Safety / Coping Plan - sample

To be developed with the student

Student Name: ________________________­­­­­­­_________ Date: _____________________

Staff Name: ___________________________________ Position: ____________________

Concern:

Safety / Coping Plan

What are you thinking, feeling, and doing that lets us know that you are struggling?

What helps? What's worked in the past?

What support do you need? How can staff help?

Student signature: _______________________ Staff signature: _____________________