Customized Policy Draft Questionnaire

• Organization Name*
• Organization Address*
  Please fill in the address of the organization that this policy draft is for.
  Street Address*

  Address Line 2

  City*

  Province / State / Region*

  Postal Code / Zip

  Antigua and BarbudaBahamasBarbadosBelizeCanadaCosta RicaCubaDominicaDominican RepublicEl SalvadorGrenadaGuatemalaHaitiHondurasJamaicaMexicoNicaraguaPanamaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesTrinidad and TobagoUnited StatesArgentinaBoliviaBrazilChileColumbiaEcuadorGuyanaParaguayPeruSurinameUruguayVenezuelaAlbaniaAndorraArmeniaAustriaAzerbaijanBelarusBelgiumBosnia and HerzegovinaBulgariaCroatiaCyprusCzech RepublicDenmarkEstoniaFinlandFranceGeorgiaGermanyGreeceHungaryIcelandIrelandItalyLatviaLiechtensteinLithuaniaLuxembourgMacedoniaMaltaMoldovaMonacoMontenegroNetherlandsNorwayPolandPortugalRomaniaSan MarinoSerbiaSlovakiaSloveniaSpainSwedenSwitzerlandUkraineUnited KingdomVatican CityAfghanistanBahrainBangladeshBhutanBrunei DarussalamMyanmarCambodiaChinaEast TimorIndiaIndonesiaIranIraqIsraelJapanJordanKazakhstanNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLebanonMalaysiaMaldivesMongoliaNepalOmanPakistanPhilippinesQatarRussiaSaudi ArabiaSingaporeSri LankaSyriaTaiwanTajikistanThailandTurkeyTurkmenistanUnited Arab EmiratesUzbekistanVietnamYemenAustraliaFijiKiribatiMarshall IslandsMicronesiaNauruNew ZealandPalauPapua New GuineaSamoaSolomon IslandsTongaTuvaluVanuatuAlgeriaAngolaBeninBotswanaBurkina FasoBurundiCameroonCape VerdeCentral African RepublicChadComorosCongoDjiboutiEgyptEquatorial GuineaEritreaEthiopiaGabonGambiaGhanaGuineaGuinea-BissauCôte d\'IvoireKenyaLesothoLiberiaLibyaMadagascarMalawiMaliMauritaniaMauritiusMoroccoMozambiqueNamibiaNigerNigeriaRwandaSao Tome and PrincipeSenegalSeychellesSierra LeoneSomaliaSouth AfricaSudanSwazilandTanzaniaTogoTunisiaUgandaZambiaZimbabwe

  Country*
• Organization Website
   
• Your Name*
  First Name

  Last Name
• Name of Director/Senior Pastor/Principal*
• Email of Director/Senior Pastor/Principal*
   
• Your Title/Role at the Organization*
• Confirm Your Email*
   
• Your Phone Number
   
• What type of organization best identifies you?*
  Association

  Church / Parish / Ministry

  Para-church / Mission

  Over-night Camp

  Day Camp

  School / Daycare

  Boarding School

  Sports Club

  Arts Centre /Club (Drama, Music, Dance)

  Homecare

  Senior's Home

  Drop-in Centre

  Transportation Company

  Other
• If you marked 'other', please elaborate.
• What are the titles of the staff at your organization? And what is the order of seniority?
  Please use the titles specific to your organization. (For example: Executive Director, Director, Board, Coach, Assistant, Administrator OR Senior Pastor, Board, Youth Pastor, Children's Pastor, Administrator, etc.)
• What insurance company do you use?
  This information is used to ensure your policies reflect the standard of your insurance company.
  
• Do you have abuse coverage?
  No, we are trying to qualify for abuse coverage.

  Yes, we already have abuse coverage.

