I will have important phone numbers available to my children and myself.
I can tell _______________ and _______________about the violence and ask them to call the police if they hear suspicious noises coming from my home.
If I leave my home, I can go (list four places): ___________________, _________________, ___________________, or _________________.
I can leave extra money, car keys, clothes, and copies of documents with _______________________.
When I leave, I will bring __________________________(see checklist below).
To ensure safety and independence, I can: Keep change for phone calls with me at all times; open my own savings account; rehearse my escape route with a support person; and review safety plan on _________________(date).
Increasing safety - When the relationship is over:
I can: change the locks; install steel/metal doors, a security system, smoke detectors and an outside lighting system.
I will inform _____________and ________________ that my partner no longer lives with me and ask them to call the police if s/he is observed near my home or my children.
I will tell people who take care of my children the names of those who have permission to pick them up. The people who have permission are: __________________, _________________and ______________.
I can tell _____________at work about my situation and ask _____________to screen my calls.
I can avoid stores, banks, and _______________that I used when living with my battering partner.
I can obtain a protective order from _________________. I can keep it on or near me at all times as well as leave a copy with _______________.
If I feel down and ready to return to a potentially abusive situation, I can call ___________________ for support or attend workshops and support groups to gain support and strengthen my relationships with other people.
Items to Take Checklist
*Birth certificates for me and my children
*Social Security cards
*School and medical records
*Money, bankbooks, credit cards
*Keys - house/car/office
*Driver's license and registration
*Change of clothes
*Passport(s), Green Card(s), work permits
*Lease/rental agreement, house deed
*Mortgage payment book, current unpaid bills
*Pictures, jewelry, items of sentimental value
*Children's favorite toys and/or blankets
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