_____________’s Safety Plan
Date:
Time:
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Place:
Objective:
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The purpose of this safety plan is:
Situation:
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I will be at:
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My itinerary is:
(Important facts to know about this situation: will I be around any people or places that have been triggering to me in the past i.e. : old girl friends, old friends who’ve been of a bad influence on me, relatives who are stressful to be around etc.)
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Boundaries / Awareness:
(the following bullets should be added to and tweaked to optimize your safety and the safety of those around you!)
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Nano second rule: no second looks
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I will not use pornography in any media form
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How will I address H.A.L.T. (Hungry, Angry, Lonely or Tired. How will I specifically deal with each of the letters of HALT)
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If I violate any of my boundaries or act out I will call a recovery brother A.S.A.P.
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These are a few other areas that you will need to look at as you consider your Boundaries / Awareness:
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My wife’s needs while I’m there
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And what she doesn’t need from me!
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​Alcohol consumption
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Alone time
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I will not allow myself to be alone with any females
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How will I deal with flirting
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How will I respond if females flirt with me
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How will I deal with touching / hugging other women
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How will I respond if a female initiates hugging or touching me
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What other boundaries and awarenesses can you add to this list? Leave no stone unturned!!