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. Author manuscript; available in PMC: 2016 Nov 1.
Published in final edited form as: Crisis. 2015 Nov;36(6):433–439. doi: 10.1027/0227-5910/a000345

Table 1.

Safety Plan template with examples

Step Boilerplate (low quality) Some evidence of personalization (moderate quality) Strong evidence of personalization (high quality)
1. Warning signs (list three items) Sad Feel sad, cry Feeling like I can’t stop crying or can’t stop being sad
2. Internal coping strategies (list three items) Read Read a book Read “The Great Gatsby”
3. People and places that provide distraction (list two people & two places)

  1. People: friend

  2. Places: public place

  1. Bob

  2. mall

  1. Bob (555)555-5555

  2. Northwest Mall
4. People I can ask for help (list three people) Friend Bob Bob (555)555-5555
5. Professionals and agencies (list two providers, one urgent care service, one Suicide Prevention Coordinator, VA Suicide Prevention Hotline) VA Suicide Prevention Hotline Dr. Bob
Town Hospital
VA Suicide Prevention Hotline 		Dr. Bob (555)555-5555
Dr. Mary (333)333-3333
Town Hospital, 100 Hospital Way
VA Suicide Prevention Hotline
6. Making my environment safe (list two items) Alcohol No alcohol in house Dump out alcohol from liquor cabinets, garage