Safe Environment Audit

Diocese of Springfield in Illinois Annual Safe Environment Compliance Audit
Charter for the Protection of Children and Young People

Audit Period: July 1, 2023 through June 30, 2024

DUE DATE: May 31, 2024

If you have any questions regarding the completion of this audit, please contact the Director of Office for Safe Environment at (217) 321-1162

Step 1 of 13

Is this a Parish or High School Audit?(Required)

Parish/Parish with Elementary School

High School

Parish/School:(Required)

City:(Required)

Pastor (Or Parochial Administrator):(Required)

Mailing Address:(Required)

Street Address Address Line 2 City State ZIP Code

AUDIT SECTION	AUDIT REPORTING	COMPLETED BY:
Section 1 Pages 2,3,4,5 & 6	Reporting on elementary school students’ personal safety training, educators, school staff and school volunteers	Parish Safe Environment Coordinator & School principal
Section 2 Pages 7, 8, 9, 10 & 11	Reporting on parish religious education program student personal safety training and volunteers	Parish Safe Environment Coordinator & Directors of Religious Education or Coordinators of Religious Education
Section 3 Page 12 & 13	Reporting on parish staff & parish volunteers	Parish Safe Environment Coordinator
Section 4 Pages 14 & 15	Reporting on other parish safe environment requirements, training compliance letter	Parish Safe Environment Coordinator & Parish Pastor, Parochial Administrator or Parish Life Coordinator

Contact Name

Telephone #:

Email Address:

Section 1

Audit Reporting

Reporting on elementary school students’ personal safety training, educators, school staff and school volunteers

Completed by:

Parish Safe Environment Coordinator & School principal

Principal complete the contact information below and provide a contact number and email address. . (If you parish does not have an elementary school, please enter “N/A” for requested information below).

High School

Principal complete the contact information below and provide a contact number and email address.

Contact Name:(Required)

Telephone #:(Required)

Email Address:(Required)

High School

2. Student Personal Safety Instruction – Was VIRTUS Empowering God’s Children curriculum conducted with students at all grade levels ?

Yes

Please provide a written explanation describing the reason why personal safety training was not addressed with students.(Required)

2A. # of Students Enrolled in the Audit Period

2B. # of Students Trained in the Audit Period

3. Parent Permission

3A. Are parents made aware of the personal safety instruction curriculum or material?

Yes

Please explain below or attach a separate explanation of the method used to inform parents of the personal safety instruction.(Required)

Please explain below why parents are not informed of the personal safety instruction.(Required)

3B. If an “opt-out” option is used for parent permission please explain the process for parents to “opt-out”?

School

Reporting on Elementary School Students Personal Safety Training, Educators, School Staff & School Volunteers – Any other person employed and working in the school (cooks, maintenance, office staff, nurse, etc.). Please complete A – G

1. Was Virtus® Touching Safety presented to students in the audit period?

Yes

Please describe the reason why personal safety training was not conducted.(Required)

Please complete 1A-1G regarding the student attendance of the personal safety training.

1A. # of Students Trained(Required)

1B. Students absent Due to Parent Non-Permission or OPT OUT(Required)

1C. Students Absent Due to Parent Non-Responding to Permission(Required)

1D. Students Absent for any other reason(Required)

1E. Total of 1B, 1C, 1D(Required)

1F. Of the students in 1C, 1D and 1E above report the number of students that have not attended personal safety training in past years and remain to be trained

1G. Total # of Students Enrolled(Required)

2. Was parent permission obtained for the Personal Safety Training?(Required)

Yes

Parent Permission Method

Written permission slips requested from the parent at the time of PST

Parents informed of the PST training curriculum during student registration when permission slips are signed.

Parent permission is in the form of an “Opt Out”. The program is described at registration or at the time of the training and parents are informed to complete the “opt out” slip if they do not want the child to participate in the PST training. VIRTUS BOOKLET MUST BE GIVEN

Other

Explain(Required)

Please answer 1) – 8) in 2A and upload a sample copy of the permission slip or opt out form used during this audit period.(Required)

Max. file size: 64 MB.

ATTACH A COPY PERMISSION OR OPT OUT FORM TO THIS AUDIT(Required)

Max. file size: 64 MB.

High School

4. Educators – Active salaried teachers in diocesan and parish schools. Includes substitute teachers for the school year. (Does not include PSR teacher) Please complete A – G.

