Template — Safety plan (collaborative, trauma-informed) (Associate Handbook)
Audience: Associates / clients
Use: Please complete collaboratively when safety planning is clinically indicated.
This plan is a living document and can be updated at any time.
SAFETY PLAN (Collaborative, Trauma-Informed)
Client Name: ___________
Date: _____________
Therapist: _____________
1) Warning Signs
(Thoughts, feelings, behaviors, or situations that signal increasing distress)
2) Internal Coping Strategies
(Things I can do on my own to reduce distress)
3) External Distractions / Grounding
(People, places, or activities that help shift attention)
4) People I Can Contact for Support
(Trusted individuals)
| Name | Relationship | Phone |
|---|---|---|
5) Professional & Crisis Supports
Therapist: ______ Phone/Email: ______
- Canada Suicide Crisis Helpline: call/text 988
- Local Emergency Department / 911
6) Making My Environment Safer
(Steps to reduce access to means or increase safety)
7) Reasons for Living / What Anchors Me (optional but helpful)
(People, values, responsibilities, hopes)
Review & Updates
Next Review Date: ___________
Notes: _____________
Signatures
Client Signature: _____________
Therapist Signature: __________
Storage instruction (clinic)
- Please store the completed safety plan in the client’s JaneApp record (documents/forms area) so it is accessible if escalation is needed.