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Safety of Minors Policy
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UMN Program Submission Form
UMN Program Submission Form
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Please indicate which type of program you would like to submit:
Step-Up Employment Program
K-12 Youth Event/Program/Camp/Intern/Conference (In-Person and/or On line)
Step-Up Youth Employment
Will you be hiring a Step-Up Youth Employment Intern?
Yes
No
Number of Youth Interns
Dates
Site Location
Host Contact Info
Name
Email
Phone
Is this your first time hosting a youth intern?
Yes
No
Have you completed all required paperwork per the Step-Up program via the City of Minneapolis?
Yes
No
Have all adults working directly with the youth intern/s completed the on-line Safety of Minors training found in the training hub?
Yes
No
Not yet
Have all adults working directly with the youth intern/s passed a background check within the last three years?
Yes
No
Not yet
Per the Safety of Minors: Health and Safety Requirements, I understand that the youth intern/s will maintain appropriate ratios, including no one-on-one interaction with an adult. Interactions must be observable and interruptible at all times.
Yes, I understand this requirement
Basic Information
Program Title
Unit
Link to Program Registration
Description
A short 2-3 sentence description.
Phone
Email (point of contact for participants)
Program Director/Leader
I verify that all program staff (faculty, staff, students- including student employees- or volunteers) who are required to complete the U of M training on safety of minors and pass a background check have or will have done so within three years prior to the event. I also verify that this program has established practices for program activities that adequately address health and safety considerations for minors.
Program Leader Email
Program Information
Start Date
Start Date: Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Start Date: Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Start Date: Year
Year
2018
2019
2020
2021
2022
2023
2024
End Date
End Date: Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
End Date: Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
End Date: Year
Year
2018
2019
2020
2021
2022
2023
2024
Months Offered
According to the start and end date, please select all the month(s) your program resides in.
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Age
Select all that apply.
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Estimated number of participants
Subject
Select one or more.
Food, Agriculture, and Natural Resource Sciences
Art, Design, Music, and Theater
Health, Nutrition, and Human Development
Leadership and Citizenship
Science, Technology, Engineering, and Math
Communication, Diversity, History, Languages, and Social Studies
Recreation
Business
Program Location
Select campus/region as well as if your program will be delivered in-person or virtually (check both boxes if your program plans to deliver both in-person and virtually).
Crookston/Northwest MN- In-person
Duluth/Northeast MN- In-person
Morris/West Central MN- In-person
Rochester/Southeast MN- In-person
Southwest MN- In-person
Twin Cities/Central MN- In-person
Crookston/Northwest MN- Virtual
Duluth/Northeast MN- Virtual
Morris/West Central MN- Virtual
Rochester/Southeast MN- Virtual
Southwest MN- Virtual
Twin Cities/Central MN- Virtual
Publish on Youth Central website?
Yes
No
Staffing Information
Have all covered staff/volunteers passed a background check within the last three years?
Yes
Not yet
Not applicable
Have all covered staff/volunteers completed the Safety of Minors mandatory training via the Training Hub?
Yes
Not yet
Not applicable
Will there be a minimum of two program staff on duty at all times who are 18 or older and two years older than the oldest participant?
Yes
Not yet
Not applicable
Will all program staff/volunteers/student workers receive an orientation?
The orientation should include expectations for program staff behavior when interacting with youth (both in-person and virtually), supervising, chaperoning or otherwise overseeing minors in program activities, recreational activities, and/or residential facilities.
Yes
Not yet
Not applicable
Safety of Minors Information
Have you planned appropriate physical environments to ensure quality learning environments and help prevent illnesses and accidents?
Yes
Not yet
Not applicable
Is there a plan to change facilities or modify activities for participants with special needs?
Yes
Not yet
Not applicable
Is there a plan to change facilities or modify activities in case of extreme weather?
Yes
Not yet
Not applicable
Have you assessed the environment to determine if minors need to be accompanied to the bathrooms?
