Creating Your Own Safety Plan

While in the relationship:

I will have important phone numbers available to my children and myself. Note: Age appropriate. You may have speed dial on your phone and only one button needs to be pushed to get 911 or a friend/neighbor.
I can tell________ and ___________ about the violence and ask them to call the police if they hear suspicious noises coming from my home.
If I leave my home, I can go (list 4 places): _________,___________,____________,
_________. For example: police station, public place, fire station, hospital, friend, relative, 24 hour store.
I can leave extra money, car keys, clothes, and copies of documents with __________.
If I leave, I will bring____________(see checklist).
To ensure safety and independence, I can: Keep change for phone calls with me at all times; open my own savings account; rehearse my escape route with a support person; and review safety plan on ____________(date).

I can change the locks, install steel/metal doors, security system, smoke detectors and an outside lighting system.
I will inform __________ and _____________ that my partner no longer lives with me and ask them to call the police if s/he is observed near my home or my children. (i.e. neighbors, co-workers, daycare, school personnel, etc.)
I will tell people who take care of my children the names of those who have permission to pick them up. Those people are ___________,____________&_______________. Provide a picture if possible.
I can tell _____________at work about my situation and ask ______________ to screen my calls.
I can avoid stores, banks, clinics, pharmacies, the WIC office, and ______________that I frequent with my abusive partner.
I can obtain a protective order from________________. I can keep it on or near me at all times, as well as leave a copy with ___________,_______________.
If I feel down and ready to return to a potentially abusive situation, I can call ______________ for support or attend workshops and support groups to gain support and strengthen my relationships with other people.

Police____________________________________

Hotline___________________________________

Friends___________________________________

_________________________________________

Shelter____________________________________