Domestic Violence Safety Plan Worksheet

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What is the theory behind the Domestic Violence Safety Plan worksheet?

Domestic violence or abuse causes serious emotional, physical, or mental damage to the individual either in a short-term or a long-term relationship/marriage. A domestic violence safety plan consists of a plan of action that can help you and your children (if any) be safe from your abuser. If you are in an abusive relationship you must have a domestic violence safety plan to keep yourself protected in the time of emergency or crisis.

How will this worksheet help you?

This domestic violence safety plan worksheet can help you create a safety plan despite your decision to stay or leave your partner. It provides you with three different sections “in times of crisis”, “when staying” and “when leaving”. These sections have different sets of safety tips that can help you in such situations. By creating this plan with the help of your counselor, therapist, or advocate, you can take the very first step toward your safety.

How to use the worksheet?

We encourage men and women who are in abusive relationships and experience domestic violence to use this worksheet and create their safety plan. The three sections are to be completed with the help of your therapist, advocate, or any trusted and reliable person. After completing it you can review it if it’s a perfect safety plan for you and practice it with your children (if any) when appropriate. 

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