Safety Plan

I, ______________________, plan to keep myself SAFE until _________________.

I also plan to do the following until the time specified above:

0 1 2 3 4 5 6 7 8 9 10
average suicidal suicidal
day thoughts intent

If I feel like 7 I will 1)_______________________________

2)_______________________________

3)_______________________________

4)_______________________________

If I feel like 8 I will 1)_______________________________

2)_______________________________

3)_______________________________

If I feel like 9 or 10 I will 1)_______________________________

Then: 1)_________________________

2)_________________________

___________________________________ ________________________________
Person developing this plan for safety DATE Witness DATE