | Where it goes in the tracker |
|---|---|
The finding number, the control and the finding word | The reference and description of the row |
What was found, with date and place | The description, without blame |
The disposition | The plan: fix, fix in the period, or accept |
The owner and the due date | The owner and the date. The due date is no later than the planning days of the priority, or an earlier date the owner can keep |
The retest, by whom and when | The retest field. The retester is not the owner (P20 CA-10, CA-14) |
A readiness finding is not the result of a control test. Do not copy it into your test results as one. Rate a deficiency by the tracker's own rules (P20 CA-12) if it also arises from a test.
Retest
A fixed control is retested after it has operated for a while (P20 CA-14), by someone other than its owner. The retest looks at the same attributes as the walkthrough, on occurrences that happened after the fix. The row closes only on a retest that finds no gap.
- If the control has not yet operated enough to retest, the row stays open with the status Fixed, awaiting retest. In every report, call the control fixed and not yet operated (SR-14).
- A control that happens once a year, or an automated control, may be retested after one occurrence (P20 CA-14). Say which route you took.
- If the retest finds a gap, the finding is recorded again with a new date and the row stays open.
- A blocking item may be at In place when the period starts, and is then tested as it stands. It becomes Priority 2 in the workbook and is made Operating in the period.
When to start the observation period
SR-13 Do the readiness assessment before the period starts (A06, A09). Fix what is a blocking item. Do not start the period with a blocking item below In place.
The start decision is made once readiness is complete, and again whenever it was Hold. The rule looks at three facts and nothing else.
Fact | Where it comes from | A reason to hold |
|---|---|---|
Blocking items below In place | The workbook, count of blocking items rated Not started or Planned | One or more |
Open design or operating gaps on key controls | The findings list and the tracker | One or more |
The dates agreed in writing with the CPA firm | The engagement letter or the firm's written confirmation | Not agreed |
If none of the three is a reason, the decision is Start. If one or more is, the decision is Hold, with the reasons stated, the actions, and the date of the next decision.
Plan backwards. A house default is that readiness is complete and the dates are agreed 14 days before the period starts (A08, MS-01 and MS-02). The observation period lengths of three, six and twelve months are market practice, not rules of the AICPA, and the CPA firm agrees the period (SR-16).
Guidance — delete before approval
Holding is not a failure. A period started with a blocking item below In place usually produces an exception on a control that mattered, and a period cannot be restarted without telling the CPA firm. A late start is cheaper than a short, weak first period.
Tell the customer who asked what has happened, in plain words and by the approved route (A10), and do not promise a date that the rule has not yet allowed.
If a customer needs something sooner than a Type 2 report can be issued, the scoping assessment (A02) lists the alternatives, including a Type 1 report. If you already hold a report, a bridge letter can cover the interval after its period.
What to tell the sponsor
Report readiness in counts and in words. The sponsor needs the result word, the counts, the blocking items by name, the gaps by priority, and the one decision they have to make. Nothing in the report is a score, a share or a rating (SR-15).
Line | What it holds |
|---|---|
Result | [[the result word from the workbook, unchanged]] |
Counts | [[n Operating, n In place, n Planned, n Not started, and n Not applicable, of 32 items]] |
Blocking items below In place | [[the count, and the IDs with a few words each]] |
Gaps by priority | [[Priority 1 n, Priority 2 n, Priority 3 n]] |
Open gaps on key controls | [[the count]] |
Dates agreed in writing | [[Yes or No, and where]] |
Decision needed | [[Start, Hold, or a decision on a disposition]] |
Self-check or independent | [[say which]] |
EXAMPLE report, 27 November 2026. Not ready to start the observation period. 11 Operating, 9 In place, 9 Planned, 3 Not started (32 items). six blocking items are below In place: RI-04, RI-13, RI-25, RI-26, RI-27, RI-28. Gaps by priority: Priority 1 6, Priority 2 9, Priority 3 6. 1 open gap on a key control (RI-13, the access review). Dates not yet agreed with the CPA firm. The start decision is Hold. This was a first look by the examination owner and the assessor.
Guidance — delete before approval
Do not say how close you are. The phrase "nearly ready" is a score in words, and the procedure allows no score (SR-15). Say which blocking items are open and what closes each.
Do not tell the sponsor that the CPA firm will issue a particular report. Say what is in management's hands.
Forms
Three forms carry the records of the procedure. Copy each into your own document system. They hold no secrets and no personal data beyond the names of roles; keep them with the readiness workbook.
