2021 Congregational Safeguarding Annual Status Report

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2021 Congregational Safeguarding Annual Status Report

SRA, please complete for review by head of congregation and submit to the Safeguarding Office.

Submit by April 30, 2021

Church*

Today's Date

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Month

Day

Year

Please note the names as requested below if these positions are filled:

How many SRAs are there at the church?

SRA 1

First Name

Last Name

Applicable Certifications are current

Yes No

SRA 2

First Name

Last Name

Applicable Certifications are current

Yes No

SRA 3

First Name

Last Name

Applicable Certifications are current

Yes No

SRA 4

First Name

Last Name

Applicable Certifications are current

Yes No

SRA 5

First Name

Last Name

Applicable Certifications are current

Yes No

SRA 6

First Name

Last Name

Applicable Certifications are current

Yes No

SRA 7

First Name

Last Name

Applicable Certifications are current

Yes No

SRA 8

First Name

Last Name

Applicable Certifications are current

Yes No

SRA 9

First Name

Last Name

Applicable Certifications are current

Yes No

SRA10

First Name

Last Name

Applicable Certifications are current

Yes No

How many Safeguarding Coordinators are there at the church?

Safeguarding Coordinator 1

First Name

Last Name

Applicable Certifications are current

Yes No

Safeguarding Coordinator 2

First Name

Last Name

Applicable Certifications are current

Yes No

Safeguarding Coordinator 3

First Name

Last Name

Applicable Certifications are current

Yes No

Safeguarding Coordinator 4

First Name

Last Name

Applicable Certifications are current

Yes No

Safeguarding Coordinator 5

First Name

Last Name

Applicable Certifications are current

Yes No

Trainers:

How many SGC trainers are there at the church?

SGC 1

First Name

Last Name

Applicable Certifications are current

Yes No

SGC 2

First Name

Last Name

Applicable Certifications are current

Yes No

SGC 3

First Name

Last Name

Applicable Certifications are current

Yes No

SGC 4

First Name

Last Name

Applicable Certifications are current

Yes No

SGC 5

First Name

Last Name

Applicable Certifications are current

Yes No

SGC 6

First Name

Last Name

Applicable Certifications are current

Yes No

SGC 7

First Name

Last Name

Applicable Certifications are current

Yes No

SGC 8

First Name

Last Name

Applicable Certifications are current

Yes No

SGC 9

First Name

Last Name

Applicable Certifications are current

Yes No

SGC 10

First Name

Last Name

Applicable Certifications are current

Yes No

How many SGP trainers are there at the church?

SGP 1

First Name

Last Name

Applicable Certifications are current

Yes No

SGP 2

First Name

Last Name

Applicable Certifications are current

Yes No

SGP 3

First Name

Last Name

Applicable Certifications are current

Yes No

SGP 4

First Name

Last Name

Applicable Certifications are current

Yes No

SGP 5

First Name

Last Name

Applicable Certifications are current

Yes No

Please select all that are applicable:

1. We are aware that the Vestry/Bishop's Committee (Decision-Makers) are required to have a 2022 SGP Policy Review in place of SGP certification. See:https://www.epicenter.org/safeguarding/safeguarding-policy-review-videos-for-vestries-and-boards/*

Yes No

2. Our Safeguarding Policy Review Confirmation form will be attached below.*

Yes No

3. We are aware that a Responsible Person must be assigned to events or programs with children or Vulnerable Adults.*

Yes No

4. All volunteers who are in a Pastoral Relationship, or who are Program Supervisors, or who minister to Vulnerable Adults are certified or are in process for Safeguarding God's People (SGP).*

Yes No N/A

5. All employees/staff who are in a Pastoral Relationship, or who are Program Supervisors or who minister to Vulnerable Adults are certified or are in process for SGP.*

Yes No N/A

6. All volunteers who need certification in Safeguarding God's Children (SGC) are either certified or in process.*

Yes No N/A

7. All employees/staff are certified or in process for SGC.*

Yes No N/A

8. All people with general key or code access to locked buildings where children may be present, without adequate adult supervision, are certified or in process for SGC.*

Yes No N/A

9. All employees/volunteer staff are certified or in process for Safeguarding God's People - Harassment (SGP-H).*

Yes No N/A

10. We have a Boy Scout pack or troop. *

Yes No

11. We would like the Safeguarding Office to contact us for additional assistance.*

Yes No

Safeguarding Policy Review Confirmation form *

No File Chosen

File uploads may not work on some mobile devices.

If "Yes" is selected under "We have a Boy Scout troop", please provide the Chartering Organization Representative (COR)*

Follow up comments/notes:

Completed by:*

First Name*

Last Name*

Position*

Email*

Is the Head of Congregation available for signature?

Yes No

Name of Head of Congregation

Prefix (optional)

First Name

Last Name

Email for Head of Congregation

Reviewed by: Head of Congregation*

First Name*

Last Name*

When you (HOC), submit the form, the SRA will receive an email with the information provided.

When submitting the form, you and the Head of Congregation (HOC) will receive an email with a PDF attachment with the information you have provided in this form. Once you and the HOC have reviewed the data, have them sign the PDF at the bottom and send to Marty Brickley at mbrickley@epicenter.org.