Student safety plan template: Student Safety Plan Template for Schools

A safety plan is a short, personal list of what a student can do, and who they can turn to, when thoughts of suicide or self-harm start. It's written with the student, in their own words, so they can use it when things are hard. This template follows the standard steps of safety planning. Pair it with your district's crisis protocol and a management plan.

If a student is in immediate danger, stay with them and call 911. For urgent help, call or text 988 (the Suicide & Crisis Lifeline). Your district's crisis protocol comes first.

Before you start

• Complete the plan with a trained school mental health professional, after a suicide risk screening or assessment. See Suicide Risk Screening in School Threat Assessment.
• Contact the parent or guardian, unless doing so would put the student at risk.
• Use the student's words. A plan they recognize as their own is a plan they're more likely to use.
• Give the student a copy, and agree on who else gets one.

Plan information

Field	Details
Student name, grade, school
Date completed
Completed with (name and role)
Parent or guardian involved?	☐ Yes ☐ No, because:
Next review date

Step 1: My warning signs

Thoughts, feelings, situations, or behaviors that tell me a hard time may be starting.

1.
2.
3.

Step 2: Things I can do on my own

Ways to take my mind off things and calm down, without contacting anyone.

1.
2.
3.

Step 3: People and places that help me feel better

People I can be with, and places I can go, that help me feel better.

Name or place	How to reach them, or where it is

Step 4: Adults I can ask for help

Include at least one trusted adult at school.

Name	Relationship	Phone or how to reach them

Step 5: Professionals and crisis lines

Who	How to reach them
988 Suicide & Crisis Lifeline	Call or text 988, any time
Crisis Text Line	Text HOME to 741741
School counselor
Therapist or clinic
Emergency	Call 911 or go to the nearest emergency room

Step 6: Making things safer

Steps my family and I agreed on to keep things I could use to hurt myself out of reach, such as locking up or removing medications and firearms.

Step	Who will do it	By when

One reason worth living for

In the student's words:

 

Signatures

	Name	Date
Student
Staff member
Parent or guardian

After the plan is made

• Add follow-up to the student's management plan: who checks in, how often, and when the safety plan will be reviewed.
• Talk with the family about safe storage of medications and firearms, and record the conversation.
• If the student is referred for counseling or a mental health evaluation, track the referral until the first appointment happens.
• Keep the plan with the student's confidential records, shared only with staff who need it to keep the student safe.

Sources

• National Institute of Mental Health, Ask Suicide-Screening Questions (asQ) Toolkit
• 988 Suicide & Crisis Lifeline

This template is general information, not clinical or legal advice. Follow your district's crisis protocol and the judgment of your school mental health professionals.