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*Report is due by April 30. A remedy for any area of non-compliance must be completed by May 31 to avoid being found deficient. Fields with a * are required.
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- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Criminal History Checks (CHC)
- **If total of CHC is equal to total compliance, plan and date are not required.
- Name of Your School Please enter valid data.
- Location: Please enter valid data.
- Employees (Non-certified)
  
  Total Number subject to CHC Please enter valid data.
  
  Total in Compliance Please enter valid data.
  
  Plan for persons neither in compliance nor place on leave Please enter valid data.
  
  Date by which non-compliance will be remedied* Please enter valid data.
- Teachers and Administrators
  
  Total Number subject to CHC Please enter valid data.
  
  Total in Compliance Please enter valid data.
  
  Plan for persons neither in compliance nor place on leave Please enter valid data.
  
  Date by which non-compliance will be remedied* Please enter valid data.
- Volunteers
  
  Total Number subject to CHC Please enter valid data.
  
  Total in Compliance Please enter valid data.
  
  Plan for persons neither in compliance nor place on leave Please enter valid data.
  
  Date by which non-compliance will be remedied* Please enter valid data.
- SEP Education of All Employees & Volunteers
- **If total of SEP is equal to total compliance, plan and date are not required.
- Employees (Non-certified)
  
  Total Number (high and low risk) Please enter valid data.
  
  Total in Compliance Please enter valid data.
  
  Plan for persons neither in compliance nor place on leave Please enter valid data.
  
  Date by which non-compliance will be remedied* Please enter valid data.
- Teachers and Administrators
  
  Total Number (high and low risk) Please enter valid data.
  
  Total in Compliance Please enter valid data.
  
  Plan for persons neither in compliance nor place on leave Please enter valid data.
  
  Date by which non-compliance will be remedied* Please enter valid data.
- Volunteers
  
  Total Number (high and low risk) Please enter valid data.
  
  Total in Compliance Please enter valid data.
  
  Plan for persons neither in compliance nor place on leave Please enter valid data.
  
  Date by which non-compliance will be remedied* Please enter valid data.
- Annual Education of Children & Youth in Personal Safety
- Children & Youth
  
  Total in religious education or youth group Please enter valid data.
  
  Total giving safety education in current year Please enter valid data.
  
  Total for whom the parents refused personal safety education Please enter valid data.
  
  Name of educational program used Please enter valid data.
- Nature of the Program
  
  Is the School using either “Personal Safety Education for Children and Youth” of the Diocese of Tucson or “Keeping Kids Safe (Happy Bear)” of the Southern Arizona Children’s Advocacy Center to provide person safety education for children and youth? Yes No
  
  If the answer is “NO”, name the program and respond as to whether the program being used has been approved by the office of child, adolescent and adult protection.
  
  Name the program Please enter valid data.
  
  Has the program been approved? Yes No
- Parent Refusals
  
  If parents have refused safety education for their children, do you have documentation of that refusal in the form of a signed statement by the parent or by your notation on a refusal form? Yes No
  
  If a child has missed the training in personal safety because of parent refusal or for any other reason, have you followed up with educational materials sent to the parents? Yes No
- Percentage Reached
  
  If the total number of students given peronsal safety education is less than 90% of the total numbers of students minus those for whom the parents explicitly refused personal safety education, please explain the reason.
- Education of Parents and Other Adults
- Total Number Educated Please enter valid data.
- Nature of Education Provided Please enter valid data.
- *Do not include in this “total number” persons who simply received an educational document for reading on their own.
  ** List education of any type, including bulletin inserts or materials sent home.
- Attachments to be Included with Report:
  Letter from the Principal attesting that the Parish is in compliance with the Safe Environment Program of the Diocese of Tucson as adopted by the Parish Board of Directors
  
  Educational Log of all SEP educational events from July 2015 through June 2016
  
  Planned educational programs from July 2016 through December 2016
- By checking this box, I certify that this report is in accordance with the Safe Environment Policy of the Diocese of Tucson.
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Audit Form Schools

Criminal History Checks (CHC)

SEP Education of All Employees & Volunteers

Annual Education of Children & Youth in Personal Safety

Education of Parents and Other Adults