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_____________’s Safety Plan 









The purpose of this safety plan is:



I will be at:

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.)


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

  • I will not use pornography in any media form

  • 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)

  • If I violate any of my boundaries or act out I will call a recovery brother A.S.A.P.

These are a few other areas that you will need to look at as you consider your Boundaries / Awareness:

  • My wife’s needs while I’m there


  • And what she doesn’t need from me!


  • Alcohol consumption 


  • Alone time

  • 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

    What other boundaries and awarenesses can you add to this list?  Leave no stone unturned!!

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