[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-352093-105":53,"doc-detail-352093-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","safety-plan-worksheet-patient-use-during-suicidal-crisis","Safety Plan Worksheet - Patient Use During Suicidal Crisis","","Safety Plan Worksheet provides structured, step-by-step instructions to complete after a recent suicidal crisis interview and to keep available for use before or during a suicidal crisis. It guides patients to identify warning signs, list internal coping strategies, select supportive people and settings, and define contacts for help and professional resources. It also helps plan environmental safety by limiting access to lethal means and records personal reasons for living, with crisis contact resources and references to VA/DOD safety planning materials.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/safety-plan-worksheet-patient-use-during-suicidal-crisis/352093/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/safety-plan-worksheet-patient-use-during-suicidal-crisis/352093.png","ImageObject",442,249,{"name":88,"@type":89},"Valentina","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-07","2026-09-22",true,{"@type":98,"interactionType":99,"userInteractionCount":73},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What is the purpose of the Safety Plan Worksheet?","Question",{"text":108,"@type":109},"It is used to complete a semi-structured interview of a recent suicidal crisis and to create a Safety Plan the patient can keep and also duplicate in the medical record.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What should be filled out in Step 1, Warning signs?",{"text":113,"@type":109},"Identify signs that indicate you might be headed toward a crisis and that the Safety Plan should be used.",{"name":115,"@type":106,"acceptedAnswer":116},"How does the worksheet address making the environment safe?",{"text":117,"@type":109},"It asks for plans to remove or limit access to lethal means, such as firearms, medications, household poisons, and sharp or other dangerous objects.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},352093,1791388612,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":73,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":9},13056703020460,"https://ap-avatar.wpscdn.com/avatar/be000253dac470eee5d?_k=1778207105932848923","Safety Plan Worksheet   \nPurpose: Complete semi-structured interview of recent suicidal crisis before proceeding to Step 1. Print copy of completed Safety Plan for patient to keep with them and place a duplicate copy in medical record. Alternatively, you can download the VA/DOD Safety Plan App.  \n\n| Step 1. Warning signs (that I might be headed toward a crisis and the Safety Plan should be used): |\n| --- |\n| 1.\u003Cbr>2.\u003Cbr>3.\u003Cbr>4. |\n| Step 2. Internal coping strategies (things I can do to distract from my problems without contacting another person): |\n| 1.\u003Cbr>2.\u003Cbr>3. |\n| Step 3. People, places and social settings that provide healthy distraction (and help me feel better): |\n| 1. Name and phone number\u003Cbr>2. Name and phone number\u003Cbr>3. Place\u003Cbr>4. Place |\n| Step 4. People I can contact to ask for help (family members, friends and co-workers): |\n| 1. Name and phone number\u003Cbr>2. Name and phone number\u003Cbr>3. Name and phone number\u003Cbr>4. Name and phone number |\n| Step 5. Professionals or agencies that can help me during a crisis: |\n| • Clinician/Agency (Name, phone, emergency contact number)\u003Cbr>• Clinician/Agency (Name, phone, emergency contact number)\u003Cbr>• Local Emergency Department (Name, phone number, location/address)\u003Cbr>• Other (Name, phone, emergency contact number) |\n| Step 6. Making my environment safe (plans for removing or limiting access to lethal means, e.g. firearm, medications, household poisons, sharp or other dangerous objects): |\n| 1.\u003Cbr>2.\u003Cbr>3.\u003Cbr>4. |\n| Step 7: My reasons for living (things that are most important to me and worth living for): |\n| 1. 4.\u003Cbr>2. 5.\u003Cbr>3. 6. |\n\nContinued >  \nSafety Plan Worksheet (continued)  \nResources  \n988 Suicide and Crisis Lifeline  \nDial 988 and press 1 for the Military/Veterans Crisis Line. [Visit ](Visit militarycrisisline.net)[militarycrisisline.net](Visit militarycrisisline.net) for OCONUS calling options.  \nReal Warriors Campaign  \n[health.mil/RealWarriors](health.mil/RealWarriors)  \nSafety Plan Components:1  \nThe safety plan involves the development of step-by-step instructions to use for patients before or during a suicidal crisis, including:2  \n• Conducting a semi-structured interview of a recent suicidal crisis  \n• Recognizing warning signs of an impending suicidal crisis  \n• Recognizing how an increase and decrease in suicidal risk provides an opportunity to engage in coping strategies  \n• Employing internal coping strategies without contacting another person for distraction from suicidal thoughts  \n• Using social contacts and social settings as a means of distraction from suicidal thoughts  \n• Contacting mental/behavioral health professionals or agencies, including crisis intervention services (e.g. , the Military/Veterans Crisis Line: dial 988 and press 1)  \n• Limiting access to lethal means: Consider prescribing naloxone for patients at risk for opioid overdose (see VA/DOD Use of Opioids in the Management of Chronic Pain CPG)3  \nReferences:  \n1. Stanley, B. , Brown, G. K. , MacRae, F. , Rotolo, C. A. , Hughes, G. , Mina, L. , & Barry, C. N. (2022) . VA Safety Planning Intervention Manual. United States Department of Veterans Affairs.  \n2. Veterans Affairs and Department of Defense. (2024) . VA/DOD Clinical Practice Guideline for Assessment and Management of Patients at Risk for Suicide. Version 3.0. [https://www.healthquality.va.gov/guidelines/MH/srb/](https://www.healthquality.va.gov/guidelines/MH/srb/)  \n3. Veterans Affairs and Department of Defense (2022) . VA/DOD Clinical Practice Guideline for the Use of Opioids in the Management of Chronic Pain. Version 4.0. [https://www.healthquality.va.gov/guidelines/Pain/cot/VADoDOpioidsCPG.pdf](https://www.healthquality.va.gov/guidelines/Pain/cot/VADoDOpioidsCPG.pdf)  \nDepartment of Veterans Affairs and Department of Defense employees who use this information are responsible for considering all applicable regulations and policies throughout the course of care and patient education. Reproduced with permission (© 2015 Stanley &","cbCaikmk6ct3He2t","https://ap.wps.com/l/cbCaikmk6ct3He2t","pdf",2442122,"English","# Safety Plan Worksheet\n## Step 1: Warning signs\n## Step 2: Internal coping strategies\n## Step 3: Healthy distraction settings\n## Step 4: People to contact for help\n## Step 5: Professionals or agencies\n## Step 6: Making my environment safe\n## Step 7: Reasons for living\n## Resources","[{\"question\":\"What is the purpose of the Safety Plan Worksheet?\",\"answer\":\"It is used to complete a semi-structured interview of a recent suicidal crisis and to create a Safety Plan the patient can keep and also duplicate in the medical record.\"},{\"question\":\"What should be filled out in Step 1, Warning signs?\",\"answer\":\"Identify signs that indicate you might be headed toward a crisis and that the Safety Plan should be used.\"},{\"question\":\"How does the worksheet address making the environment safe?\",\"answer\":\"It asks for plans to remove or limit access to lethal means, such as firearms, medications, household poisons, and sharp or other dangerous objects.\"}]","Safety Plan Worksheet - Patient Use During Suicidal Crisis | PDF",1790097657]