Self-Harm Safety Plan Worksheet

1. Identifying My Triggers

Think about situations, feelings, or thoughts that lead you to want to hurt yourself. List three below:

1. _______________________________________________________________
   
   
   
   
   
2. _______________________________________________________________
   
   
   
   
   
3. _______________________________________________________________
   
   
   
   
   

2. Healthy Coping Strategies

Pick three helpful strategies (you can use Coping Strategies Cards for ideas). Describe how you will use each one when you feel the urge to self-harm:

Strategy 1: ______________________________

• How I will use it:
  
  
  
  
  
  
  
  
  
  

Strategy 2: ______________________________

• How I will use it:
  
  
  
  
  
  
  
  
  
  

Strategy 3: ______________________________

• How I will use it:
  
  
  
  
  
  
  
  
  
  

3. Support Contacts

Who can you reach out to when you’re feeling unsafe or having urges? List at least three people or resources and how to contact them:

1. Name/Role: ___________________________ Phone/Contact: ___________________
   
   
   
   
2. Name/Role: ___________________________ Phone/Contact: ___________________
   
   
   
   
3. Name/Role: ___________________________ Phone/Contact: ___________________
   
   
   
   

4. My Step-by-Step Safety Plan

Write the steps you will follow, from first noticing urges to getting help if needed:

1. _______________________________________________________________
   
   
   
   
2. _______________________________________________________________
   
   
   
   
3. _______________________________________________________________
   
   
   
   
4. _______________________________________________________________
   
   
   
   
5. _______________________________________________________________
   
   
   
   

5. Reflection and Commitment

What is one thing you will do today to help keep yourself safe?

I commit to using this plan and reaching out for help when I need it.

Signature: ______________________ Date: __________

Self-Harm Discussion Prompts Handout

Purpose

These prompts are designed to help you explore what leads to self-harm urges and to think about healthier ways to cope. There are no right or wrong answers—this is your chance to share honestly.

Facilitator Guidelines

• Create a calm, private environment.
• Speak in a gentle, non-judgmental tone.
• Offer to pause or skip any question if it feels too hard.
• Validate feelings and thank the student for sharing.

Discussion Questions

1. When you notice yourself starting to feel upset or under pressure, what thoughts or feelings come up first?
   
   
   
   
   
   
   

2. Can you remember a recent moment when you had the urge to self-harm? What was happening around you or inside you at that time?
   
   
   
   
   
   
   
   
   

3. Which situations, places, or people tend to trigger these urges most often?
   
   
   
   
   
   
   
   
   
   
   

4. What physical sensations or early warning signs (like racing heart, tiredness, racing thoughts) let you know an urge is coming?
   
   
   
   
   
   
   
   
   
   
   

5. Have you ever managed to stop yourself from self-harming? If so, what did you do instead, and how did it feel afterward?
   
   
   
   
   
   
   
   
   
   
   
   
   

6. Who in your life do you feel you can talk to when you’re feeling down or unsafe? How do they help?
   
   
   
   
   
   
   
   
   
   
   

7. Imagine you’re faced with an urge but can’t use self-harm. What is one activity, memory, or thought you could turn to instead?
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   

8. If you could send a message of support to yourself at a tough moment, what would you say?
   
   
   
   
   
   
   
   
   
   
   

9. What is one small step you can commit to taking the next time you notice a self-harm urge?
   
   
   
   
   
   
   
   
   
   
   

Reminder: You are not alone. If these questions bring up strong feelings, please reach out to a counselor or trusted adult right away.

Coping Strategies Card Activity

Cut out and shuffle these cards. When you feel an urge to self-harm, draw one card, try the strategy, and write below how you will use it in the moment.

Deep Breathing

Take slow, deep breaths: inhale for 4 seconds, hold for 2, exhale for 6. Repeat 5 times.

How I will use this when I feel the urge:

Grounding with 5 Senses

Name 5 things you can see, 4 you can touch, 3 you can hear, 2 you can smell, 1 you can taste.

How I will use this when I feel the urge:

Physical Activity

Do 10 jumping jacks or run in place for 1 minute.

How I will use this when I feel the urge:

Visualization

Close your eyes and imagine a calm, safe place. Describe it in detail to yourself.

How I will use this when I feel the urge:

Coping Object

Hold a textured item (stress ball, soft cloth). Focus on how it feels in your hand.