Form 1: Walkthrough record
Item | Entry |
|---|---|
Record number and date | [[WT-nn, YYYY-MM-DD]] |
Control (ID in the control inventory and statement) | [[ID; what is done, by whom, how often, and the record it leaves]] |
Owner, and key control (yes or no, and why) | [[name or role; yes / no; reason]] |
Assessor, and why they do not perform the control | [[name; reason, or: self-check]] |
Occurrence followed (date and reference) | [[e.g. leaver ticket number and date]] |
Person who performed it, and where we watched | [[name or role; system]] |
What we saw, in order | [[trigger, action, approval, record]] |
The record, and where it was retrieved from | [[location in the system of record]] |
Who: matches the statement? | [[Yes / No; note]] |
What: matches the statement? | [[Yes / No; note]] |
When: matches the statement? | [[Yes / No; note]] |
How: matches the statement? | [[Yes / No; note]] |
Record: exists and can be read without help? | [[Yes / No; note]] |
Finding word (the first question answered No) | [[Scope gap / Design gap / Operating gap / Evidence gap / No gap found]] |
Follow-up | [[workpaper number for the test of occurrences; finding record number]] |
Form 2: Finding record
Item | Entry |
|---|---|
Finding number and date | [[FD-nn, YYYY-MM-DD]] |
Control or readiness item (ID) | [[control ID; item RI-nn of the workbook]] |
Finding word | [[one of the five words]] |
What was found (facts, with date and place) | [[what was seen, not who is to blame]] |
Evidence reference | [[walkthrough record, workpaper, screenshot location]] |
Blocking item, and key control | [[Yes / No; Yes / No]] |
Priority (from the workbook) | [[Priority 1 / Priority 2 / Priority 3]] |
Disposition | [[Fix before the period starts / Fix in the period and expect an exception / Describe it and accept it]] |
Owner, and due date | [[name or role; YYYY-MM-DD]] |
Tracker row (P20-A08) | [[row reference]] |
Retest: by whom (not the owner), and when | [[name; YYYY-MM-DD, after the fix has operated]] |
Status | [[Open / Fixed, awaiting retest / Closed after retest / Accepted and described]] |
Form 3: Start-decision record
Item | Entry |
|---|---|
Date of the decision | [[YYYY-MM-DD]] |
Readiness result word, and the counts by level | [[from the workbook: result word; Not started n, Planned n, In place n, Operating n]] |
Assessed by (a self-check or not) | [[name; independent / self-check]] |
Blocking items below In place (count, and the IDs) | [[n; RI-nn, RI-nn]] |
Open design or operating gaps on key controls (count, and the finding numbers) | [[n; FD-nn]] |
Dates agreed in writing with the CPA firm | [[Yes / No; where the writing is]] |
Decision from the rule | [[Start / Hold]] |
Reasons, if Hold | [[one line each]] |
Actions and the date of the next decision, if Hold | [[what; owner; YYYY-MM-DD]] |
Period start and end, if Start | [[YYYY-MM-DD to YYYY-MM-DD]] |
Decided by (sponsor and examination owner), and when | [[names; YYYY-MM-DD]] |
Attached | [[the workbook copy, the findings list, the dates in writing]] |
EXAMPLE finding record. FD-03, 27 November 2026. Control: review of access to the production systems. Item: RI-13. Finding word: Design gap: the review is written in the access policy, but no reviewer is named and no output is defined. Blocking item: Yes. Key control: Yes. Priority 1. Disposition: Fix before the period starts. Owner: Head of Engineering. Due: 11 December 2026. Retest: by the assessor, after the fixed review has operated as P20 CA-14 asks.
EXAMPLE start-decision record, first look. 27 November 2026. Result: Not ready to start the observation period. Blocking items below In place: 6 (RI-04, RI-13, RI-25, RI-26, RI-27, RI-28). Open gaps on key controls: 1. Dates agreed: No. Decision: Hold. Reasons: 6 blocking items are below In place; 1 design or operating gap on key controls is open; the dates are not agreed in writing with the CPA firm.
