Your Safety Comes First

Name

First Name

Last Name

Email

Subject

Message

Safety Plan

Suicide Safety Plan - Please list any animals, hobbies, or music you love.

Step 1: Warning signs:

1.

_________________________________________________________________

2.

_________________________________________________________________

3.

_________________________________________________________________

Step 2: Internal coping strategies—things I can do to take my mind off my problems without

contacting another person:

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. Suicide Prevention Lifeline Phone: 1-800-273-TALK (8255) or 988

4. Local Emergency Serv____________________________________________

Emergency Services Address________________________________________

Emergency Services Phone_________________________________________

Step 6: Making the environment safe:

1.____________________________________________________________

2.___________________________________________________________