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).
When the relationship is over:
- 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.
Important Phone Numbers:
Checklist Items to Take:
- Birth Certificates for myself and children
- Social Security Cards
- School & Medical Records
- Money, bankbooks, credit cards
- Keys – house/car/office
- Driver’s License/registration
- Change of clothes
- Welfare Identification
- Passport, Green Card, Work permits
- Divorce Papers
- Lease/rental agreement
- House Deed/mortgage payment book
- Bills, Insurance Papers
- Address Book
- Pictures, jewelry, sentimental things
- Children’s favorite toys, books