Section B: Administrators Names & Positions Name: Name: Name: Position: Position: Position: Section A: Contact Information Name of House of Worship: Phone Number: Fax Number: Facility Address: Facility Coordinator: Head of Establishment Website Address: Name: Name: Name: Position: Position: Position: Section C: Facility Information Size & Type Building (per Congregants & Staff Rooms Building) #of Buildings # of # of Interior Rooms Children/Youth #of Floors # of Adults # of Miscellaneous # of Exits # of Staff # of Kitchens Type of # of Individuals # of Bathrooms Structure with Disabilities Approximate # in attendance for # of Rooms-Total Square largest service of Footage year Maximum # of public safety # of Elevators Capacity personnel Additional # of congregants Is an AED machine Information present during the on the campus? If so, week days are there people trained (average) to use it? Who? Additional Considerations Is the facility used by organizations outside of the house of worship? How often is the facility used by non-members of the house of worship? Is the facility accessible to people with disabilities? How often is the facility used for outreach ministries?
Section A: Contact Information Name of House of Worship: Phone Number: Fax Number: Facility Address: Facility Coordinator: Head of Establishment Website Address: Section B: Administrators Names & Positions Name: Position: Name: Position: Name: Position: Name: Position: Name: Position: Name: Position: Section C: Facility Information Size & Type Building (per Building) Congregants & Staff Rooms #of Buildings # of Children/Youth # of Interior Rooms #of Floors # of Adults # of Miscellaneous # of Exits # of Staff # of Kitchens Type of Structure # of Individuals with Disabilities # of Bathrooms Approximate Square Footage # in attendance for largest service of year # of Rooms-Total Maximum Capacity # of public safety personnel # of Elevators Additional Information # of congregants present during the week days (average) Is an AED machine on the campus? If so, are there people trained to use it? Who? Additional Considerations Is the facility used by organizations outside of the house of worship? How often is the facility used by non-members of the house of worship? Is the facility accessible to people with disabilities? How often is the facility used for outreach ministries?
Revised-House-of-Worship-Facility-and-Congregation-Snapshot-Form.docx