NEW SAFETY PLAN

First Name

Last Name

Todays Date

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: