Safety plan

And Crisis Intervention

WHAT (SITUATIONS, THOUGHTS, FEELINGS, BODY SENSATIONS, OR BEHAVIORS) DO YOU
EXPERIENCE THAT INDICATE A SUICIDAL CRISIS MAY BE DEVELOPING OR LET YOU KNOW
YOU ARE UNWELL EMOTIONALLY?

1.

2.

3.

LIST THE COPING STRATEGIES THAT CAN BE USED TO DIVERT THOUGHTS, INCLUDING
SUICIDAL THOUGHTS.

1.

2.

3.

LIST THE PLACES AND PEOPLE THAT CAN BE USED AS A DISTRACTION FROM THOUGHTS
OF SUICIDE.

1.

2.

3.

LIST ALL THE PEOPLE THAT CAN BE CONTACTED IN A CRISIS, ALONG WITH THEIR CONTACT
INFORMATION

Contact Name: Phone Number:

Contact Name: Phone Number:

Contact Name: Phone Number:

 LIST M E N T A L H E A L T H P R O V I D E R S , A S W E L L A S 24/7 E M E R G E N C Y C O N T A C T N U M B E R S T H A T
CAN BE ACCESSED IN A CRISIS

Contact Name: Phone Number:

Contact Name: Phone Number:

Contact Name: Phone Number:

LIST THE STEPS TO BE TAKEN TO REMOVE ACCESS TO MEANS OF SUICIDE FROM THE
ENVIRONMENT.

1.

2.

3.s

WHEN DO YOU FEEL MOST AT EASE DURING THE DAY? WHO DO YOU LOVE? WHAT DO YOU
ENJOY DOING? WHAT DID YOU USED TO ENJOY DOING? WHAT IS IMPORTANT TO YOU, OR
USED TO BE IMPORTANT TO YOU? WHAT HAS KEPT YOU ALIVE UP UNTIL NOW?

1.

2.

3.

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