Roles and responsibilities
Role | What they do in the procedure |
|---|---|
Executive sponsor [[e.g. chief technology officer or chief operating officer]] | Backs the examination with time and money, signs management's assertion with the examination owner, and decides scope questions that cost money. |
Examination owner [[name; often the Head of Information Security or a compliance lead]] | Runs the readiness work and the calendar, is the CPA firm's day-to-day contact, keeps the description, and reports the position in counts and words. |
Assessor [[a person who does not perform or own the controls they read]] | Walks through and tests the controls, records each finding in one of the five words, and rates the readiness items. Does not perform, own or approve the controls assessed (SR-11, P20 CA-10). |
Control owner [[the person who performs or supervises the control]] | Performs the control as written, keeps the record it leaves, and answers the auditor's requests for that evidence. |
Head of Information Security [[the role the earlier packs call the Head of Information Security]] | Owns the security controls, the risk assessment and the incident process; does not test their own controls (P20 CA-10). |
Head of Engineering [[or the engineering lead]] | Owns change management, hosting, monitoring and the technical description of the system. |
Legal [[in-house or external counsel]] | Reviews customer contracts and commitments, the engagement letter, the bridge letter and what is shared under a confidentiality agreement. |
The matrix shows who is responsible (R), accountable (A), consulted (C) and informed (I); A/R is both. Columns, in order: Spons for executive sponsor; Owner for examination owner; Assess for assessor; Ctrl for control owner; Sec for Head of Information Security; Legal for Legal. Each step has one accountable role. No control owner tests their own control.
Step | Spons | Owner | Assess | Ctrl | Sec | Legal |
|---|---|---|---|---|---|---|
RP-01 Confirm the scope | A | R | C | C | ||
RP-02 Draft the description | I | A/R | C | C | C | |
RP-03 List the controls and their owners | I | A | R | R | ||
RP-04 Choose the assessor | A | R | C | |||
RP-05 Walk through each control | A | R | C | |||
RP-06 Test a few occurrences | A | R | C | |||
RP-07 Record each finding in one of five words | I | A/R | I | |||
RP-08 Decide what to do about each gap | A | R | C | C | C | |
RP-09 Run the self-assessment | I | A | R | I | C | |
RP-10 Retest the fixes | A | R | C | |||
RP-11 Decide to start | A | R | C | C | I | |
RP-12 Agree the dates with the CPA firm | A | R | I | C |
Common mistakes
Mistake | What to do instead |
|---|---|
The assessor is the person who runs the controls (SR-11). | Choose someone who does not perform them, or record the check as a self-check. |
Ratings are given from memory or from what people say. | Every rating rests on a finding, a walkthrough or a record (P20 CA-03). |
The sample is chosen by the owner. | The assessor takes the population from the system of record and chooses the occurrences. |
A fix is closed when it is made. | It is closed when a retest finds no gap, after the control has operated (P20 CA-14). |
The readiness result is reported as a share, a score or a traffic light, which SR-15 does not allow. | Report the result word, the counts and the blocking items by name (SR-15). |
The period starts because the date was promised to a customer. | Hold and tell the customer plainly. A late start is cheaper than a period with a gap in the middle. |
Readiness is done once, a month before. | Run the workbook early as a first look, and again after the findings. A first look shows how long the blocking items will take. |
The CPA firm is asked to do the assessment as well. | Ask the firm before involving it at all (SR-24). The firm that examines you does not design or operate your controls. |
Related documents
Document | Relationship |
|---|---|
SOC 2 Report Scoping Assessment | Settles the scope that RP-01 confirms |
System Description & Boundary Template | The template of the description drafted at RP-02 |
Trust Services Criteria Response Register | The register of criteria and controls completed at RP-03 |
Control Owner & Evidence Plan | The owners and evidence plan completed at RP-03 |
Auditor (CPA Firm) Selection & Engagement Checklist | Choosing and engaging the CPA firm, which the start decision needs |
Observation Period & Exceptions Calendar | The calendar of milestones, the log of exceptions and the dates of the period |
SOC 2 Readiness Self-Assessment | The workbook that RP-09 runs |
Bridge Letter & Management Response Templates | What to tell customers while the report is not yet there |
P20-A08 Control Deficiency & Remediation Tracker | Where the findings are tracked to a retest |
P20-A06 Control Test Workpaper Template | Where a test of occurrences is recorded |
P20-A03 Control Inventory & Ownership Register | The owners and statements of the controls |
P09-A03 Incident Response Plan | Decision rights and notification clocks for incidents, which this procedure leaves unchanged |
[[Your control inventory, policy register, access review records and change records]] | [[The records the walkthroughs ask for]] |
Definitions
Term | Meaning in this procedure |
|---|---|
Readiness | Management's own check of the system, the controls and the evidence before the observation period starts. It is not the auditor's work and it is not an opinion. |
Blocking item | A readiness item that, if it is below In place, means the observation period should not start yet. |
