Sample Safety Plan
Step 1: Warning signs (thoughts, images, mood, situation, behavior) that a crisis may be developing:
1.	 	
2.	 	
3.	 	

Step 2: Internal coping strategies – Things I can do to take my mind off my problems without contacting another person (relaxation technique, physical activity):
1.	 	
2.	 	
3.	 	

Step 3:	People and social settings that provide distraction:

Name 	

Phone 	
Name 	

Phone 	

Place 	

Place 	

Step 4:	People whom I can ask for help:

Name 	

Phone 	

Name 	

Phone 	

Name 	

Phone 	

Step 5:	Professionals or agencies I can contact during a crisis:
Clinician Name 	

Phone 	

Clinician Pager or Emergency Contact # 

Clinician Name 	

Phone	 Clinician Pager or Emergency Contact # 

Local Urgent Care Services  	

Urgent Care Services Address  	

Urgent Care Services Phone  	

Local Urgent Care Services  	

Urgent Care Services Address  	

Urgent Care Services Phone  	

Suicide Prevention Lifeline Phone: 1-800-273-TALK (8255)

Step 6:	Making the environment safe:
1.	 	
2.	 	

Safety Plan Template ©2008 Barbara Stanley and Gregory K. Brown, is reprinted with the express permission of the authors. No portion of the Safety Plan Template may be reproduced without their express, written permission. You can contact the authors at bhs2@columbia.edu or gregbrow@mail.med.upenn.edu.

The one thing that is most important to me and worth living for is: