Crisis/Safety Plan in Word and Pdf formats

Crisis/Safety Plan

Family Name:_______________________________ Date: _______________

WrapAround Service Coordinator:_______________________________________

Describe the crisis behavior or situation in detail, what does it look like?

Who is involved in the crisis?

Are there other activities going on in the environment that make the situation better

or worse?

List the triggers that lead to the crisis:

How often does the crisis occur? (choose best option)

Daily __________ How many times? _____________

Weekly __________ How many times? _____________

Monthly __________ How many times? _____________

Other __________ How many times? _____________

Crisis/Safety Plan