Suicide Risk Assessment Documentation
Date of Assessment
Assessor Name/Title
Patient Name / ID
Presenting Situation
Summary of Presenting Situation
Suicidal Ideation
Yes
No
If yes, describe (frequency, intensity, duration):
Suicidal Plan
Yes
No
If yes, describe (plan, means, timing, access):
Suicidal Intent
Yes
No
If yes, describe:
History of Suicide Attempts
Identified Risk Factors
Identified Protective Factors
Level of Suicide Risk
Low
Moderate
High
Safety Plan/Intervention