10. Safe Place Site Agreement Application Date _________________Site fee paid __________ Company ___________________________________________ Training completed ___________________________________ Address ____________________________________________ Hours of operation ___________________________________ City, State, Zip Code___________________________________ Contact ____________________________________________ Position ____________________________________________ Phone _____________________________________________ FAX _______________________________________________ Email ______________________________________________
11. Safe Place Site Agreement Responsibilities of Sponsoring Agency to Safe Place Locations 1. To hold an orientation for employees at each location prior to its opening as a Safe Place site. 2. To provide a procedure sheet that includes step-by-step instructions for Safe Place. 3. To dispatch Safe Place volunteers to assist youth at the request of the Safe Place location. 4. To make available a Safe Place sign and other materials. (Safe Place agency) accepts the responsibilities to the Safe Place Locations. ____________________________________ __________________ Safe Place Coordinator Date
12. Safe Place Site Agreement Responsibilities of Safe Place Locations 1. To designate responsibility for Safe Place program to a management level employee (who is at least 21 years of age at each site.) 2. To provide a safe environment (such as an employee's lounge or a manager's office) where the youth in crisis can wait until a Safe Place volunteer can respond, and to check on him/her as needed. 3. To be supportive of the youth, to relay information about him/her to (your agency) shelter staff and to keep such information confidential. 4. To display the Safe Place sign in a highly visible area on the outside of the building, to display the Safe Place decal on the entrance that the youth would use when requesting help, and to keep the Safe Place Site Manual in a location where all employees can have easy access to it. 5. To inform all new employees about Project Safe Place, including the procedures to follow if a youth requests help. 6. To install the Safe Place sign on the building or provide funds to offset the cost if this is not possible. 7. To remove the Safe Place sign from the building if site is no longer participating with Safe Place program. I understand and accept the responsibility of being a Safe Place location. _______________________________ of _________________________ Date ______________________ (Contact name) (Company name)
16. “ Attention Managers” Site Check It is difficult to visit each of our ______ Safe Place sites as often as I would like, so I want to remind you of a few very important responsibilities. Please answer the six questions on this sheet and if anything needs attention, call me at the Safe Place office at ________ . A Safe Place volunteer or staff person will be following up with a visit to your site in the coming weeks. 1) Is the Safe Place sign securely attached and visible? Yes / No 2) Is the Safe Place manual where all employees have easy access? Yes / No 3) Are all employees familiar with the Safe Place program? Yes / No 4) Does your location need a training session? Yes / No 5) Is there an "If Closed Call" decal on your front door or window? Yes / No 6) Do you have the yellow Safe Place procedure sheet posted? Yes / No Site Name: ____________________________________________________________ Contact: ______________________________________________________________ Address: ______________________________________________________________ Phone Number: ___________________ Fax Number: _________________________
23. Record Keeping This lady is smiling because she went on the National Safe Place Data Base and recorded her new sites and sites maintained. She is up to date and can relax. Notice how calm she looks!!!