Name:_______________________ Date:___________

These steps outlined here represent my plan for ensuring my safety and preparing in advance for the possibility for further violence. Although I do not have control over my partner's violence, I do have a choice about how to respond to him/her and how to best get myself and my children to safety.

Step 1: Safety During A Violent Encounter.

It may not always be possible to avoid a violent incident. However, these are measures I may be able to utilize:

A. If I decide to leave, I will ___________________. (Practice how to get out safely. What doors, windows, elevators, stairwells or fire escapes would you use?)

B. I can keep my purse/wallet and car keys ready and put them (place)__________________ in order to leave quickly.

C. I can tell _____________________about the violence and request they call the police if they hear suspicious noises coming from my house.

D. I can teach my children how to use the telephone to contact the police and the fire department.

E. I will use _______________________ as my code for my children or my friends so they can call for help. (Example: the blinds are open in a certain room as opposed to normally open, a unique code word, etc.)

F. If I have to leave my home, I will go to ____________________ (Decide this even if you don't think there will be a next time). If I cannot go to the location above, then I can go to________________, __________________or ______________________________.

G. I can also teach some of these strategies to some/all my children.

H. When I expect we are going to have an argument, I will try to move to a space that is lowest risk, such as ___________________ ____________________. (Bathrooms, garages, kitchens, near weapons or in rooms without access to an outside door can cause danger).

I. I will use my judgment and intuition. If the situation is very serious, I can give my partner what he/she wants to calm him/her down. I have to protect myself until I/we are out of danger.

Step 2: Safety When Preparing To Leave.

Battered men and women frequently leave the residence they share with the batterer. Leaving must be done with a careful plan in order to ensure safety. Batterers often strike back when they believe that a battered person is leaving the relationship. I can use some or all the following safety strategies:

A. I will leave money and an extra set of keys with __________________ so that I can leave quickly.

B. I will keep copies of important documents or keys at _______________________.

C. I will open a savings account by ______________ (date), to increase my independence.

D. Other things I can do to increase my independence include: _______________________________________________________________________ ______________________________________________________________________.

E. Keep the shelter's hot line and the phone number to the police department on me - and I can seek shelter by calling this hot line. ________________________

F. I can keep change for phone calls on me at all times. I understand that if I use my telephone credit card, the following month the telephone bill will tell my batterer those numbers that I called after I left. To keep my telephone communications confidential, I must use coins, call collect, or I might get a friend to permit me to use their telephone credit card for a limited time when I first leave.

G. I will check with ____________________ and ________________ to see who would be able to let me stay with them or lend me some money.

H. I can leave extra clothes with _________________________.

I. I will sit down and review my safety plan every ________________ (day, week, month) in order to plan the safest way to leave the residence.__________________ (domestic violence advocate or friend) has agreed to help me review this plan.

J. I will rehearse my escape plan and, as appropriate, practice it with my children.

Step 3: Safety In My Own Home.

There are many things that a person can do to increase his or her safety in his or her own residence. It may be impossible to do everything at once, but safety measures can be added step by step. Safety measures I can use include:

A. I can change the locks on my doors and windows as soon as possible.

B. I can replace wooden doors with steel/metal doors.

C. I can install security systems including additional locks, window bars, poles to wedge against doors, an electronic system, etc.

D. I can purchase rope ladders to be used for escape from second floor windows.

E. I can install smoke detectors and purchase fire extinguishers for each floor in my home.

F. I can install an outside lighting system that lights up when a person is coming close to my home.

G. I will teach my children how to use the telephone to make a collect call to me and to __________________ (friend/minister/other) in the event that my partner takes the children.

H. I will tell people who take care of my children which people have permission to pick up my children and that my partner is not permitted to do so. The people I will inform about pick-up permission include:
_________________________________________ (school),
________________________________________ (day care staff),
_______________________________________ (babysitter),
___________________________________ (Sunday school teacher),
________________________________________ (teacher),
________________________________________ (and),
________________________________________ (others),

I. I can inform ______________________________ (neighbors),
______________________________________ (pastor), and,
_______________________________________ (friend) that my partner no longer resides with me and they should call the police if he is observed near my residence.

Step 4: Safety With An Order Of Protection

One can never be sure which violent partner will obey and which will violate protection orders. I recognize that I may need to ask the police and the court to enforce my protection order.The following are some steps that I can take to help the enforcement of my protection order:

A. I will keep my protection order ____________________ (location) (Always keep it on or near your person. If you change purses/wallets/coats, that's the first thing that should go in).

B. I will give my protection order to police departments in the communities where I usually visit family or friends, and in the community where I live.

C. There should be a county registry of protection orders that all police departments can call to confirm a protection order. I can check to make sure that my order is in registry. If a protection order is not listed, it cannot be enforced. The telephone number for the county registry of protection order is _________________________________.

D. For further safety, if I often visit other counties or work in another county, I might file my protection order with the court in those counties. I will register my protection order in the following counties:___________________ and _________________ that I have a protection order in effect.

E. I can call the local domestic violence program if I am not sure about B, C, or D above or if I have some problem with my protection order.

F. I will inform my employer, my minister, my closest friend and _____________ and ____________that I have a protection order in effect.

G. If my partner destroys my protection order, I can get another copy from the County Courthouse by going to the Circuit Court Clerk's office.

H. If my partner violates the protection order, I can call the police and report a violation, contact my attorney, call my advocate, and/or advise the court of the violation.

I. If the police do not help, I can contact my advocate or attorney and will file a complaint with the chief of the police department.