Key control | A control that the principal commitments depend on, so that if it did not work as written a commitment could be missed. The examination owner and the sponsor choose the key controls, and write the choice down. This is a term of this pack and not of the AICPA. |
Assessor | Walks through and tests the controls, records each finding in one of the five words, and rates the readiness items. Does not perform, own or approve the controls assessed (SR-11, P20 CA-10). |
Exception | A test result in which a control did not operate as described for a sampled occurrence. Some sources call these deviations. The auditor decides how one is described in the report. Management records the cause and its response, and also records those it finds itself in the period. |
Observation period | The period a Type 2 report covers, from its first day to its last. Also “the period”. |
Type 2 report | A report on the description and on the design and operating effectiveness of the controls throughout a period, with the auditor's tests and results. |
Attestation | An independent professional's written opinion on a subject that someone else (management) is responsible for. A SOC 2 report is an attestation. It is not a certificate and it is not a pass or a fail. |
Worked example: Acme
EXAMPLE, not part of the procedure. Acme Corp (EXAMPLE) is a US software-as-a-service provider with about 400 staff, selling to businesses that ask for a SOC 2 report. It is not the organisation used in the earlier packs. It hopes to start a six-month observation period on 1 January 2027 (the period would end on 30 June 2027). Five weeks before that, on 27 November 2026, the examination owner and an assessor from another team ran the readiness workbook as a first look. Replace the example with your own, or delete this section before approval.
The first look
Not ready to start the observation period. 11 Operating, 9 In place, 9 Planned, 3 Not started, of 32 items. The six blocking items below In place are these.
Item | What it says | Rating |
|---|---|---|
RI-04 | A draft system description covers the nine topics. | Planned |
RI-13 | Access to in-scope systems is reviewed periodically. | Planned |
RI-25 | Someone who does not perform the controls has assessed them and listed the gaps. | Not started |
RI-26 | Known gaps have owners and dates, and none that would produce an exception on a key control is open. | Planned |
RI-27 | A licensed CPA firm is engaged, with licence, peer review and independence checked. | Planned |
RI-28 | The observation period dates are agreed in writing with the CPA firm. | Not started |
The start decision rule takes three facts: 6 blocking items below In place, 1 open design gap on a key control (RI-13) and dates not agreed. It gives Hold, for three reasons: 6 blocking items are below In place; 1 design or operating gap on key controls is open; the dates are not agreed in writing with the CPA firm.
The days that are left
The calendar asks for readiness to be complete 14 days before the start (A08, MS-01), which is 18 December 2026. From 27 November 2026 that leaves 21 days. The planning default for a Priority 1 gap is 30 days, which is more. The examination owner asked the owners of the six items whether they could close them in 21 days. RI-27 and RI-28 depend on the CPA firm, and a draft engagement letter was already with it. RI-04 needed one more round of the description. RI-13 needed one run of the access review. RI-25 and RI-26 are done by the assessment itself once the walkthroughs are finished. All the owners said yes. The sponsor accepted that, and wrote down that the default was a planning figure and that the start date would move if any item slipped.
The second decision
On 18 December 2026 the six items were rated again, with the findings behind each. The result was Ready to start, with actions: 13 Operating, 13 In place, 5 Planned, 1 Not started, of 32 items, and no blocking item below In place. RI-13 was In place: the first review had run, and it would be tested as it stands (Priority 2). The sponsor and the examination owner applied the rule again.
Case | Blocking items below In place | Open gaps on key controls | Dates agreed | Decision | Reasons |
|---|---|---|---|---|---|
A: assessed 27 November 2026 | 6 | 1 | No | Hold | 6 blocking items are below In place; 1 design or operating gap on key controls is open; the dates are not agreed in writing with the CPA firm |
B: 18 December 2026, after the fixes | 0 | 0 | Yes | Start | No reason to hold |
C: 18 December 2026, fixes done, dates not agreed | 0 | 0 | No | Hold | the dates are not agreed in writing with the CPA firm |
Case B is the decision they took: Start, with the period from 1 January 2027 to 30 June 2027. Case C shows the same position with the dates not yet agreed in writing. The rule says Hold, for one reason, and the owner would have chased the CPA firm for the writing before the start.
Guidance — delete before approval
The values above are the example's, and so are the dates. They show how the rule is applied. They are not a promise that a similar position in your company will start on time.
Adapting this procedure
Small organisation
Guidance — delete before approval
In a small company the same person may run most of the controls and the whole programme. Keep the five finding words and the three facts of the start decision. Make the assessor a manager from another team, an adviser who is not the CPA firm, or a trusted colleague, and say so on the record. If nobody independent exists, the check is a self-check. Record it and report it as one.
