Safety Plan Worksheet

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Safety Plan Worksheet

This is good to print out and keep on you at all times.

My potential escape routes:

How will I actually leave?

Do I have access to transportation? If not, what is my "plan B?"

What would be the best time?

What other concerns do I need to attend to in this part?

My safe place(s) to go: Figure out ahead of time a safe place. This could be the home of a friend or relative who will offer unconditional support, a motel, hotel, or a shelter.

Places I can go that are safe:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________

Survival kit checklist: Put this list somewhere safe, someplace you will easily remember, or leave it with a trusted neighbor, friend, or relative. Important papers can also be left in a bank deposit box.
____ Money for a cab

____ Change of clothes
____ Extra house and car keys
____ Birth certificates, passports
____ Medications, and copies of prescriptions
____ Insurance information
____ Checkbook
____ Savings passbook
____ Credit cards
____ Legal documents (separation agreements and protection orders)
____ Address books
____ Any valuables
____ Any papers that show jointly owned assets

National Domestic Violence Hotline: 1-800-799-SAFE or 1-800-787-3224(TDD).

CIRCLE OF SUPPORT WORKSHEET

We have given you a way to think about your support system. You are the sun at the middle of the page. Imagine yourself as the center of your own solar system.

	Now draw circles to represent the people or organizations that are part of your life. Put the important ones close to you and the less important ones further out in the solar system.
	Write in their names.
	Now put a plus (+) in the ones that represent people who support and nurture you. Put a minus (-) in the ones that are negative (who perhaps undermine your sense of yourself).
	As an extension of this exercise, you can write down what sorts of things you think you can rely on these people to provide (Babysitting? A shoulder to lean on? A place to stay in an emergency?).

If after working with this image you really do NOT have any people in your solar system, or even if you only have one or two - and they are far away - please use your EAP program to help you develop a stronger support system

DON'T THINK YOU ARE CRAZY!

Do you sometimes find yourself feeling like there must be something wrong with YOU? Take a look at these "crazy making" thoughts. How many of them sound familiar?

1. I must be doing something wrong or this wouldn't be happening.
2. I just don't trust my own judgment any more.
3. I feel trapped and powerless - I don't know where to turn.
4. There must be something wrong with me.
5. If only I didn't make him mad so much, this wouldn't be happening to me.
6. He says this is normal, so it must be that I'm just really crazy.
7. I'd better not talk to (my friend, my mother, my sister, my co-worker) about this because it will just make things worse.
8. I must be really weak to be staying here.
9. If I just keep a low profile and keep quiet, maybe it won't happen again.
10. If I just stop doing ________, he won't get angry any more.
11. It's not really his fault, it's only when he's drunk.

If a lot of these statements sound familiar to you, you are not alone! Consider reaching out to others: a good friend, a trusted community member, or someone else.