NEW SAFETY PLAN

First Name
Last Name
Todays Date

MonthDayYear
Date
Step 1: Warning signs (thoughts, images, mood, situation, behavior) that a crisis may be
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.
People and social settings that provide distraction:
1. Name
Phone
2. Name
Phone
3. Place
4. Place
People whom I can ask for help:
Name
Phone
Name
Phone
3. Name
Phone
Professionals or agencies I can contact during a crisis:
Clinician Name
Phone
Clinician Pager or Emergency Contact #
Local Urgent Care Services
Urgent Care Services Address
Urgent Care Services Phone
Step 6: Making the environment safe:
1.
2.
The one thing that is most important to me and worth living for is:
Should be Empty: