Patient Safety Plan Template 2026

1. Click ‘Get Form’ to open the Patient Safety Plan Template in the editor.
2. Begin with Step 1: Identify warning signs. List specific thoughts, images, moods, or behaviors that indicate a crisis may be developing. Use the provided lines to document these signs clearly.
3. Move to Step 2: Internal coping strategies. Write down activities that can help distract you from problems without needing to contact others. Consider relaxation techniques or mindfulness practices.
4. In Step 3, list people and social settings that provide distraction. Include names and phone numbers of supportive individuals, as well as safe places you can visit.
5. Proceed to Step 4: Identify individuals you can ask for help during a crisis. Document their names and contact information for easy access.
6. For Step 5, note professionals or agencies you can contact in a crisis. Include clinician names, emergency contacts, and local urgent care services.
7. Finally, in Step 6, outline ways to make your environment safe by identifying potential risks and how to mitigate them.

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