Notification of Safety Plan (Template) I, _____________________________________, together with __________________________________ Student Name
School Counselor, Principal, or Designee
have developed this plan to help me keep safe. This safety plan will be/has been reviewed with ______________________________________, so that they can help me to follow the plan and support me to feel Parent/Guardian Name
better, cope safely, and stay alive. ____________________________________________________
______________________________________ Signature of School Representative
Date
Part 1: I will be aware of these situations and behaviors that tend to upset me to a serious degree: 1. 2. 3.
4.
Part 2: I will pay attention to my warning signs (thoughts, feelings, body sensations) that I’m upset: 1. 2. 3.
4.
Part 3: When I notice my early warning signs I will try to calm myself down by doing the following: 1. 2. 3.
4.
Part 4: If I am unable to calm down on my own, I will ask for help from these safe and supportive adults: 1. 2. 3.
4.
Part 5: When I’m upset, my Parent/Guardian can help me by saying or doing these things: 1. 2. 3.
4.
5. Making the home environment safer by maintaining direct supervision of the youth; removing firearms, weapons, and poisons; and either removing or putting under secure, locked storage harmful substances such as alcohol, prescriptions and over the counter medications. Part 6: If I feel that neither I nor my Parent/Guardian can keep me safe, then our crisis plan is: 1. Call 9-1-1 for emergency services or go to nearest hospital ER, if safe to transport 2. Call the National Suicide Prevention Lifeline at 1-800-273-TALK or 1-800-273-8255 3. Call the Crisis Intervention Center Hotline, the Phone, at 1-800-437-0303. This form is based on the Safety Plan Template by Barbara Stanley and Gregory K. Brown @2008
This piece of legislation has had a great impact on the highway safety .... campaigns such as Click It or Ticket and Drive Sober or Get Pulled Over, and also ..... U-3) Percent of Utah Motor Vehicle Crash Occupant Fatalities Ages 10-19 That were ...
businesses that attacks the top five contributing factors to fatalities on Utah roads: ..... A contract will be secured with one or more advertising agencies to assist with the ...... website www.roadrespect.utah.gov, social media including Facebook.
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There was a problem loading this page. Department of Public Safety Strategic Business Plan - FY17.pdf. Department of Public Safety Strategic Business Plan ...
... for key staff on previous, relevant work products. Electronic submittal of proposal materials is encouraged; all files should be sent in an accessible PDF format.
Program the defrost control sequence to automatically depressurize or bleed the coil upon ... In cases where ammonia may be released in an aerosolized form with lubricating oil from the refrigeration system, the flammable .... components (e.g., sucti
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Jan 9, 2014 - to stretch the bolt lids and leave an opening to the cask interior. But cited references do not include the 1-ton impact limiters at each end, which would increase the bending. For HBF, 140 g forces, a 60 mph side impact, would easily s
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Apr 12, 2016 - Emergency Medical Aid Act. Freedom of Information and Protection of Privacy Act · Fire Code Regulation. Occupational Health and Safety Act.