“Empowering the abused woman to recover with God's truth"
The Lula McGrady Foundation, Inc.
P.O. Box 490562
Leesburg, FL 34749-0562
352.406.2209 - Office
email@example.com – Email
www.lulamcgrady.org - Web site
Personal Safety Plan
Please answer the questions below to develop your own safety plan. Let us know if you would like a copy of your plan.
Client Name:_________________________________________________ Date:_______________________________
1. If I decide to leave, I will________________________________________________.
2. I can keep a bag ready and put it______________________ so I can leave quickly.
3. I can tell________________________________about the violence for them call the police when
4. I will leave money and an extra set of keys with___________________________________________.
5. I will keep important documents and keys at___________________________________________________.
6. The domestic violence hotline is _____________________.
7. The shelter's hotline is _________________________.
8. I will rehearse the escape plan and practice it with my children.
9. I can change the locks on my doors and windows as soon as possible.
10. I will teach my children how to use the phone to make collect calls to me and to
___________________________ (friend, family, minister) if my partner tried to take them.
11. I will tell the people who care for my children, who have permission to pick them
up. My partner is NOT allowed to pick them up. Inform the following people:
12. I can tell my the following people that my partner no longer lives with me and that
they should call the police if he is near my residence:
13. I can call the local domestic violence agency if I am not sure how to register my
protection order with the police departments.
14. If my protection order gets destroyed, I know I can go to the County Courthouse and
get another copy.
15. I can tell my boss, security, and ____________________________ at work about this situation.
16. I can ask___________________________________ to help screen my phone calls.
17. When leaving work I can do the following:
18. When I am driving home from work and problems arise, I
19. If I use public transportation, I can________________________________________
20. If I feel depressed and ready to return to a potentially violent situation/ partner, I can call__________________________________________________________________________
Client Signature:______________________________________________ Date:____________________________