4A. Total number employed at the school during the audit period

4B. Number Completing PGC Training

4C. Subtract 4B from 4A and enter the total remaining to be trained

4D. For those not trained enter date by which training will be completed

Month

Day

Year

4E. Of the educators reported in A. above report the number that have completed ISP / FBI Fingerprint Criminal History Check

4F. Subtract 4E from 4A and enter the total remaining to be background checked

4G. Date by which the fingerprint check will be completed

Month

Day

Year

Use the space below, (or attach a separate sheet) to explain any gaps between the total numbers and the numbers remaining to be trained or background checked for and how the school is planning on closing those gaps.

School

2A. Reporting on Parent Permission at the Elementary School

(Enter N/A if requested information does not apply to you)

1) Enter # of parents per student(s) enrollment (Count 1 parent per student i.e., mother & father as 1. Count 1 parent for any number of siblings) Answer required from all schools.(Required)

2) Enter # of permission forms returned from parents(Required)

3) Enter # of parents choosing non-permission. (includes permission or opt out forms) Regardless of the method of training this statement must be answered by all schools Answer required from all schools.(Required)

4) Enter # of handbooks given to parents choosing non-permission in number 3) above. Also enter # of parents in 3) that received handbooks in previous years. Answer required from all schools.(Required)

5) Enter # of parents that did not respond (includes parents that refused to sign the form one way or another)(Required)

6) Indicate by checking Yes or No if the School or PSR program maintains a written record of the parents that did not respond from one school year to the next school year.

Yes

N/A

7) Indicate by checking Yes or No if all parent permission forms are retained on file @ the school for two years from the date received.

Yes

N/A

8) Indicate by checking Yes or No if all parent non-permission and Opt Out forms are retained on file @ the school for two years from the date received.

Yes

N/A

3. Educators – Active salaried teachers in diocesan and parish schools. Includes substitute teachers for the school year. (Does not include PSR teacher) Please complete A – G.

3A. Total number of Educators and Substitute Teachers employed at the school during the audit period(Required)

Provide an explanation for any increase/decrease in the total count in A above from last audit:

3B. Number of the Total Completing Safe Environment Training(Required)

3C. Subtract 3B from 3A and enter the total remaining to be trained(Required)

3D. For those not trained enter date by which training will be completed

Month

Day

Year

3E. Of the educators reported above report the number that have completed ISP / FBI Fingerprint Criminal History Check(Required)

3F. Subtract 3E from 3A and enter the total remaining to be background checked

3G. Date by which the fingerprint check will be completed

Month

Day

Year

High School

5. School Staff – Any other person employed and working in the school (cooks, maintenance, office staff, nurse, etc.). Please complete A – G

5A. Total number employed at the school during the audit period

5B. Number Completing PGC Training

5C. Subtract 5B from 5A and enter the total remaining to be trained

5D. For those not trained enter date by which training will be completed

Month

Day

Year

5E. Of the school staff reported above report the number that have completed ISP / FBI Fingerprint Criminal History Check

5F. Subtract 5E from 5A and enter the total remaining to be background checked

5G. Date by which the fingerprint check will be completed

Month

Day

Year

School

4. School Staff – Any other person employed and working in the school (cooks, maintenance, office staff, nurse, paid coaches, etc.). Please complete A – G

4A. Total number of paid school staff employed at the school during the audit period(Required)

Provide an explanation for any increase/decrease in the total count in A above from last audit:

4B. Number Completing Safe Environment Training(Required)

4C. Subtract 4B from 4A and enter the total remaining to be trained(Required)

4D. For those not trained enter date by which training will be completed

Month

Day

Year

4E. Of the school staff reported above report the number that have completed ISP / FBI Fingerprint Criminal History Check(Required)

4F. Subtract 4E from 4A and enter the total remaining to be background checked(Required)

4G. Date by which the fingerprint check will be completed(Required)

Month

Day

Year

5. School Volunteers – All active non-salaried persons who assist the school as a volunteer working in a child-based program non-paid coaches, children’s programs, field trips, lunch room, teachers aid, etc. Please complete A – H.

