Form 7 - Safe Sanctuaries

Safe Sanctuaries Report
CHARGE
CHURCH
DISTRICT
District Email
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
Date
PA Child Abuse

MonthDayYear
Date
PA State Police

MonthDayYear
Date
Save Sanctuaries

MonthDayYear
Date
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
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
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
Date
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

Interviewing all paid staff and volunteersApplications for all paid staff and volunteersDHS, State Police clearance & FBI Fingerprint for PAID staffDHS, State Police clearance & Notarized statement/FBI Fingerprint for VOLUNTEERS per PA laws
SUPERVISION

Two (2) unrelated adults in each classroom OR a roving teacherUncovered windows in doors and/or Open doors in all children’s classroomsNo one under age 18 left alone with children. Five (5) year age difference between at least 2 adults “in charge” and oldest eligible children/youthProvide training yearly on aspects of church’s Safe Sanctuaries Policy
REPORTING

A procedure for reporting abuse to authoritiesProcedures for informing the District Superintendent that a report has been made
RESPONDING

One (1) person designated as media spokespersonA procedure for assisting a victim of abuseA list of prospective abuse counselorsA procedure for dealing with the alleged perpetrator and his/her family
INTERNET SAFETY

Permission to use photos on webUse and safeguards of photosUse of computers within the churchCommunication between adults and children/youthAppropriate Social Network Site
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