  Not sure
• POLICY INTRODUCTION
• This protection policy should be written for:*
  Please click all that apply. We will customize your policy with this audience in mind.
  Children

  Youth

  Vulnerable Adults

  Staff and Volunteers

  Organization

  Other
• If you marked 'other', please elaborate.
• Which components do you wish to be included in your policy introduction?*
  Please click all that apply. We will customize your policy with this in mind.
  Your vision and mission

  Recognition of need

  Rights of a Child

  Spiritual basis

  Commitment to protection

  Other
• If you marked 'other', please elaborate.
• Your draft policies will include definitions of abuse. It is standard for us to include emotional, physical, and sexual abuse and neglect. Please check all other definitions you would like included.
  Harrassment

  Discrimination

  Exposure to Domestic Violence

  Spiritual Abuse

  Other
• If you selected 'other', please elaborate.
• Organization's Logo
  Please upload your organization's logo, which will be used throughout your policies and form templates.
   
• Current Forms
  Please upload any current forms that you have, if you wish for them to be incorporated. If you have multiple documents, upload the main document here, and then email additional documents to info@plantoprotect.com
   
• Current Policies
  Please upload any current policies that you have, if you wish for them to be incorporated. If you have multiple documents, upload the main document here, and then email additional documents to info@plantoprotect.com
   
• Where are your programs and activities located?*
  Select the choice that closely matches your location.
  >We own the building, and are the sole occupants.We own the building, and have renters and other users.We rent the facility, and are the only tenants.We rent the facility, and it is open to the publicWe use numerous locations and sites.OtherUnsure how to answer this question
• If you marked 'other', please elaborate.
• SCREENING AND TRAINING
• Who at your organization is responsible for screening volunteers?*
  Plan to Protect Screening Committee

  Plan to Protect Administrator

  Program Leader

  Ministry Leader

  Other
• If you marked 'other', please list who is responsible for screening.
• Screening Requirements*
  What requirements will you ask your volunteers and staff to adhere to prior to being placed into a position of trust? You may want to check what your insurance company requires.
  Six month waiting period prior to placement

  Application

  Interview

  Two References

  Criminal Record Checks and Vulnerable Sector Search

  Member in good standing

  Adherent in good standing

  Agreement with mission/vision/core beliefs

  Final Approval

  Other
• If you marked 'other', please elaborate.
• Do you wish to grandfather in exsisting volunteers, or do you want them to go through the full screening process?*
• Who will be responsible for giving final approval?*
• Training Requirements*
  What abuse prevention training will be required for your staff and volunteers?
  Orientation training prior to placement

  Annual Refresher training

  On-line Plan to Protect training

  Other
• If you marked 'other', please elaborate.
• Program Policies
• Programs*
  Please check all the boxes that apply to your programming. We will include policies and procedures for these programs.
  Nursery

  Pre-School and toddlers

  Elementary age children

  Jr. High

  Sr. High

  Disabled persons

  Visitation (for the disabled or elderly at home, hospital or senior's centres)

  Sleepovers

  Billeting (ie. during touring or tournaments trips)

  Overseas trips (choral / missions / class)

  Off-site trips

  Overnight trips (ie. retreats, conferences, camping)

  Special events (carnivals, fairs, etc.)

  Events in partnership with other groups, schools, churches, etc.

  Refugee / New Immigrant Sponsorship

  Other
• If you marked 'other', please elaborate.
• List all activities that your offer where children, youth and vulnerable adults participate. Please take time to include all activities beyond your regularly scheduled programs. What are the names and ages for your programs and groups.*
  Many community groups have specific names for their groups i.e. Scouts, Brownies, Awana, the ROCK, Tweens, etc. Please list the name of each group and include a brief description (including the age group it is for).
  
• What kind of activities does your organization do that would be considered higher risk activities? Of these activities, which need leadership approval or skilled/certified instructors to lead?*
  A higher risk activity would be based on frequency and/or severity. For example if you take a group of young people by Metro/Transit once a month to an urban ministry project, that would be both a frequent activity and a higher risk activity. Even greater risk would be white water rafting, rock climbing, Wild Water Kingdom, Amusement Parks, etc.
  
