Mamas for Mamas | Client Safety Plan

Client Name *

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Last

Email *

Date

What are your top triggers or stressors?

List warning signs, thoughts, images, mood, situation, body sensations, or behaviours that indicate a crisis may be developing:

List personal coping or distraction strategies, such as activities that you can do to elevate a positive mood. Examples: physical activity, self care, relaxation/meditation, etc.

Friends or family you can call for support and help:

Name *

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Phone *

Name *

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Name *

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Professionals to contact during a crisis:

Clinician Name *

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Last

Phone *

Physician Name *

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Last

Phone *

Local Crisis Line Ph.# *

Suicide Prevention Lifeline Call 1-800-273-TALK (8255)
Crisis Services Canada Call 1.833.456.4566 | Text 45645

Steps to make your environment safe:

Reasons for living (family, spouse, children, friends, parents, pet, goals, travel, career)

Sometimes, when people are feeling sad, they have a hard time seeing the reasons for living. If this is the case for you right now, what are some reasons that others might point out for you?

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