5A. Total number of volunteers. Enter total number assisting as a volunteer in a child-based programs for PSR, School if applicable, and parish.(Required)

5B. Number Completing Safe Environment Training(Required)

5C. Enter the total remaining to be trained(Required)

5D. For those not trained enter date by which training will be completed(Required)

Month

Day

Year

5E. Of the volunteers reported above report the number that have completed a Criminal History Check and are not expired(Required)

5F. 5E subtracted from 5A(Required)

5G. For those remaining to be background checked in E, how many are re-checks that need to be conducted?(Required)

5H. Date by which the Criminal History Check will be completed(Required)

Month

Day

Year

Use the space below to explain any gaps between the total numbers and the numbers remaining to be trained or background checked and how the school is planning on closing those gaps.

High School

6. School Volunteers – All active non-salaried persons who assist the school as a volunteer working in a child based program coaches, children’s programs, field trips, lunch room, teachers aid, chaperones, school boards, etc. Please complete A – G.

6A. Total number of volunteers. Enter total number assisting as a volunteer in a child based programs for PSR, School if applicable, and parish.

6B. Number Completing PGC Training

6C. Subtract 6B from 6A and enter the total remaining to be trained

6D. For those not trained enter date by which training will be completed

Month

Day

Year

6E. Of the volunteers reported above report the number that have completed a Criminal History Check

6F. Subtract 6E from 6A and enter the total remaining to be background checked

6G. For those remaining to be background checked in F, How many are re-checks that need to be conducted?

6H. Date by which the Criminal History Check will be completed

Month

Day

Year

Use the space below to explain any gaps between the total numbers and the numbers remaining to be trained or background checked for school staff and volunteers and how the school is planning on closing those gaps.

Date:

MM slash DD slash YYYY

RE: Elementary School Principal Training Compliance Letter

TO: Most Reverend Thomas John Paprocki:

The above referenced elementary school in the Diocese of Springfield in Illinois has received and implemented all aspects of the diocese’s Safe Environment Training Program.

The program includes training of every required group, (applicable to this school environment): students, volunteers, parents, educators and employees in programs that provide adults with the steps necessary to create an environment safe from child sexual abuse and to give children enrolled in our schools the knowledge they need to stay safe.

RE: High School Principal Training Compliance Letter

TO: Most Reverend Thomas John Paprocki:

The above referenced Catholic high school in the Diocese of Springfield in Illinois has received and implemented all aspects of the diocese’s Safe Environment Training Program.

Signature(Required)

Section 2

Audit Reporting

Reporting on parish religious education program student personal safety training and volunteers

Completed by:

Parish Safe Environment Coordinator & Directors of Religious Education or Coordinators of Religious Education

Please list the DRE or CRE below responsible for completing the audit information as well as a contact number and email address where the person can be reached.

(If you parish does not have a religious education program, please enter “N/A” for requested information below).

Contact Name:(Required)

Telephone #:(Required)

Email Address:(Required)

Parish School of Religion (PSR)

1. Check this box if no PSR program exists for the reporting parish. No other information is needed.

CHECK HERE

2. Indicate the parishes that will be included in the information reported on this audit. If you typically report for multiple parishes per audit, indicate those here.

3. Check this box if children of this parish are enrolled in a religious education program at another parish and enter the name and location of the parish conducting the training.

Check here

Name and location of the parish conducting the training(Required)

4. If check box explanations in 2 & 3 above do not apply, please continue to fully complete Section 2 item numbers 6- 9.

Parish School of Religion (PSR)

5. Please complete A – J regarding the student attendance of the personal safety conducted in the PSR classroom.

(Enter N/A if requested information does not apply to you)

5A. # of Students Enrolled in the Parish PSR Program

5B. # of Students Trained(Required)

5C. Students absent Due to Parent Non-Permission or OPT-OUT(Required)

5D. Students Absent Due to Parent Non-Responding to Permission(Required)

5E. Students Absent for any other reason(Required)

5F. Total of 5C, 5D, 5E above(Required)

Hidden

Sum of 5B and 5F

Hidden

Difference of 5A and (5B + 5F)

The values of 5A and 5B + 5F are equal, please proceed with the rest of the audit.

The values of 5A and 5B + 5F are not equal, please ensure the values you entered are correct in order to proceed with the audit.

5G. Of the students in 5C, 5D and 5E above report the number of students that have not attended personal safety training in past years and remain to be trained.

5H. Was VIRTUS Empowering God's Children training curriculum used?

Yes

N/A

6. Was parent permission obtained for the Personal Safety Training?

Yes

No – Please explain below

N/A

Please check the method below that best describes how parent permission is obtained or provide an explanation in of the method used.