• What kind of activities does your leadership wish to prohibit i.e. Bungee jumping, consuming alcohol or recreational drugs, white-water rafting, minors driving all-terrain vehichles, etc. *
  We recommend that you spell out in your policies activities that are not permitted during activities and events.
• PROTECTION PROCEDURES
• What procedures would you like included in your protection policies.*
  Please check all that apply. Carefully consider the guidelines and procedures you wish to provide direction on to your volunteers and staff.
  Registration

  Attendance Taking

  Ratios & Supervision

  Diapering

  Occasional Visitors

  Appropriate/Inappropriate Touch

  Classroom Management & Discipline

  Washroom Guidelines

  Shower/Change Room Guidelines

  Off-site Trips

  Health & Safety

  Administering Medication

  Emergencies

  Injuries & Accidents (Incident Reports)

  Computer Use

  Communication (ie. email/phone/social media)

  Bullying

  Transportation

  Photography

  Video and Webcasting

  Personal Information

  Offenders Policies (guidelines regarding attendance of a person convicted of crimes against children/youth)

  Gender Identity human rights guidelines

  Disciplinary Action (for Personnel)

  Small Groups in Homes

  Drug and Alcohol Use

  Whistleblower

  Other
• Do you wish to comment on any of the activites listed above? If you have selected 'other', please elaborate.
• When engaging with the vulnerable sector (children, youth and vulnerable adults), what parameters do you wish to place on your volunteers and staff outside of program times? (Examples include social media, meeting off-site, mentoring, counselling, home visits, phone calls, etc.)*
• How is registration for programs facilitated?
  Electronic Check-In

  Manual

  Does not apply
• Please provide a brief description as to how and when registration is facilitated? If electronic, what is the name of the program that you use?
• How is attendance facilitated?
  Electronic Check-In

  Manual

  Does not apply
• If applicable, who is responsible for diapering children
  Only parents

  Volunteers / Staff

  Does not apply

  New Option
• Does your facility have
  Gender specific restrooms

  Individual restroom

  Separate restrooms only for children

  Other
• If you have selected 'other', please elaborate.
• When Personnel are working, how will they be identified?*
  Personal Namebadge

  Organization Namebadge

  No Identification

  Other
• If you have selected 'other', please elaborate.
• REPORTING AND RESPONSE
• Your draft policies will include provincial requirements for reporting abuse. Do you have additional information you would like included in this section?
• When a volunteer or staff makes a report to authorities of a suspicion of abuse or an allegation of abuse which might directly impact the organization, who in authority should be informed?*
  Please provide a title or function not a specific person's name.
• Who on behalf of the organization will be the media spokesperson?*
  Please provide a title or function not a specific person's name.
• APPENDICES / DOCUMENTATION
• Would you like us to provide customized draft forms to reflect your policies?*
  Yes

  No
• How is documentation and files managed, protected and retained? Please include how files are saved and backed up?*
• FINAL FEEDBACK
• We recommend that your policies be reviewed annually. How often should your policies be updated?*
  >Annual review with update every two yearsAnnual review with update every three yearsAnnual review with update every four yearsAnnual review with update every five yearsOther
• If you marked 'other', please elaborate.
• Other Comments
• I have read the conditions noted above regarding the copyright and distribution restrictions of Plan to Protect® and the draft policies and procedures which will be customized on our behalf. We understand the restrictions and copyright guidelines and will adhere to them. Plan to Protect® reserves the right to seek financial reimbursement with the assistance of legal representation if these restrictions are not upheld.
  Your agreement is a condition for customized policy preparation.
  I agree

  I disagree
• Untitled
• Consent
  With Canada's anti-spam legislation we are required to obtain your consent to send you electronic communications. We do need express permission from each individual within an organization that we are communicating with. You may unsubscribe or withdraw your consent at any time by contacting us at Plan to Protect, 117 Ringwood Dr., Unit 11, Stouffville, ON L4A 8C1, or emailing us at info@plantoprotect.com.
• Please confirm your consent to receive electronic communications from Plan to Protect® as described.*
  Yes, I give my consent for Monthly e-Newsletters & Plan to Protect® Updates

  No, I do not give my consent
• Submission
  Thank you for filling out this form. Once your form is completed, please click to confirm you are not a robot, and then click on SUBMIT. If any required fields have been missed, a message will pop up with any missing fields. A message will pop up when the form has been successfully submitted. Once we receive it, you will receive an email confirmation.