Yes
Not yet
Not applicable
Environmental assessment may include considering the relative age of participants, the presence of minors or adults not from the same program, sight lines, and distance.
Is there a plan for the safe movement of minors?
Yes
Not yet
Not applicable
Do minors attend without a parent or other caretaker?
Please review the health and safety requirements on this page: https://policy.umn.edu/operations/minorsafety-appa
Yes
No
Does the program collect and keep within easy access information on each participant including current medications administered during program time frame and contact information for parents/guardians?
Yes
No
Do program staff know how to find and use this information?
Yes
No
Has the program established and communicated practices to prevent accidents and illnesses, including adequate first aid and proper handling of medications?
Yes
No
Does the program have emergency plans for fire, weather (e.g., tornado), toxic gas evacuations, unfamiliar packages, intruders, lost or missing children, and other emergencies?
Yes
No
Has the program established and communicated to program staff appropriate procedures for addressing emergencies, accidents and illnesses?
Yes
No
Will the program obtain a signed release of liability from all parents/guardians of minors prior to participation?
Yes
No
Does the program lodge people overnight?
More information on health and safety requirements can be found here: https://policy.umn.edu/operations/minorsafety-appa
Yes
No
Will the program follow lodging requirements?
More information on lodging requirements can be found here: https://policy.umn.edu/operations/minorsafety-appa
Yes
No
Will there be a minimum of two program staff on duty overnight who are 21 or older?
Yes
No
Has the program operated previously?
Yes
No
Were any incidents of suspected abuse known to have been reported to or by staff in the last year?
Yes
No
Was the incident reported to police, sheriff or local social service agency?
Yes
No
Did the incident allegedly occur during the program or involve program staff or volunteers?
If yes, contact the policy owner to review actions, including preventing future incidents.
Yes
No
Notification Date
Will a minor be present in lab environment?
Yes
No
In addition to the general release and waiver form, has each participants' adult caregiver signed off on the Labs Use Agreement Form (Paid Lab activity) or the Volunteers/Guests in Labs Form?
Yes
No
Are you prepared to give a safety overview of the lab space?
Yes
No
Not Yet
Has your unit/department head received written communication informing them that minors will be in the lab on certain days and times?
Yes
No
Not Yet
Do you require any enrolled college students using the lab to complete a specific training safety module related to the lab activity?
Yes
No
Have you required the minors to also take the training module (this is a requirement).
Yes
No
Not Yet
Do you need an additional HSRM risk assessment because chemicals, dust, fumes, vapors, gases, biological materials, radioactive materials or other substances may be present?
Yes
No
Virtual Program Information
Is this a virtual program?
Yes
No
Is the platform supported by the University of MN?
Supported platforms include Zoom, Flipgrid, Microsoft Teams, and Canvas.
Yes
No
Have safety guidelines been addressed related to your platform?
Yes
No
Not yet
Will you be live streaming your program?
Yes
No
Have safety precautions been put in place related to risks of live streaming?
Yes
No
Not yet
Have all staff/volunteers completed virtual safety guidelines training?
Yes
No
Not yet
Has oversight been established to include a minimum of two adults during all virtual engagement activities?
Yes
No
Not yet
Is recording taking place?
Yes
No
Have all participants been informed that the recording will take place?
Yes
No
Not yet
Has the purpose for the recording been communicated to all participants?
Yes
No
Not yet
Will you delete the recording within 30 days?
Yes
No
Will the recording be kept on a University accessible device?
Yes
No
I agree to the
terms of service
.
I verify that I have read and understand the Safety of Minors Policy, including the Health and Safety Appendix. I verify that all program staff (faculty, staff, students- including student employees- or volunteers) who are required to complete the U of M training on safety of minors and pass a background check have or will have done so within three years prior to the event. I also verify that this program has established practices for program activities that adequately address health and safety considerations for minors.
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UMN Program Submission
Safety of Minors Policy