JCC Culture of Safety Application Question Title * 1. Please put your contact information Name Position at the JCC Email address City State Question Title * 2. Please pick your JCC BB Riback Berkshire Hills Eisenberg Camp B'nai B'rith Camp, MB B'nai B'rith Camp, OR Camp Livingston Camp Mountain Chai Camp Tawonga Capital Camps & Retreat Center Fresh Air Society / Tamarack Camps JCC Maccabi Sports Camp NJ Y Camps Pinemere Camp Association Poyntelle Camp Shalom Institute Surprise Lake Camp Aaron Family JCC of Dallas Addison-Penzak JCC of Silicon Valley Adolph and Rose Levis JCC David Posnack JCC Harry and Rose Samson Family JCC JCC of Greater Kansas City JCC of Greater Vancouver JCC of Indianapolis Lawrence Family JCC of San Diego County- Jacobs Family Campus Mandel JCC of the Palm Beaches Mandell JCC of Greater Hartford Mayerson JCC Michael-Ann Russell JCC Osher Marin JCC Robert E. Loup Jewish Community Center Schwartz/Reisman Centre Stroum Jewish Community Center The JCC of Greater Buffalo - Benderson Family Building The Jewish Community Center of Greater Columbus Tucson JCC YM & YWHA of Washington Heights & Inwood Barbara and Ray Alpert JCC Barshop JCC of San Antonio Boulder JCC Dave & Mary Alper JCC Edith & Carl Marks JCH of Bensonhurst Galbut Family Miami Beach JCC Gordon JCC Harold and Elaine Shames JCC on the Hudson I.J. & Jeanne Wagner JCC JCC of Central NJ JCC of Louisville JCC of Northern Virginia JCC of Stamford JCC of the Greater St. Paul Area JCC Rockland Jewish Community Alliance of Jacksonville Jewish Community Center of Austin Jewish Educational Alliance Kingsbay YM-YWHA Levite JCC Memphis JCC Miles Nadal JCC Milton & Betty Katz JCC New Orleans JCC Omaha JCC Prosserman JCC Riverdale YM-YWHA Rose and Max Rady JCC Sandra and Leon Levine Jewish Community Center Shimon and Sara Birnbaum JCC Shorefront YM-YWHA of Brighton Manhattan Beach Sidney Albert Albany JCC Siegel JCC Springfield JCC Sunrise Association (Sunrise Day Camps Association, Inc.) Tampa JCC The Roth Family JCC of Greater Orlando Valley of the Sun JCC Weinstein JCC Westside JCC Worcester JCC York JCC Bender JCC of Greater Washington Betty & Milton Katz JCC Edlavitch JCC of Washington, DC Evelyn Rubenstein Jewish Community Center JCC Chicago JCC Metrowest JCC of Greater Baltimore JCC of Greater Pittsburgh JCC of Metropolitan Detroit JCCs of Greater Boston Kaplen JCC on the Palisades Mandel JCC of Cleveland Marcus JCC of Atlanta Merage JCC of Orange County Oshman Family JCC Peninsula JCC Sid Jacobson JCC St. Louis Jewish Community Center Asheville JCC Augusta Jewish Community Center Bergen County JCC Calgary Jewish Community Centre Charleston JCC Charlotte & Dick Levin JCC Contra Costa JCC Dwares JCC of the Jewish Alliance of Greater Rhode Island East Valley JCC Greenwich JCC JCC Jersey Shore JCC of Greater Ann Arbor JCC of Southern Nevada JCC of Toledo JCC of Windsor JCC of Youngstown JCC Princeton Mercer Bucks & Abrams Camps Jewish Community Alliance of Northeast Pennsylvania Jewish Community Alliance of Southern Maine Jewish Community Center of Schenectady Jewish Community Center of the East Bay Jewish Federation of Greater Harrisburg Jewish Senior Services Kaiserman JCC Katie and Irwin Kahn Jewish Community Center Marilyn and Marvin Simon Family Jewish Community Center Marjorie and Oscar Boonshoft - Center for Jewish Culture and Education Mittleman JCC Moise Safra Community Center Raleigh-Cary JCC Rosen JCC Scranton JCC Shaw Jewish Community Center of Akron The Jewish Community Center of the Lehigh Valley The Jewish Federation of Sarasota-Manatee Valley Jewish Community Center Question Title * 3. Is your JCC a Redwoods client? Yes No Not sure Question Title * 4. What is your JCC's size of JCC (if known) Small Medium Large Metro Not sure Question Title * 5. Yes, I am interested in participating in the Pilot program and will commit the time:- Take the 45-minute Benchmark & Protect self-assessment at the beginning of the initiative - by Sunday, June 25, 2017 - The Culture of Safety Pilot Program participants will have a call with The Redwoods Group to review their safety practices and protocols and together discuss the three areas of safety the JCC identified as goals to adopt throughout the course of the initiative.- One-day in-person visit at their JCC with a Redwoods consultant in September 2017 focused on helping them achieve their goals and improve their culture of safety.- Monthly one-hour check-in calls with a Redwoods consultant to receive guidance and answer questions as their JCC works towards improving its practices.- One hour debrief at the end of the Initiative.- Taking the 45-minute Benchmark & Protect self-assessment at end of the initiative (January 10-February 1, 2018.) Yes, I am interested in participating in the Pilot program and will commit the time. No, I am not interested in the Pilot Program but I will complete the Benchmark and Protect self-assessment No I am not interested in participating in the Culture of Safety Initiative. Question Title * 6. Approximate number of Full Time Employees ( FTEs) at your JCC Question Title * 7. Approximate number of Part Time Employees ( PTEs) at your JCC Question Title * 8. Please identify three areas of safety you would like to address. 1 2 3 Done