6A. Written permission slips requested from the parent at the time of PST

6B. Parents informed of the PST training curriculum during student registration when permission slips are signed. Please answer 1) – 8) in 2A. and attach a copy of the information detailing the personal safety program and a sample copy of the permission slip.

6C. Parent permission is in the form of an “Opt Out”. The program is described at registration or at the time of the training and parents are informed to complete the “opt out” slip if they do not want the child to participate in the PST training.

6D. Other – Please Explain Below

Please answer 1) – 8) in 6E and attach a sample copy of the permission slip

Max. file size: 64 MB.

Please answer 1) – 8) in 6E. and attach a copy of the information detailing the personal safety program and a sample copy of the permission slip.

Drop files here or

Max. file size: 64 MB.

Please answer 1), 3) & 8) in 6E and attach a copy of the information detailing the personal safety program and the opt out form.

Drop files here or

Max. file size: 64 MB.

Explain(Required)

PLEASE ATTACH SAMPLE PERMISSION FORM YOU USE(Required)

Max. file size: 64 MB.

6E. Reporting on Parent Permission in the PSR Program

1) Enter # of parents per student(s) enrollment (number of families) Answer required from all schools.(Required)

2) Enter # of permission forms returned from parents(Required)

5) Enter # of parents that did not respond (includes parents that refused to sign the form one way or another)(Required)

6) Indicate by checking Yes or No if the School or PSR program maintains a written record of the parents that did not respond from one school year to the next school year.(Required)

Yes

N/A

7) Indicate by checking Yes or No if all parent permission forms are retained on file @ the school for two years from the date received.(Required)

Yes

N/A

8) Indicate by checking Yes or No if all parent non-permission and Opt Out forms are retained on file @ the school for two years from the date received.(Required)

Yes

N/A

7. Religious Education Volunteers – All active non-salaried persons who assist the parish as a volunteer working in a child-based program such as catechists, youth ministers, children’s programs, field trips, teacher’s aide, etc. Please complete A-G.

7A. Total number of volunteers. Enter total number assisting as a volunteer in a child-based programs for PSR, School if applicable, and parish.

7B. Number completing Safe Environment training

7C. Subtract 7B from 7A and enter the total remaining to be trained

7D. For those not trained enter date by which training will be completed

Month

Day

Year

7E. Of the volunteers reported above report the number that have completed a Criminal History Check and are not expired

7F. Subtract 7E from 7A and enter the total remaining to be background checked

7G. For those remaining to be background checked in F, how many are re-checks that need to be conducted?

7H. Date by which the Criminal History Check will be completed

Month

Day

Year

Use the space below to explain any gaps between the total numbers and the numbers remaining to be trained or background checked and how the school is planning on closing those gaps.

Section 3

Reporting on Parish Staff and Parish Volunteers

Audit Reporting

Reporting on parish staff & parish volunteers

Completed by:

Parish Safe Environment Coordinator *

Parish/School:(Required)

City:(Required)

Pastor (Or Parochial Administrator):(Required)

Street Address:(Required)

1. The individual responsible for completing the audit information for Section 3 & 4 must be listed as well as a contact number and email address where the person can be reached. *

Contact Name:(Required)

Telephone #:(Required)

Email(Required)

2. If this parish is responsible for any other parishes, please identify them below.

3. Please indicate if the information in this audit section will include the reporting parishes listed above?(Required)

Yes

Include all statistics and answer all questions for the parishes listed above in this report.

Please indicate the parishes not included in the reporting for this audit section and complete and submit a separate audit reporting for any parish listed in this section.

4. Parish Employees – All active paid persons, (other than priest/deacons, educators or school staff), who are employed by and work directly for parishes such as parish ministers, rectory staff, etc. Please complete A – G.

4A. Total number employed at the PARISH during the audit period(Required)

IF THERE ARE NO PAID EMPLOYEES ON STAFF AT THE PARISH PLEASE ENTER ZERO HERE and do not complete the B, C, D, E, F, & G

Provide an explanation for any increase/decrease in the total count in 4A above from last audit:

4B. Number completing Safe Environment training(Required)

4C. Subtract 4B from 4A and enter the total remaining to be trained(Required)

4D. For those not trained enter date by which training will be completed

Month

Day

Year

4E. Of the Parish Employees reported above report the number that have completed a Criminal History Check and are not expired(Required)

4F. Subtract 4E from 4A and enter the total remaining to be background checked(Required)

4G. For those remaining to be background checked in F, how many are re-checks that need to be conducted?(Required)

4H. Date by which the Criminal History Check will be completed

Month

Day

Year

Use the space below to explain any gaps between the total numbers and the numbers remaining to be trained or background checked and how the school is planning on closing those gaps.

5. Parish Volunteers – All active non-salaried persons who are 18 years and older volunteering in the parish, in any capacity (excluding PSR and school Volunteers) as outlined in the revised Pastoral Policy on Sexual Abuse of Minors by Church Personnel. Please complete A – G.

5A. Total number of volunteers(Required)

Enter total number assisting as a volunteer 18 years and older (excluding PSR and School Volunteers)

5B. Number completing Safe Environment training(Required)

5C. Subtract 5B from 5A and enter the total remaining to be trained(Required)

5D. For those not trained enter date by which training will be completed

Month

Day

Year

5E. Of the volunteers reported above report the number that have completed a Criminal History Check and are not expired(Required)

5F. Subtract 5E from 5A and enter the total remaining to be background checked(Required)

5G. For those remaining to be background checked in F, how many are re-checks that need to be conducted?(Required)

5H. Date by which the Criminal History Check will be completed

Month

Day

Year

Use the space below to explain any gaps between the total numbers and the numbers remaining to be trained or background checked and how the school is planning on closing those gaps.

Section 4

Reporting on Other Safe Environment Requirements & Training Compliance Letter

Audit Reporting

Reporting on other parish safe environment requirements, training compliance letter

Completed by:

Parish Safe Environment Coordinator & Parish Pastor, Parochial Administrator or Parish Life Coordinator.

Other Parish Safe Environment Requirements

1A. Is The Policy on Working with Minors and The Policy on Sexual Abuse of Minors by Church Personnel communicated to employees and volunteers?(Required)

Yes

1B. Does the pastor/school principal know when and how to report an allegation of sexual abuse of a minor?(Required)

Yes

1C. Does the pastor/school principal know how to obtain outreach for victims?(Required)

Yes

1D. Does the pastor ensure that visiting or non-permanent clergy (e.g. weekend assistants, priests who witness marriages, perform baptisms, conduct funerals or otherwise engage in supply ministry from outside the diocese) are clergy in good standing AND is that letter kept on file in your office?(Required)

Yes

1E. Has the parish offered and promoted safe environment training and screening to adults?(Required)

Yes

1F. Does the parish have the Victim Assistance Brochures available for those attending services at the church? Victim Assistance Brochures must be posted in public spaces at the parish level on an ongoing basis.(Required)

Yes

1G. Does the parish publish the diocese Victim Assistance Contact Information in the parish bulletin and online or anywhere else for the general information of parish members at least twice yearly?(Required)

Yes

Proof of bulletin announcements required to be submitted with this audit report(Required)

Drop files here or

Max. file size: 16 MB.

1H. Is the training compliance letter appropriately signed and attached with this completed audit report?(Required)

Yes

RE: Training Compliance Letter

Parish(Required)

Date(Required)

MM slash DD slash YYYY

TO: Most Reverend Thomas John Paprocki, Bishop of Springfield in Illinois

The above referenced parish in the Diocese of Springfield in Illinois has received and implemented all aspects of the diocese’s Safe Environment Training and Background Check Policies.

The parish provides training programs that provide adults with the steps necessary to create an environment safe from child sexual abuse and provides children enrolled in our schools and/or Parish Schools of Religion the knowledge they need to stay safe. The parish also requires a background check of every required group in compliance with the Policy on Sexual Abuse of Minors by Church Personnel.

Sincerely in Christ,

Signature(Required)

Check appropriate title

Pastor

Parochial Administrator

Pastoral Facilitators

Director of Campus Ministry

Review your Submission

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This field is for validation purposes and should be left unchanged.

Safe Environment Audit

Section 1

High School

High School

School

High School

School

High School

School

High School

RE: Elementary School Principal Training Compliance Letter

RE: High School Principal Training Compliance Letter

Section 2

Parish School of Religion (PSR)

Parish School of Religion (PSR)

Section 3

Section 4

RE: Training Compliance Letter

Review your Submission

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