Student Name Hanna miller

Teacher Name Coach Epps

Personal Safety Survey: How Safe Are

You?

Directions
Complete the following survey and submit a reflection with yourself assessment on how safe you
believe you are. Is your personal safety a high priority? What areas could you improve upon? What
areas of safety do you take for granted? Violence does not have to be part of your everyday life. To
see how well you are protecting yourself from unsafe situations, consider the following statements
and decide whether each one is always, sometimes, or never true for you.

Instructions
● Print your own copy of this or save your own copy to your Google Drive
● Share this document with your teacher

General Safety Considerations Always Sometimes Never

I am aware of my surroundings. y

I tell someone where I’m going whenever I

y
leave home

I am careful about giving personal information

y
or my daily schedule to people I don’t know.

I vary my daily routine and walking patterns. y

If I walk at night, I walk with others. y

Auto Safety Always Sometimes Never

I look in the backseat before I get in my car. y

I look around before parking, stopping, or

y
getting into or out of my car.
I keep my car doors locked at all times. y

I have a plan of action in case my car breaks

y
down.

I scan ahead of me and behind me, with my

y
mirrors, for potential dangers.

If I sense an aggressive driver I do not retaliate

y
or engage.

I avoid dangerous, high-risk places whenever

y
possible.

If hit from behind, I drive to the nearest police

station or well-lit, populated area, motioning y
for the person who hit me to follow.

If I notice anyone loitering near my car, I go

y
straight to a safe place and call the police.

I never hitchhike. y

I leave the car running while I go to the ATM or

y
run in a quick store.

I do not text while driving. y

I do not use a hand held phone while driving. y

I do not drink and drive. y

ATM Safety Always Sometimes Never

I avoid using ATMs at night. y

I try to take someone with me when I use an

y
ATM

I look for suspicious people or activity before

y
entering or driving into an ATM area.

I do not write my personal identification

y
number on any paper I carry with me.
I take all my ATM and credit card receipts with
me to avoid leaving behind personal y
information

I take all my ATM and credit card receipts with

me to avoid leaving behind personal y
information.

I check the ATM machine for any unusual

y
attachments to the card intake

Internet Safety Always Sometimes Never

I have a secure password y

I do not share my password y

I turn off my computer when not in use y

I do not put my credit card information on an

y
unsecured site

I do not friend people I do not know y

I do not click on AD websites y

I only use secure wireless connections y

I have current antivirus software on my

y
computer

Violence, Rape & Homicide Always Sometimes Never

I carefully limit my alcohol intake at parties y

I do not drink alcohol on a first date y

I refuse to be with anyone who seems violent

y
or controlling.

I do not allow anyone to strike me or touch me

y
inappropriately.
I don’t stay around anyone who has a gun and
y
is drinking alcohol or using other drugs.

I break off any relationship that is verbally or

y
physically abusive.

Ramps, Parking Lots & Public

Always Sometimes Never
Transportation

I park in well-lit areas y

I avoid walking down ramps in parking lots if

y
there are other options

I check the backseat of my car before getting

y
in

I keep my car locked until I arrive at my car y

While waiting for transportation, I am aware of

Y
my immediate surroundings.

While waiting for transportation, I place myself

y
so that I am protected from behind.

I hold items under my arm so that they will be

y
difficult to grab.

While riding on buses or trains, I look aware

y
and alert.

Scoring: Give yourself 3 points for each Always, 2 points for each Sometimes and 1 point for each
Never

If Your Score Your Risk is 90–99 You are probably safe as long as you continue to follow these
precautions.

If Your Score Risk is 80–89 You may need to reexamine some of your habits and make changes to
improve your safety.

If your Score Risk is 79 or less You may need to make significant changes in your habits to improve
your safety.

Your Score:
Write Your Reflection Here:

I am very safe.