Child Safety Plan Worksheet

Safety Sides	How to ensure safety?	Number to contact	Places to meet in emergency	Notes
Safety for home	Lock doors Windows locked Harmful items out of reach
Browsing safety	not to share personal information beware of strangers online
Strangers	Don’t talk to anyone you don’t know or accept gifts from them Ask help from people you know
Fire Alert Safety	Have smoke alarms Exercise fire drills
Medical Information	Have a list of medicines esp. for allergies Have doctor information
Safe Routes	Walk with someone Don’t use shortcuts via alleys or isolated areas
At School	Know school emergency procedures Inform the teacher about any issue
Boundary for safety	Teach the child about good and bad touch Listen to your child so they know they can rely on you
Family Code	Have a secret code word for emergencies? Don’t share the code with people you don’t know.

You can download more Mental Health worksheets here.

Please note: There may be a more up-to-date and editable version of this worksheet available here which may be more suitable to present to clients if you are a therapist or to use in a classroom as a teacher or guidance counselor.

References:

1. Toros K, DiNitto DM, Tiko A. Family engagement in the child welfare system: A scoping review. Child Youth Serv Rev. 2018 May 1;88:598–607.

2. Chambers D, Cantrell A, Booth A. Recognition of risk and prevention in safeguarding of children and young people: a mapping review and component analysis of service development interventions aimed at health and social care professionals. BMC Health Serv Res. 2021 Nov 17;21(1):1241.