Safety Plan

This safety plan should be used when the client needs to address a safety issue when the provider isn't present.

Client:

Date:

Challenging Behaviors	Strategies for Calming	Crisis Response	Safety Plan
Describe the behaviors that may indicate a crisis is occurring.	List strategies that can be used to help the client calm down.	Describe the steps to take if a crisis occurs.	Outline the safety plan to follow during a crisis.

Client Name

Client Signature Clear Signature

Date Signed

Client Name

Client Signature Clear Signature

Date Signed

Staff Name

Staff Signature Clear Signature

Date Signed