University of Virginia
Safety Plan Worksheet for Victims/Survivors of Abuse

If you are in an abusive relationship:

The following steps are my plan for increasing my safety and preparing to protect myself in case of further abuse. Although I can't control my abuser's violence, I do have a choice about how I respond and how I get to safety. I will decide for myself if and when I will tell others that I have been abused, or that I am still at risk. Friends, family and co-workers can help protect me, if they know what is happening, and what they can do to help.

To increase my safety, I can do some or all of the following:

1. When I must talk to my abuser in person, I can ______________________________________.

2. When I talk to my abuser on the phone, I can __________________________________________.

3. I will make up a "code word" for my family, co-workers, or friends, so they know when to call for help for me. My code word is _________________.

4. When I feel a fight coming on, I will try to move to a place that is lowest risk for getting hurt such as _____________________(at home) or (at work) __________________________ or__________________________ . (in public)

5. I can tell my family, co-workers, boss, or a friend about my situation. I feel safe telling: _________________________.

6. I can use an answering machine or ask my co-workers, friends or other family members to screen my calls and visitors. I have the right to not receive harassing phone calls. I can ask: ______________________________(home) or ___________________________(work) to help screen my phone calls.

7. I can keep change for phone calls with me at all times. I can call any of the following people for assistance or support if necessary and can ask them to call the police if they see my abuser bothering me.

8. When leaving work I can: _____________________________________________.

9. When walking, riding or driving home, if problems occur, I can: _____________________ _______________________________________________________________.

10. I can attend a support group for women who have been abused. Support groups are held:
_______________________________________________ at the Shelter for Help in Emergency .

11. Telephone Numbers I Need to Know:

Police Department: ____________________________

Probation Officer: ____________________________

Shelter for Help in Emergency: Hotline: 293-8598 and Business Office: 293-6155

UVA Women's Center's Sexual Sexual and Domestic Violence Services: 982-2774

Counselor: __________________________________________________

Clergy Person: ______________________________________________

Attorney: ___________________________________________________

Other: ______________________________________________________