Form 7 - Safe Sanctuaries

Safe Sanctuaries Report
CHARGE
CHURCH
DISTRICT
District Email
example@example.com
Second Approval
example@example.com
All churches must have and follow a written Safe Sanctuaries policy. If you have revised your church policy since last year, submit it with this report. Your policy MUST include all the elements listed. If it does not, please revise your policy to include the missing elements.
Church
Pastor(s) Name
Dates of Last Clearances
FBI

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
PA Child Abuse

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
PA State Police

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Save Sanctuaries

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Lay Person responsible for overseeing church's Safe Sanctuaries policy with contact information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
E-mail
example@example.com
Phone
Format: (000) 000-0000.
Layperson who serves as Safe SanctuariesCoordinator (if different than Lay Person named above) to the church council with contact information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
E-mail
example@example.com
Phone
Format: (000) 000-0000.
Number of people from congregation who have had Safe Sanctuaries training within previous 5 years?
Date the latest written policy was accepted by church council

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Is your policy fully implemented?
Does your policy include all of the below procedures?
Attach a Copy of any new or revised policy

Effective 01/01/20 ALL Safe Sanctuaries Training must be done through MinistrySafe available on https://susumc.org/safe-sanctuaries/
SCREENING
SUPERVISION
REPORTING
RESPONDING
INTERNET SAFETY
If any of the above procedures are not being used, explain
Form Submission Info

Who is filling this out and where should the final PDF be sent
Name

First NameLast Name
Email
example@example.com
Please verify that you are human
Should be Empty:

Safe Sanctuaries Report

Dates of Last Clearances

Lay Person responsible for overseeing church's Safe Sanctuaries policy with contact information

Layperson who serves as Safe SanctuariesCoordinator (if different than Lay Person named above) to the church council with contact information

Form Submission Info