Template library · Assessments & screeners
Safety Planning Assessment template
Develop a personalized safety plan with the client for use during a crisis.
Collaborative safety planning intake
- 16 fields across 3 sections
- Included with MyWellOps
- Edit it, or save your own version
What’s in it
Assessment Details
- Client NameText
- Date of BirthDate
- Client ID / MRNText
- Date of AssessmentDate
- Clinician / CoachText
- Location / ModalityText
Safety Plan Components
- Warning signs that a crisis may be developingText
- Internal coping strategiesText
- People and social settings that provide distractionText
- People to ask for helpText
- Professionals / agencies to contact during a crisisText
- Steps to make the environment safer (means restriction)Text
Signatures
- Clinician SignatureSignature
- Date signed (clinician)Date
- Client SignatureSignature
- Date signed (client)Date
When to use it
Use an assessment at the start of work to set a baseline, then repeat it at review points so you and the client can see what has changed.
How it works in MyWellOps
- Pick it from Documents.
- Send it to the client to complete, or fill it in together during a session.
- Each completed copy is kept on the client’s record, so earlier results are there to compare.
Spend less time on admin, more time with clients
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