J. I can also file a private criminal compliant with the district justice in the jurisdiction where the violation occurred or with the district attorney. I can charge my battering partner with a violation of the Order of Protection and all the crimes that he commits in violating the order. I can call the domestic violence advocate to help me with this.

Step 5: Safety On The Job And In Public

Each battered man or woman must decide if and when he or she will tell others that her partner has battered him or her and that he or she may be at continued risk. Friends, family and co-workers can help to protect him or her. Each man or woman should consider carefully which people to invite to help secure his or her safety.I might do any or all of the following:

A. I can inform my boss, the security supervisor and ________________ at work of my situation.

B. I can park close to the entrance of my workplace.

C. I can ask security to walk me to my car.

D. I can identify an emergency contact person in the event my employer is unable to reach me.

E. I can provide the reception area and security personnel with a photo and instruct them to call police if spotted.

F. I can ask ________________ to help screen my telephone calls at work.

G. I can save threatening messages on my voice mail for future legal action.

H. When leaving work, I can _____________________________________________________________________.

I. When driving home if problems occur, I can _________________________________ (drive to a public place, drive to a police station, use my cell phone).

J. If I use public transit, I can ______________________________________________.

K. I will go to different grocery stores and shopping malls to conduct my business and shop at hours that are different than those when residing with my battered partner.

L. I can use a different bank and take care of my banking at hours different from those I used when residing with my battering partner.

M. I can also _____________________________________________________.

Step 6: Safety And Drug Or Alcohol Use.

Most people in this culture use alcohol. Many use mood-altering drugs. Some of this use is legal and some is not. The legal outcomes of using illegal drugs can be very hard on a battered person, may hurt his or her relationship with their children and put them at a disadvantage in other legal actions with their battering partner. Therefore, men and women should carefully consider the potential cost of the use of illegal drugs. But beyond this, the use of any alcohol or other drug can reduce a person's awareness and ability to act quickly to protect themselves from their battering partner. Furthermore, the use of alcohol or other drugs by the batterer may give him/her an excuse to use violence.

Therefore, in the context of drug or alcohol use, the battered person needs to make specific safety plans.

If drug or alcohol use has occurred in my relationship with the battering partner, I can enhance my safety by some or all of the following:

A. If I am going to use, I can do so in a safe place and with people who understand the risk of violence and are committed to my safety.

B. I can also ___________________________________________.

C. If my partner is using, I can _____________________________.

D. I might also __________________________________________.

E. To safeguard my children, I might _____________________________________and ______________________________________________.

Step 7: Safety And My Emotional Health.

The experience of being battered and verbally degraded by partners is usually exhausting and emotionally draining. The process of building a new life for myself takes much courage and incredible energy. To conserve my emotional energy and resources and to avoid hard emotional times, I can do some of the following:

A. If I feel down and ready to return to a potentially abusive situation, I can _____________________________________________.

B. When I have to communicate with my partner in person or by telephone, I can _____________________________________________.

C. I can try to use "I can . . . " statements with myself and to be assertive with others.

D. I can tell myself - "___________________________________________________________________" whenever I feel others are trying to control or abuse me.

E. I can read ____________________________to help me feel stronger.

F. I can call ___________________, ___________________ and _________________as other resources to be of support of me.

G. Other things I can do to help me feel stronger are _____________________________________________________________, and _______________________________.

H. I can attend workshops and support groups at the domestic violence program or _________________________, or ___________________to gain support and strengthen my relationship with other people.

Step 8: Items To Take When Leaving.

When the abused leave partners, it is important to take certain items with them. Beyond this, they sometimes give an extra copy of papers and an extra set of clothing to a friend just in case they have to leave quickly.

Money:
Even if I have never worked, I can legally take 1/2 of the funds in the checking and savings accounts. If I don't take any money from the accounts, my abuser can legally take all money and/or close the account and I may not get my share until the court rules on it, if ever. Items with asterisks (*) on the following list are the most important to take. If there is time, the other items might be taken, or stored outside the home. These items might be placed in one location, so that if we have to leave in a hurry, I can grab them quickly. When I leave, I should have:

* Identification for myself
* Children's birth certificate
* My birth certificate
* Social security cards
* School and vaccination records
* Money
* Checkbook, ATM (Automatic Tellers Machine) card (that are in my name only, not my abuser's. These records can be made available to the abuser if it isn't)
* Credit cards (that are in my name only, for the above reasons)
* Keys - house/car/office
* Driver's license and vehicle registration
* Medication and Welfare identification, work permits, Green card/Passport(s), Divorce papers, Medical records - for all family members, Lease/rental agreement, house deed, mortgage payment book, Bank books, Insurance papers, Small saleable objects, Address book, Pictures, jewelry, Children's favorite toys and/or blankets, Items of special sentimental value

Telephone numbers I need to know:

Police department - home - 911Metro Domestic Violence Division,
District Attorney General's Office __________________________
school/work__________________________________________
work/school__________________________________________
Battered women's program _______________________________
County registry of protection orders ________________________
Work number_________________________________________
Supervisor's home number________________________________
Minister______________________________________________
Other________________________________________________

I will keep this document in a safe place and out of the reach of my potential attacker.

Review date:_________________________

IF YOU NEED HELP IN FILLING OUT THIS PLAN YOU MAY ASK THE POLICE DOMESTIC VIOLENCE DIVISION DETECTIVES, COUNSELORS, YMCA SHELTER WORKER, THE DISTRICT ATTORNEY'S VICTIM WITNESS OFFICE PERSONNEL OR A CLOSE AND TRUSTED FRIEND.