Recovery For Abused Women

“Empowering the abused woman to recover with God's truth"

Personal Safety Plan for Victims of Domestic Violence and Abuse

The Lula McGrady Foundation, Inc.                                                                                  

P.O. Box 490562                        

Leesburg, FL 34749-0562     

352.406.2209 - Office

dehooks@lulamcgrady.org – 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

    violence erupts.

 

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:

 

      School_________________________________________________________ 

      DayCare_______________________________________________________

      Babysitter_____________________________________________________

      Teacher_______________________________________________________

                                                                                                                                 

 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:

 

 

      Neighbors__________________________________________________

      Friends_____________________________________________________

 

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

 

can_____________________________________________________________________

        ___________________________________________________________________

         ___________________________________________________________________

 

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:____________________________

 

Jesus loves YOU! You are not alone!

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