Crisis/safety Plan

Crisis/Safety Plan

Family Name:_______________________________

Date: _______________

WrapAround Service Coordinator:_______________________________________

Describe the crisis behavior or situation in detail, what does it look like?

Who is involved in the crisis?

Are there other activities going on in the environment that make the situation better

or worse?

List the triggers that lead to the crisis:

How often does the crisis occur? (choose best option)

Daily

__________

How many times? _____________

Weekly

__________

How many times? _____________

Monthly __________

How many times? _____________

Other

__________

How many times? _____________

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Parent category: Business