Making a Safety Plan

The following information is for Victims of Domestic Violence.
It is adapted from the State of Alaska, Dept. of Law - Criminal Division, Victim-Witness Assistance Program

To follow is a Safety Plan Checklist
You may also download this as a PDF at the bottom of the page.

However, Please Note the Caution: For your Safety, Do not leave this lying around


Organizations I can call for help:

Emergency       ___________911_________________

Police              _______________________________

Crisis Line         _________907-283-7257____________

Shelter            _________907-283-9479____________


People I can call for support:

Family                 ______________________________

Friend                 ______________________________

Counselor           _______________________________

Other                 _______________________________

Places I can go if I must leave home: (do not write down addresses)

1.           ____________________________

2.           ____________________________

3.           ____________________________

4.           ____________________________

Things I will take if I have to leave:

  • Money
  • Keys
  • Driver’s license
  • Car registration
  • Checkbooks
  • Credit cards
  • Medications
  • Address book
  • Green card(s)
  • Other _____________________________
  • Other _____________________________

Additional things I will take if I have time:

  • My birth certificate
  • My children’s birth certificates
  • Automobile pink slip
  • Lease, rental agreement or house deed
  • Bankbooks
  • Insurance papers
  • Pictures  and personal items of importance
  • Family medical records
  • Social security cards
  • Welfare identification
  • School records
  • Work permits
  • Passport
  • Divorce papers
  • Jewelry
  • Other
  • Other

Preparations I can make as part of my Action Plan:

  1. Pack a bag with clothing, toiletries and medications for myself and my children and keep it in a safe place.
  2. Have extra money, keys, identification and copies of important papers in a safe place in case I need them.
  3. Keep extra clothing, toiletries, money and copies of important documents with someone I trust. (I will memorize this name.)

  4.  Know the location of a family violence shelter or other safe place and how to get there.
  5. Alert my neighbors to call 911 if they hear any suspicious sounds coming from my home.
  6. Practice making an emergency escape (with my children) and traveling to the location I have chosen as a safe place.
  7. Join a support group or talk with a counselor.
  8. Read about domestic violence and learn about my legal rights.
  9. Make a list of other preparations I may want to consider.

  • ____________________________________________
  • ____________________________________________
  • ____________________________________________