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).

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:

  • Identification
  • Birth Certificates for myself and children
  • Social Security Cards
  • School & Medical Records
  • Money, bankbooks, credit cards
  • Keys – house/car/office
  • Driver’s License/registration
  • Medications
  • 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