1. Forms
  2. Schudules & Planners
  3. Event Planning Template
  4. Event Management Template
  5. Safety Plan Template

Download Safety Plan Template for Free

You can find a Safety Plan Template here. The Safety Plan is usually a one-page document to list some important information related to public safety issues; it is a file to enhance safety management. Most safety plans usually begin with some basic information such as warning signs and internal coping strategies. Then you can find the most important information of people you can ask for help in an emergency, professionals or agencies you can contact during a crisis.

(4.5 based on 542 votes)
Sample Safety Plan
Step 1: Warning signs (thoughts, images, mood, situation, behavior) that a crisis may be
developing:
1. _____________________________________________________________________________________________
2. _____________________________________________________________________________________________
3. _____________________________________________________________________________________________
Step 2: Internal coping strategies – Things I can do to take my mind off my problems
without contacting another person (relaxation technique, physical activity):
1. _____________________________________________________________________________________________
2. _____________________________________________________________________________________________
3. _____________________________________________________________________________________________
Step 3: People and social settings that provide distraction:
1. Name____________________________________________________Phone______________________________
2. Name____________________________________________________Phone______________________________
3. Place__________________________________________4.Place______________________________________
Step 4: People whom I can ask for help:
1. Name____________________________________________________Phone______________________________
2. Name____________________________________________________Phone______________________________
3. Name____________________________________________________Phone______________________________
Step 5: Professionals or agencies I can contact during a crisis:
1. ClinicianName____________________________________________Phone______________________________
ClinicianPagerorEmergencyContact#_________________________________________________________
2. ClinicianName____________________________________________Phone______________________________
ClinicianPagerorEmergencyContact#_________________________________________________________
3. LocalUrgentCareServices______________________________________________________________________
UrgentCareServicesAddress___________________________________________________________________
UrgentCareServicesPhone_____________________________________________________________________
4. SuicidePreventionLifelinePhone:1-800-273-TALK(8255)
Step 6: Making the environment safe:
1. _____________________________________________________________________________________________
2. _____________________________________________________________________________________________
SafetyPlanTemplate©2008BarbaraStanleyandGregoryK.Brown,isreprintedwiththeexpresspermissionoftheauthors.NoportionoftheSafetyPlanTemplatemaybereproduced
withouttheirexpress,writtenpermission.Youcancontacttheauthorsat[email protected]or[email protected].
Theonethingthatismostimportanttomeandworthlivingforis:
________________________________________________________________
Safety Plan Template
< 1 / 1 >
Download

Most Popular Templates