Domestic Violence Personalized Safety Plan (Page 5 of 5) in pdf

Domestic Violence Personalized Safety Plan Page 5

Items on the following lists with asterisks by them are the most important to take with you. If there is time, the

other items might be taken, or stored outside the home. These items might best be placed in one location, so that

if we have to leave in a hurry, I can grab them quickly. When I leave, I should take:

*Identification for myself

*Children’s birth certificate

*My birth certificate

*Social Security cards

*School and vaccination records

*Money

*Checkbook, ATM card

*Credit cards

*Key - house, car, office

*Driver’s license and registration

*Medications

*Copy of protection order

*Welfare identification, work permits, green cards

Passport(s), divorce papers

Medical records - for all family members

Lease/rental agreement, house deed, mortgage payment book

Bank books, insurance papers

Address book

Pictures, jewelry

Children’s favorite toys and/or blankets

Items of special sentimental value

Telephone numbers I need to know:

Police/sheriff’s department (local) - 911 or ___________________________

Police/sheriff’s department (work) __________________________________

Police/sheriff’s department (school) _________________________________

Prosecutor’s office _______________________________________________

Battered women’s program (local) __________________________________

National Domestic Violence Hotline: 800-799-SAFE (7233)

800-787-3224 (TTY)

County registry of protection orders __________________________________

State registry of protection orders ___________________________________

Work number ___________________________________________________

Supervisor’s home number _________________________________________

I will keep this document in a safe place and out of the reach of my potential attacker.

Review date: _________________________

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Domestic Violence Personalized Safety Plan Page 5