Appendix 8.2 – Safety Planning Template

Survivor Safety Plan

Immediate Safety Concerns

• Current threats identified:
• Immediate risks requiring intervention:
• Emergency contacts/supports:
• Safety concerns related to school/work/home:

Digital Safety Strategies

• [ ] Password changes completed
• [ ] Phone number changes completed
• [ ] Two-factor authentication enabled
• [ ] Privacy settings reviewed
• [ ] Accounts secured
• [ ] Blocking/reporting completed
• [ ] Evidence preserved
• [ ] Shared devices reviewed
• [ ] New contact protocols established
• [ ] Other:

Contact Disruption Plan

• Strategy for reducing or ending offender contact:
• Safety considerations before intervention:
• Caregiver role/support:
• Follow-up monitoring required:

Emotional Stabilization Supports

• Coping strategies identified:
• Safe supports identified:
• Counselling/therapy referrals
• Crisis resources provided:

School/Community Safety

• School notified:
  • [ ] Yes
  • [ ] No
• Workplace/community safety concerns:
• Transportation/home safety concerns:
• Safety accommodations requested:

Long-Term Safety Planning

• Monitoring plan:
• Ongoing support needs:
• Advocacy/legal needs:
• Follow-up schedule:
• Review date: