OUR FAMILY SAFETY PLAN

This is a draft family safety plan which may be adapted by domestic violence programs. It includes some basic elements of joint safety planning for battered women and their children. This version may be too long for some children, but it also omits other important elements that some domestic violence programs may want to include.
Some examples are planning for safety at school, child care or visitation exchanges, and safety procedures in case of fire or in the presence of weapons. Domestic violence programs may use this draft to create their own family safety planning form, which may be further adapted to meet the needs of individual families.

Our names:
Mother:	 Children:   	

Safe people kids in our family can talk to or call when there is trouble:

1.  	
2.  	
3.  	
4.  	
5.  	

Phone	 Phone	 Phone	 Phone	 Phone 	

Our family uses a signal when there is trouble. Our family signal is
 	.

When we see or hear the signal, the children will

 	_

Where can kids go when we don’t feel safe at home?
A safe place has more than one exit.
A safe place does not have things that can be used as weapons.

Safe places in our home:

Safe places near our home:

How will the kids get out of the house if there is danger?
 	_

Who will be responsible for helping the younger brothers or sisters if there is danger?   	

What will this person do?

Things the children should NOT do when there is trouble:
1.  	
2.  	

Kids in our family understand that we should NOT try to stop a fight between adults.
Kids in our family understand that when adults in our house fight, IT IS NOT OUR FAULT.

When someone is afraid or hurt, the kids in our family can call 911.
When we call 911, we will:
Describe what is happening.
Tell our address. Our address is

Tell our phone number. Our phone number is

Stay on the phone to answer questions. I know how to call 911.

Here are some other things our family does to stay safe:
1.  	

2.  	

3.  	

4.

In order to stay safe, our family needs to be careful who we tell about our safety plan. People who can know about our safety plan are:
1.	 	
2.	 	
3.	 	
If we have to leave home quickly, here are the things we’d like to take with us:

Child’s name:

1.	 	
2.	 	
3.		 Child’s name:

1.  	
2.  	
3.	 Child’s name:

1.  	
2.  	
3.  	

Wisconsin Coalition Against Domestic Violence www,wcadv.org