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Safety Plan Page 1 

 

Planning ahead and creating a safety plan can increase your safety while in your relationship and if/ when the relationship is over.  Print this document, fill it out, and store it in a safe place.

To increase your safety in the relationship, consider the following:

1.)  I’ll have important phone numbers available to my children and  

      myself:

      Police:____________________________________________

      Hotline:___________________________________________

      Shelter:___________________________________________

      Friends:___________________________________________

 2.)  I will tell _____________ and _________________ about the

       violence and ask them to call the police if they see or hear

       suspicious noises coming from my house.

 3.)  If I leave my home, I will go....(try to list at least 4 places)

       __________________________________________________

       ______________________________________________

       __________________________________________________

       __________________________________________________

 4.)  I will leave extra money, car keys, clothes and copies of

       documents with:_____________________________________

 5.)  To insure safety and independence, I will try to keep change

        for phone calls with me at all times; open my own savings

        account; rehearse my escape plan with my children and

        support person and review my safety plan on the following

        date:_____________________________________________

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