This Safety Plan is designed for immigrant victims of domestic violence. Please review with your clients and assist him/her to complete the Safety Plan as it best fit his/her individual and family needs. For Non-English speaking client, please provide interpreter to ensure that he/she has a full understanding and play and active role in creating his/her safety plan. Create Safety Plan outside of home without the knowledge of abusive partner and should include children if possible. Remember, you do not deserve to be hit or threatened. Benefits of establishing a Safety Plan: • You do have a choice about how to respond to him/her and how to best keep children safe, though you are not in control of partner’s abuse. • You have a chance establish a plan legal and non-legal ways to keep safe • You can establish preventative measures to keep safe when you’re not ready to leave, but interested in taking steps to keep safe to promote safety. • Whether you are ready to leave, planning to leave, or have already left, you can use this tool as a guide to help keep safe and avoid other incidence of violence.
Personal safety Plan:
1. Safe exit(s) from my home__________________________________ Practice safety exit (get children involved if possible)
2. During an argument, I will avoid rooms with an outside door (i.e., bedroom or bathroom) or those that have weapons (i.e., kitchen knives, guns, etc.)
3. I can let ___________________________ and ______________________know about what is going on or ask neighbor to call the police if they hear suspicious noise coming from my house. Ask if I can stay with them in an emergency or until I find permanent housing.
4. Know where I can get help_______________________________________
5. I will call 911/ Teach children to dial 911
6. Keep these items in a safe place…away from my house: • Pack a change of clothes for me and each children (i.e. baby food, formula, diapers) • A spare key to house/office/car • Prescriptions/insurance papers • Money/bank book/lease agreement/mortgage papers/house deed • Social security cards for you and children (abusers social security number)/immunization records/school records/special toys and or blanket • Phone number of programs that offer domestic violence services that you can call for help _________________________________, __________________________________, and _____________________________ • A copy of protective order (and other court related documents) • Birth certificate/green card/passports /identification • Pictures/jewelry/sentimental items
7. I have concerns about immigration… I will take with me and/or put in a safe place: Pictures of bruises, police reports, marriage license, immigration papers I have, (i.e., 1-94, copies of visa application, work permit application), photos of wedding, copies of my husbands green card or certificate of naturalization, marriage certificate, social security, and copy of utilities or lease agreement (showing that you lived together).
8. Once he/she leaves, I will change locks, replace wood door with steel or metal doors.
9. I will obtain a Protective order form ___________________________County. I will keep it with me at all times, and give a copy to my employer and child’s school.
10. If I feel upset, down, frustrated or confused and want to go back to my abuser I will call______________________________, ___________________________________, and/ or__________________________________________ for support.
11. I will review my safety plan every __________months and make changes if needed. 12. Things I do to make me feel stronger are:____________________________________________ ______________________________________________________________________________