Safety Worksheet 


A collaborative safety worksheet for therapists and clients to work through together in session.

With tables and a clear flow from immediate action through to asking for help, this form offers examples and space for clients to develop their own plan in case of moments of despair.

One aspect of our work can be supporting people in deep pain. As professionals providing care to clients at risk of self harm and suicide, this worksheet can provide a part of the framework we create with our clients to support their safety.

It offers a process of collaboration between client and therapist, moving through the following sections.

  • Moving to a safe location
  • Removing immediate risk
  • Regulating the physical experience
  • Reasons for living
  • Asking for Help
  • Specifying Next Action
  • Emergency Procedure


This document is

  • clear and collaborative
  • including examples
  • 11 sections over five pages
  • Updated August 2021

This document is not

  • is not a safety contract
  • is not a training course or guide
  • It does not require a client's signature or commitment

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