_____________’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!)

 

• 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

 

• How will I deal with flirting 

 

• How will I respond if females flirt with me

 

• How will I deal with touching / hugging other women

 

• 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!!