My Personal Safety Plan (Template) printable pdf download

My Personal Safety Plan

(Template)

Coping Strategies

It is best to complete your Personal Safety Plan with a supportive person, especially when you are not

in crisis. You can also provide a copy of it to a caregiver or emergency contact/resource.

Name:

Phone Number:

______________________________________

________________________

Responsibilities:

(school, work, pets, children, etc.) __________________________________________

What Happens when I am not doing well? or Indicates that a crisis may be developing? (warning signs,

symptoms, triggers, thoughts, mood, behaviour, images)

(e.g. How do I act? What do I feel?)

_____________________________________________________________________________________

What can I do to help myself when I am not doing well? What can I do to help myself cope? (activities,

coping strategies, things to do to take my mind off my problems?

(e.g. have a warm bath, listen to

music, physical activity, relaxation techniques, breathing slowly, etc.)

_____________________________________________________________________________________

Who can I call or seek help from? (supports, resources, safe places)

(e.g. family, friends, crisis line,

professionals or Agencies, etc.)

1.__________________________________________

Phone# ________________________________

2. __________________________________________ Phone# ________________________________

3. __________________________________________ Phone# ________________________________

4. __________________________________________ Phone# ________________________________

5. 24-hour telephone support - Free and Confidential - DMHS C.A.L.L. 1-800-742-1890 or 905-666-0483

6. Distress Centre Helpline 1-800-452-0688 or 905-430-2522

Important things in my life, most important to me, worth living for, give my life meaning:

_____________________________________________________________________________________

My Personal Safety Plan (Template)