*I will have important phone numbers available to my children and myself.
*I can tell ___________ and _____________about the violence and ask them to call the police if they hear suspicious noises coming from my home.
*If I leave my home, I can go (list four places): _____________________, ________________, ____________________, or ______________.
*I can leave extra money, car keys, clothes, and copies of documents with ________________.
*I I leave, I will bring __________________________(see checklist next page).
*To ensure safety and independence, I can: Keep change for phone calls with me at all times; open my own savings account; rehearse my escape route with a support person; and review safety plan on _________________(date).
*I can: change the locks; install steel/metal doors, a security system, smoke detectors and an outside lighting system.
*I will inform _____________and ________________ that my partner no longer lives with me and ask them to call the police if s/he is observed near my home or my children.
*I will tell people who take care of my children the names of those who have permission to pick them up. The people who have permission are: __________________, _________________and ______________.
*I can tell _____________at work about my situation and ask _____________to screen my calls.
*I can avoid stores, banks, and _______________that I used when living with my battering partner.
*I can obtain a protective order from _________________. I can keep it on or near me at all times as well as leave a copy with _______________.
*If I feel down and ready to return to a potentially abusive situation, I can call ____________________for support or attend workshops and support groups to gain support and strengthen my relationships with other people.
Police____________________
Hotine ___________________
Friends ___________________
Shelter ____________________
*Identification
*Birth certificates for me and my children
*Social Security cards
*School and medical records
*Money, bankbooks, credit cards
*Keys - house/car/office
*Driver's license and registration
*Medications
*Change of clothes
*Welfare identification
*Passport(s), Green Card(s), work permits
*Divorce papers
*Lease/rental agreement, house deed
*Mortgage payment book, current unpaid bills
*Insurance papers
*Address book
*Pictures, jewelry, items of sentimental value
*Children's favorite toys and/or blankets