Child Crisis Safety Plan Form
Use this form to create a child-centered safety plan with warning signs, calming strategies, trusted supports, safe places, and emergency steps.
Child and Guardian Information
Child’s Preferred Name
*
Child’s Age
*
Primary Guardian/Caregiver Name
*
First Name
Middle Name
Last Name
Crisis Triggers and Early Warning Signs
Main crisis triggers
*
Early warning signs before crisis
*
Calming Strategies and Safe Supports
Calming strategies that help the child settle down
*
Comfort items or coping activities
Preferred trusted support person
*
Safe Places and Emergency Steps
Safe places the child can go
*
Places to avoid
Emergency steps and who to contact first
*
Save Safety Plan
Should be Empty: