Safety Plan - Friends for Lives

Support Tutor Name

Form Completion Date:

Life Student Name

Phone

Email

Address

6 Step Coping Plan...

(1) Aloneness

What needs to be done now for safety and who can help with this?

(2) Pain / Desparation

What needs to be done now for safety and who can help with this?

(3) Prior Suicide Behaviour

What needs to be done now for safety and who can help with this?

(4) Alcohol / Drugs

What needs to be done now for safety and who can help with this?

(5) Mental Health

What needs to be done now for safety and who can help with this?

(6) Suicide Plan

What needs to be done now for safety and who can help with this?

Now read through the items in the lists below and select three activities from each list that you rarely do, but would agree to do more often. Then complete an Agreement Schedule for each section.

SECTION ONE -Spiritual Self Care

Select the 3 things you will agree to do more often...

Spiritual Self Care Agreement Schedule.

Write down an agreement with yourself that otlines how you will commit to making positive changes in order to do the 3 thibgs selected more regularly.

SECTION TWO - Psychological Self Care

Select the 3 things you will agree to do more often...

Psychological Self Care Agreement Schedule.

Write down an agreement with yourself that otlines how you will commit to making positive changes in order to do the 3 thibgs selected more regularly.

SECTION THREE - Emotional Self Care

Select the 3 things you will agree to do more often...

Emotional Self Care Agreement Schedule.

Write down an agreement with yourself that otlines how you will commit to making positive changes in order to do the 3 thibgs selected more regularly.

SECTION FOUR - Physical Self Care

Select the 3 things you will agree to do more often...

Physical Self Care Agreement Schedule.

Write down an agreement with yourself that otlines how you will commit to making positive changes in order to do the 3 thibgs selected more regularly.

SECTION FIVE - Work and Social Self Care

Select the 3 things you will agree to do more often...

Write down your Work and Social Care Agreement Schedule.

Write down an agreement with yourself that outlines how you will commit to making positive changes in order to do the 3 thibgs selected more regularly.

Support Tutor - Agreed Plan of Action

Write down what has been organised to support the Life Student and what plans and time frames have been agreed.

Life Student - Comments in Support of the Safety Plan

Write down comments about the plan created and say how you will stick to and how you believe it will help you to feel better..

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FFL Safety Plan