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DIOCESAN CHARTER COMPLIANCE
2011 PASTORS’ ANNUAL REPORT

REPORTING PROCEDURES, SAFE ENVIRONMENT PROGRAM, AND BACKGROUND CHECKS

I have made available within my parish the printed material by which anyone may report an incident of abuse in the name of the Church. I have made these materials available in the following manner(s):
Please click on drop down menu and then select Yes or No:

	from the pulpit
	in the bulletin/parish newsletter

	other (please describe and document)

The Safe Environment Program (VIRTUS) necessary for those in contact with minors was offered to parishioners at the following sites this year (please identify):

Please click on drop down menu and then select Yes or No:

The Safe Environment Annual Compliance May Report of activities provided in our parish school or parish religious education program has been sent to the Diocesan Office of Safe Environment by the principal and/or catechetical leader.

I have completed and included Page 2 of this report, which denotes a current list of all adults, paid and/or volunteer, who are employed or volunteer in my parish and work with youth or are in contact with minors. The list denotes whether or not they have been background checked and have had VIRTUS training, if required. (DO NOT include catechetical leaders, catechists, principals, or school staff. DO include parish staff and youth ministers, if present in your parish.)

The parish has on-file on its premises the following documents: (Please select Yes or No)

	Current background check clearance for all employees and volunteers working with youth
	Acknowledgement of participation in Safe Environment Program (VIRTUS) for all employees or volunteers working with youth
	Signed Acknowledgement of Receipt of either the full Statement of Policy and Procedures on Sexual Abuse or its summary for all employees and volunteers who work with youth (Reference - Code of Pastoral Conduct, Pastoral Handbook IV.20)

DIOCESAN CHARTER COMPLIANCE
LIST OF EMPLOYEES AND VOLUNTEERS IN PARISH
PLEASE READ THESE INSTRUCTIONS CAREFULLY BEFORE COMPLETING FORM

• Please list all current parish employees and volunteers. (DO NOT LIST catechetical leaders, catechists, principals, or school staff)
• For each person listed, please check the box under either Employee or Volunteer to indicate their status.
• For each person listed, please select YES or NO in the appropriate drop down menu under VIRTUS Training Completed and Background Check Completed to indicate whether or not he/she has had VIRTUS training and/or been background-checked. (If you do not know whether or not the individual has been VIRTUS-trained, please refer to enclosed instruction sheet on how to view the list of VIRTUS-trained personnel. Records of persons from your parish who have been background checked are maintained in your parish rectory files.)

Name	Employee or Volunteer	VIRTUS Training Completed	Background Check Completed

Please make a selection. I affirm that the above is true to the best of my knowledge.
Date A value is required.Ex. mm/dd/yyyy

Your Name: A value is required.

Please print this page for your records before you click on the Submit button. After you have printed the page please click on submit to send the information.