Safety Plan for Self-Harm Worksheet

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Video & audio overview of the worksheet

What is the theory behind the worksheet?

In conjunction with a Commitment to Living Agreement, a Safety Plan can benefit a client who has engaged in self-harm behaviors and suicidal ideation. These plans provide a prepared action plan that a client or their support network can access and follow without needing further thought or problem-solving.

By having a plan co-constructed and at hand, a client can feel supported and decrease the level of anxiety regarding intrusive thoughts or self-harm behavior.

How will the worksheet help?

This template offers a structure for a Safety Plan. This plan offers a step-by-step guide and an individualized action plan for the client to complete.

The completed worksheet can then be made into a resource that the client can keep and pass on to members of their support network.

How to use the worksheet?

Working with your client to construct this safety plan can provide them with a clear outline of what to do if they feel unsettled and think about self-harming.

Remember you can adjust this template to suit your client’s needs.


Center for Suicide Prevention. (n.d). Safety Plans To Prevent Suicide. 

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