Safety Plan Agreement
Person's Name
Date
Personal Warning Signs
Describe thoughts, images, moods, situations, or behaviors that indicate a crisis may be developing:
Internal Coping Strategies
What can you do on your own to help yourself not act on urges?
Social Contacts & Safe Environments
List people and safe places you can go to for support:
Professional Resources
List professionals or agencies you can contact in a crisis:
Making the Environment Safe
Steps you will take to keep your environment safe:
Person's Signature
Date
Supporter's Signature
Date