Do not skip the walkthroughs because you know the system. The aim is to see what an outsider will see.
Regulated or customer-driven
Guidance — delete before approval
If a customer, a regulator or an investor has set a date or a minimum period, put it in the scope note at RP-01 and read it in the start decision. If the date cannot be met, tell them early and in plain words, with what you can offer in the meantime (A10).
If you are subject to a law with notification duties, those belong to the incident plan and the pack that holds it. This procedure never alters them.
Outsourced providers
Guidance — delete before approval
If providers run part of the system, include their reports in the walkthrough: for each carve-out, read the provider's latest SOC 2 report and the controls you assume of it, and record what you find (RI-05, RI-21).
A control that a provider performs for you is walked through with the provider, by way of its report and your own check of it. You cannot watch their staff, and you do not need to. Record that the evidence is the report.
Delete this section before approval.
Framework references
These references show where this document supports an external framework. They indicate relevance only and do not reproduce the text of any standard. Editions referenced: AICPA Trust Services Criteria (TSP section 100, 2017, with revised points of focus, 2022), by number and series title only; the AICPA description criteria (DC section 200, 2018, with revised implementation guidance, 2022), by topic only; ISO/IEC 27001:2022 and NIST CSF 2.0, by number and title; the Journal of Accountancy and the AICPA & CIMA pages named in the references; as published and read on 18 October 2026.
Framework | Reference | Supported by |
|---|---|---|
ISO/IEC 27001:2022 | Clause 9.2 — Internal audit | A planned check, by someone who does not do the work, of whether the arrangements work as written |
ISO/IEC 27001:2022 | Annex A 5.35 — Independent review of information security | Review by someone independent of those who run the controls, which the assessor's role reflects |
NIST CSF 2.0 | ID.IM-01 — “Improvements are identified from evaluations” | The assessment finds improvements from an evaluation, and the tracker follows each to a retest |
AICPA, SOC 2 | AICPA Trust Services Criteria (TSP section 100), introduction: a Type 2 SOC 2 report gives an opinion on the suitability of design and operating effectiveness of controls throughout a specified period and describes the tests and results; a Type 1 report addresses the same subject matter without an opinion on operating effectiveness or a description of tests, and is as of a specified date. The Journal of Accountancy (2016, an AICPA publication) gives the same split for SOC 1 and says SOC 2 reports come in both types. Neither source states a minimum period | The difference between a design opinion at a date and an opinion on operation over a period, which is why a control must have run before it can be observed |
AICPA, SOC 2 | SOC 2 CC3.1, Risk Assessment | The series is about risk assessment. The procedure asks management to identify the risks to its commitments before the period starts, and the readiness items point to the risk register |
AICPA, SOC 2 | SOC 2 CC4.1, Monitoring Activities | The series is about monitoring activities. The walkthrough and the test of occurrences are management's own checks of whether controls work as written |
AICPA, SOC 2 | SOC 2 CC4.2, Monitoring Activities | The series is about monitoring activities. Findings are recorded with an owner and a date, and tracked to a retest |
The Trust Services Criteria and the description criteria are published by the AICPA for CPAs who examine a service organisation. Nothing in law makes a SOC 2 report mandatory. A customer's contract, a procurement policy or an investor can ask for one, and the organisation chooses whether to commission an examination. The report is a CPA firm's opinion about the organisation's description and its controls. It is an attestation, not a certificate, and nobody is “SOC 2 certified” or “SOC 2 compliant” by holding one.
The observation period lengths, the three-month limit of a bridge letter, the order of the steps and the sample of questions for a CPA firm are market practice and house defaults. They are not rules of the AICPA, and the CPA firm and your customers decide what they accept.
ISO/IEC 27001 references name the clause or control this document relates to, by number and title only. No text of the standard is reproduced. A reference does not say that holding an ISO/IEC 27001 certificate equals, replaces or shortens a SOC 2 examination.
Criteria are cited by number and series title only. The statements of the criteria are in the Library. Citing a criterion does not say that any document, control or practice meets it.
A reference says what its source describes and which CISO Times document helps with that work. It does not say that a document from this pack meets a criterion, and it does not say that an organisation will receive an unqualified opinion.
This pack does not say which document, record or practice meets a criterion. Each reference says what its source describes and which CISO Times document helps with that work. Using a document does not by itself show that a criterion is met.