How I will use this when I feel the urge:

Positive Affirmations

Repeat statements like “I am strong,” “This feeling will pass,” or write your own.

How I will use this when I feel the urge:

Write It Out

Journal or jot down what you’re feeling and why. Let thoughts flow without editing.

How I will use this when I feel the urge:

Music Break

Listen to a favorite or calming song for 2–3 minutes. Notice how it makes you feel.

How I will use this when I feel the urge:

Call a Supporter

Reach out to a trusted person (friend, staff, counselor). Talk or text about how you feel.

How I will use this when I feel the urge:

5-Minute Timeout

Find a quiet spot, set a timer for 5 minutes, and focus on breathing or stretching.

How I will use this when I feel the urge:

Hot/Cold Sensation

Hold an ice cube or splash cold water on your wrists. Notice the sensation.

How I will use this when I feel the urge:

Creative Expression

Draw, color, or doodle your feelings. You don’t need to be an artist—just express.

How I will use this when I feel the urge:

Progressive Muscle Relaxation

Tense each muscle group for 5 seconds, then release. Move from toes up to your head.

How I will use this when I feel the urge:

Instructions for Use:

1. Print on cardstock and cut along the lines.
2. Shuffle and place cards in a small box or pouch.
3. Draw one card whenever you notice an urge.
4. Try the strategy fully, then jot down how you used it before moving on.

Personal Safety Plan

Name: ______________________ Date: __________

1. My Top 3 Triggers

List the three most common thoughts, feelings, or situations that lead to urges:

1. ________________________________________
   
   
   
2. ________________________________________
   
   
   
3. ________________________________________
   
   
   

2. Coping Strategies & How I’ll Use Them

Choose three strategies and describe how you will put each into action:

Strategy 1: ____________________________

• How I will use it:
  
  
  
  
  

Strategy 2: ____________________________

• How I will use it:
  
  
  
  
  

Strategy 3: ____________________________

• How I will use it:
  
  
  
  
  

3. Support Contacts

People I can reach out to when I feel unsafe. Include name/role and contact info:

1. Name/Role: __________________ Contact: ___________________
   
   
   
2. Name/Role: __________________ Contact: ___________________
   
   
   
3. Name/Role: __________________ Contact: ___________________
   
   
   

4. My Step-by-Step Plan

Outline the actions you will take in order, from first noticing an urge to getting help:

1. _______________________________________________________
   
   
   
2. _______________________________________________________
   
   
   
3. _______________________________________________________
   
   
   
4. _______________________________________________________
   
   
   
5. _______________________________________________________
   
   
   

5. Encouraging Message to Myself

Write a short phrase or mantra you can repeat in a tough moment:

“I will __________________________________________________”

My Commitment: I agree to follow this plan and reach out for help when I need it.

Signature: ______________________ Date: __________

Self-Harm Discussion

Purpose

This discussion helps you explore what leads to self-harm urges and think about safer, healthier ways to cope. Your answers are private and there are no wrong responses—this is your space to share honestly.

Facilitator Guidelines

• Create a supportive, confidential environment.
• Speak with empathy and without judgment.
• Offer breaks or let the student skip a question at any time.
• Thank the student for sharing and validate their feelings.

Discussion Questions

1. When you first notice an urge to self-harm, what thoughts or feelings show up?
   
   
   
   
   
   
   

2. Think of a recent moment when you felt like harming yourself. What was happening around you or inside you that triggered the urge?
   
   
   
   
   
   
   
   
   

3. Which people, places, or situations tend to make these urges stronger?
   
   
   
   
   
   
   
   
   
   
   

4. What early warning signs (e.g., racing heart, tight chest, negative self-talk) alert you that an urge is coming?
   
   
   
   
   
   
   
   
   
   
   

5. Have you ever managed to stop an urge before acting on it? If yes, what did you do instead and how did you feel afterward?
   
   
   
   
   
   
   
   
   
   
   
   
   

6. From Coping Strategies Cards, which strategy feels most doable for you in the moment, and why?
   
   
   
   
   
   
   
   
   
   
   

7. Who do you trust to talk to when you’re feeling unsafe or overwhelmed? How would you reach out to them?
   
   
   
   
   
   
   
   
   
   
   

8. What is one small step you can commit to next time you notice a self-harm urge?
   
   
   
   
   
   
   
   
   
   
   

Reminder: You are not alone. If these questions bring up strong emotions, please reach out immediately to a counselor, staff member, or crisis line.