Domestic Violence Safety Plan

1. Important Contact Information

Trusted Contacts (Name / Phone): Emergency Numbers:

2. Safe Areas in Home

List safe areas (e.g., exits, rooms without weapons):

3. Code Word(s)

Personal code word (to use with children/friends):

4. Plan for Leaving

• Items to take (ID, keys, money, medications, etc.):

Safe places to go:

5. Safety at Work or in Public

Steps to increase safety:

6. Children's Safety

Instructions for children (where to go, who to call):

7. Other Notes