School Safeguarding Annual Status Report for 2021-2022

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School Safeguarding Annual Status Report for 2021-2022

SRA, please complete for head of school and submit to the Safeguarding Office.
Submit by January 31, 2022

School*

Today's Date

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Month

Day

Year

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

How many SRAs are there at the school?

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 at the school?

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 at the school?

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 Safeguarding God's People-Exploitation (SGP-E) trainers are there at the school?

SGP-E 1

First Name

Last Name

Applicable Certifications are current

Yes No

SGP-E 2

First Name

Last Name

Applicable Certifications are current

Yes No

SGP-E 3

First Name

Last Name

Applicable Certifications are current

Yes No

SGP-E 4

First Name

Last Name

Applicable Certifications are current

Yes No

SGP-E 5

First Name

Last Name

Applicable Certifications are current

Yes No

Please select all that are applicable:

Head of School

Yes No

Name of Head of School

First Name

Last Name

Applicable Certifications are current

Yes No

______________________________________________________________________________________________________________________

Assistant Head of School

Yes No

Name of Assistant Head of School

First Name

Last Name

Applicable Certifications are current

Yes No

______________________________________________________________________________________________________________________

Upper Head of School

Yes No

Name of Upper Head of School

First Name

Last Name

Applicable Certifications are current

Yes No

______________________________________________________________________________________________________________________

Middle Head of School

Yes No

Name of Middle Head of School

First Name

Last Name

Applicable Certifications are current

Yes No

______________________________________________________________________________________________________________________

Lower Head of School

Yes No

Name of Lower Head of School

First Name

Last Name

Applicable Certifications are current

Yes No

______________________________________________________________________________________________________________________

All Department Heads that Supervise or other Supervisors are current in SGP-E

Yes No

Applicable Certifications are current

Yes No

Please select all that are applicable:

1. We are aware that School Board members are no longer required to have SGP certification but must have a SGP-E Policy Review. See: https://www.epicenter.org/safeguarding/safeguarding-policy-review-videos-for-vestries-and-boards/

Yes No N/A

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

Yes No N/A

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

Yes No N/A

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

Yes No N/A

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

Yes No N/A

6. All employees are certified or in process for SGC.**

Yes No N/A

7. All vendors are certified or in process for SGC.*

Yes No N/A

8. All Vendor Training Only Agreements are current and on file with the Safeguarding Office.*

Yes No N/A

9. 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

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

Yes No N/A

11. We have a Boy Scout of America pack or troop. *

Yes No N/A

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

Yes No N/A

Safeguarding Policy Review Confirmation form *

No File Chosen

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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 School available for signature?

Yes No

Reviewed by: Head of School

[clear]

Use your mouse or finger to draw your signature above

Name of Head of School

Prefix (optional)

First Name

Last Name

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

Name of Head of School

Prefix (optional)

First Name

Last Name

Email for Head of School

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